Iliac region

Iliac region (regio iliaса) - part of the front-side of the Department of abdominal wall within Podkrepa (hypogastrium) medially from the iliac crest bone. In Paris anatomical nomenclature (PNA) there is no term "regio iliaca", this area of the anterior abdominal wall is described as regio inguinalis (groin). Within the groin area, however, in addition to the inguinal canal, are projected education, lying in iliac fossa, so it is better to call the iliac area ilio-inguinal (regio ilioinguinalis). In modern clinical practice the term " iliac area" refers not only to the appropriate area of the abdominal wall, but also to be part of the abdomen - iliac fossa.
The layers of the abdominal wall, corresponding to the position iliac fossa,see Groin. Iliac fossa is a funnel, wide part of which is directed upwards, and narrow down where large vessels pass on his thigh. The hole formed by the wing of the Ilium and filled iliac muscle (m. iliacus), medially from which there is a greater psoas muscle (m. psoas major); both muscles, when combined, form iliopsoas muscle (m. iliopsoas), is attached to a small trochanter of the femur. On top of these muscles are appropriate parts of the circular fascia belly - fascia iliaca and fascia psoica (JNA). In front of these fascia is a rich layer of retroperitoneal fat - textus cellulosus retroperitoneal, covered the front abdominal wall. The latter does not reach the inguinal ligament (N. I. Pirogov, 7.5-10 mm), and there formed a triangular space that seeks to end the Department of external iliac vessels.
In iliac fossa are part of the intestine, large vessels with the lymph nodes, branches lumbar plexus, ureter, the vessels of the testicles or ovaries), the ductus deferens (women round ligament of the uterus); the elements of the intestine lie in the abdomen, other bodies outside the peritoneum. In the right iliac fossa is the end of the ileum to the lower end of the mesentery of thin intestines, cecum with vermiform process, as well as the initial division of the ascending colon (in cases when the cecum is low). Consequently, the upper-medial Department ilio-inguinal region is often denoted in the clinic of the term "ileo-Catalina region", and the angle formed by the iliac and blind intestine, called ileo-secalinum. In the left iliac fossa are sigmoid with its mesentery, the final division of the descending colon, and the loop of thin intestines.
Large vessels - General and the external iliac artery and vein (a. et v. iliaca communis et iliaca ext.) - lie at the inner edge of a large lumbar muscles, retroperitoneal fat, and external iliac artery is located outside, and the same vein medially and several posterior to the artery. Still further medially are internal iliac vessels, topographically related to the small pelvis organs.
Near the inguinal ligament from the external iliac artery depart lower epigastric artery (a. epigastrica inf.) and deep, envelope Ilium artery (a. circumflexa ilium profunda), and in front, it crosses deep, envelope Ilium Vienna (v. circumpleха ilium profunda). To the outer and the common iliac arteries adjacent lower and upper iliac lymph nodes (nodi lymphatici iliaci). From the bottom of the lymph nodes, the node that lies ahead external iliac artery (sometimes sometimes two)is a good identification when access to end the division of this artery.
Iliac part of the ureter at its transition to the pelvis crosses in front iliac vessels; and the right ureter, more distant from the spine, often crosses external iliac artery and left - common iliac (printing. Fig. 1 and 2). Men in front of the ureter cross the blood vessels of the testis that near deep inguinal ring fits the ductus deferens (the ductus deferens), then as part of the spermatic cord these formations are sent to the inguinal canal. In women, the urethra is crossed in front vessels ovary and in the inguinal canal gets round ligament of the uterus. From the side of the abdominal cavity ureter front right covered by end ileum with its mesentery and blind intestine (if she stretched), to the left is the root of the mesentery of the sigmoid colon, in which thicker flanking the ureter are branches of the inferior mesenteric artery.

