WFUMB Course Book

Abdominal Wall and Peritoneum - Chapter 30 Media Library

Chapter Images

Fig 30.1 Anatomical transverse section of lower anterior abdominal wall (Stavros 2010)
Fig 30.2 Abdominal wall anatomy with frequent anterior hernia sites (
Fig 30.3 Right groin anatomy from outside (left panel) and inside (right panel) with hernia sites: lateral and medial hernias both appear outside anterior to the external inguinal ring, femoral hernias pass below the inguinal ligament, medially to the femoral vein. On the right panel (from the inside) a “direct” (= medial) hernia leaves the abdominal cavity through the weak zone of Hesselbach´s triangle, medial to the epigastric vessels. An “indirect” (= lateral) hernia leaves the abdominal cavity through the internal inguinal ring, lateral to the epigastric vessels.
Fig 30.4 Right groin anatomy with femoral hernia passing below the inguinal ligament, anteromedially to the femoral vein. (
Fig 30.5 Clinical aspect of an incarcerated hernia
Fig 30.6 Transverse CD sonogram of the right groin: the large iliacofemoral vessels (red: artery, blue vein) and the small bundle of inferior epigastric vessels (red artery accompanied by two blue veins) running from the groin to the rear plane of rectus abdominis muscle are seen
Fig 30.7 Transverse sonogram of right groin: the green tube shows, anterior to the epigastric vessels, the position of the inguinal canal, in which indirect/lateral inguinal hernias and in male subjects the spermatic cord are placed
Fig 30.8 Transverse sonogram of the right groin: indirect hernia in inguinal canal (compare to green tube in fig. 30.6), anterior to the epigastric artery, leaving the abdominal cavity lateral thereof
Fig 30.9 Transverse sonogram of right groin: direct inguinal hernia (green arrows) medial to the epigastric vessels (red arrows, in CD box)
Fig 30.10 Longitudinal sonogram of the right groin in standing patient: femoral hernia. Please note the deep position anterior to the pubic bone, distal to the inguinal ligament (green arrows)
Fig 30.11 Gai´s hernia types A-C
Fig 30.12 Hernia Type Gai A, dome shaped hernia, not “higher” (green arrow) than its base is wide (blue double arrow). When found in the groin, probably no reason of patient´s complaints. Often seen in medial direct groin hernias in early stage
Fig 30.13 Hernia Type Gai B, finger shaped. IIR: internal inguinal ring = blue double arrow approx. as wide as the hernia diameter (green double arrow) in the Inguinal canal (IC). Often seen in lateral indirect hernias in early stage (Haffar 2021)
Fig 30.14 Hernia Type Gai C, hernia diameter (blue double arrow) larger than hernia ring (two red arrows), risk of incarceration! Therefore indication for operation
Fig 30.15 Peritoneal reflections and the recesses thus created
Fig 30.16 Echofree fluid around the liver – transudate in cirrhosis
Fig 30.17 Fibrin structures in ascites in severe exudative pancreatitis
Fig 30.18 Structured fluid collections in abdomen in pseudomyxoma peritonei (neoplasm of peritoneum)
Fig 30.19 Septated ascites in severe peritonitis
Fig 30.20 Small amount of free fluid in Morison pouch
Fig 30.21 Free perisplenic fluid
Fig 30.22 Free fluid in lower abdomen between small bowel loops – sea anemone phenomenon
Fig 30.23 Free fluid in lower abdomen peri uterine
Fig 30.24 Typical points of free gas collections after perforation
Fig 30.25 Free gas collection between abdominal wall and left liver lobe (reverberations)
Fig 30.26 Small free gas collection between abdominal wall and left liver
Fig 30.27 Large free gas collection between abdominal wall and liver – only a small part of liver is visible
Fig 30.28 Gas collection dorsal of left liver lobe (arrow) after perforation of ulcus duodeni
Fig 30.29 Small gas collection (arrow) inside the left liver lobe after covered perforation of duodenal ulcer
Fig 30.30 Free gas collection (reverberations) and dilatated small bowel loops in situation of ileus
Fig 30.31 Gas collection around the right kidney in situation of retroperitoneal perforation after ERCP and papillotomy
Fig 30.32 Schema of benign ascites (left) and malignant ascites (right) modified after Meckler
Fig 30.34 Retracted mesentery in peritoneal carcinosis
Fig 30.35 Free fluid and LN metastasis in the omentum in peritoneal carcinosis
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