Umbilical Ligaments & folds

Median Umbilical Ligament

·         Remnant of embryonic urachus

·         extends from apex of bladder to umbilicus, on the deep surface of anterior abdominal wall

·         Unpaired

·         covered by median umbilical folds

·         used as a landmark for surgeons who are performing laparoscopy such as laparoscopic inguinal hernia repairs,other than that it has no function in a born human

Medial Umbilical Ligament

·         Remnant of fetal umbilical arteries which serves no function except for part that becomes adult umbilical artery  

·         Paired

·         on the deep surface of the anterior abdominal wall

·         covered by medial umbilical fold (plica umbilicalis medialis ) 

·         landmark for surgeons during laparoscopic inguinal hernia

Lateral Umbilical Ligament

·         Inferior epigastric artery - medial branch of distal segment of External Iliac Artery

·         ascends along medial margin of deep inguinal ring 

·         continues b/w rectus abdominis muscle & posterior lamina of sheath

·         then appears on the anterior parietal peritoneum to create Lateral Umbilical Ligament

·         not always readily visualised, but knowledge of its location is important to avoid injury to vessels

Lateral Umbilical Fold

·         Lateral umbilical fold overlies the inferior epigastric artery & accompanying veins

·         Unlike median & medial umbilical folds the contents of lateral umbilical fold remains functional after birth 

·         extends from from deep inguinal ring to arcuate line

·         lateral umbilical fold - reference site to classify hernia 

·         Direct Hernia - medial to lateral umbilical fold 

·         Indirect Hernia - lateral to lateral umbilical fold due to placement of opening of deep inguinal ring in the space lateral to lateral umbilical fold, which allows the passage of ductus deferens,testicular artery & spermatic cord and its contents in men & round ligament of uterus in women.