iliac region
Fig. 1. Right iliac fossa front: 1 - the ureter; 2 - n. genitofemoralis; 3-v. cava inf. eta. iliaca communis; 4 - vesica urinaria; 5 - a. iliaca int. (peritoneum); 6 - a. et v. testiculares; 7 - a. iliaca ext.; 8 - n. femoralis; 9 - m. iliacus; 10 - m. psoas major; 11 - n. cutaneus femoris lat.
Fig. 2. Cross-cutting at the level of the fifth lumbar vertebra (according to Pirogov): 1 - v. cava inf.; 2 - a. iliaca communis; 3-ureter; 4 - m. psoas major; 5 - m. transversa abdominis; 6 - n. cutaneus femoris lat.; 7 - crista iliaca; 8 - caecum; 9 - m. iliacus; 10 - a. femoralis; 11 - m. gluteus medius.


Behind the urethra passes sex-femoral nerve (n. genitofemoralis) or his sexual and femoral branches (r. genitalis, was femoralis). Therefore, when the ureter stones pain localized in the area of the surface of the inguinal ring and scrotum or on the thigh, under the inguinal ligament.
In the furrow between large and lumbar iliac muscle is femoral nerve (p. femoralis)and above and outwards from it are lateral cutaneous nerve of thigh, ilio-inguinal, iliac-hypogastric nerve, nn. cutaneus femoris lat., ilioinguinalis, iliohypogastrics)that overlap usually held behind them branches iliopsoas artery (a. iliolumbalis) and the lower lumbar artery (a. lumbalis ima).
Pathology. The most frequent diseases, localized within the iliac fossa are inflammation of the vermiform process (see Appendix.), twisted sigmoid colon (see), and retroperitoneal organs bruises in the pelvis fractures, inflammation iliac lymph nodes, often with the involvement of retroperitoneal fat (phlegmonous adenitis). These inflammation occur more frequently as a complication of suppurative appendicitis, especially when retrocasino position process or as a result of a purulent process in the lower limbs. As retroperitoneal fiber iliac region at the top goes fibre in the lumbar region, and below in the wall fiber pelvis, have been spreading of inflammatory process of the iliac region in the lumbar and, conversely, of the lumbar and pelvic in iliac fossa. Iliac cellulitis can occur in men as a complication of purulent prostatitis, inflammation of the seminal vesicles, the women on the grounds of parametritis and phlegmon of the broad ligament, at those and others - as a result of ulcerative proctitis. Phlegmon iliac fossa can be localized into different layers (C. F. Voino-Yasenetsky): subperiosteal abscess wing of the Ilium (on the grounds of osteomyelitis); cellulitis loose fiber between the iliac muscle and periosteum; abscess in the thickness of the iliopsoas muscles (see Pait); cellulitis retroperitoneal fat. A characteristic common iliac phlegmon is flexion contracture of Tazo-hip joint (psoas-symptom), developing as a result of involving in pathological process of femoral nerve.
Access to retroperitoneal organs iliac fossa is via lumbar-ilio-inguinal incision proposed N. I. Pirogov. Depending on the localization of pathological process can be applied to one or another part of this section, sometimes an entire section.
C. N. Shevkunenko suggested vnebrachnyi incision, which is a refinement of the section Pirogov. It gives an opportunity to expose not only the authorities iliac-psoas region, and the small pelvis (bladder, seminal vesicles, the tubes that carry sperm, uterine artery and others). To access the iliac arteries N. I. Pirogov has developed two ways: one is to not covered by the peritoneum the Department of external iliac artery (cut just above the inguinal ligament), the other covered peritoneum Department of this artery, as well as to the General and internal iliac arteries (section 5 cm above the inguinal ligament).
At breaking abdominal bag with him usually leave the ureter, the vessels of the testicles or ovaries), the ductus deferens (or round ligament of the uterus). Surgery on the iliac vessels are being made in the treatment of occlusion of the bifurcation of the aorta, hip, and other vessels by shunting with application of tubes made of plastic. Measures taken recently kidney transplantation in iliac fossa (centuries Petrovsky) is: with the imposition of vascular joints connecting the renal artery with internal iliac (last crossed, and the distal section of its Perevoznaya; it does not affect blood flow to the pelvic organs), and renal vein connects to external iliac.