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Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Pelvis: Inferior and Superior Epigastric Arteries

Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Pelvis

Inferior and Superior Epigastric Arteries

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD

Peer Review Status: Internally Peer Reviewed


The inferior epigastric artery was not well understood until Mall (1898; F.P. Mall, an Iowan by birth, Belle Plaine, medically trained in Germany was the first Professor of Anatomy at The Johns Hopkins Medical School) studied its development. This artery has received much attention in the literature because of its relation to femoral hernia. It was shown in 1813 by Beckers that when the artery originated beneath the inguinal ligament it passed medial to the inguinal ring. Since that time numerous other reports of the medial passage of the inferior epigastric have been recorded; Poynter found this condition 12 times.

The epigastric may arise from the external iliac at a higher point than usual; it has been found 6.2 cm above the inguinal ligament.

It may arise from the femoral below the inguinal ligament or even from the profundus femoris artery, or as a common trunk with the circumflex iliac.

The inferior epigastric may be doubled.

The inferior epigastric may arise from, or conversely, give rise to the obturator artery. This variation is due to the anastomosis of the epigastric and obturator through their pubic branches. It is of considerable importance to the surgeon, since the obturator artery, when derived from the inferior epigastric, may run either lateral or medial to the femoral ring to reach the obturator foramen. This origin of the obturator artery from the epigastric occurs in about 20% of individuals.

From Pick, et al.(1942), "The pubic branch of the inferior epigastric anastomoses with the pubic branch of the obturator. Although usually small, the anasomosis may be considerably enlarged as an accessory obturator artery and is sometimes known as the abnormal obturator artery. At this point its exact course becomes of significant clinical interest. It may pass caudally on the medial side of the femoral vein and therefore lateral to the femoral ring, or it may course medial to the femoral ring and pass along the free edge of the lacunar ligament, in which situation it would be exposed to injury in surgical intervention. This unusual origin of the obturator artery occurs in 30% of all subjects, but in a portion of these cases only, the artery courses around the medial side of the femoral ring, in which situation it is liable to injury in operation for femoral hernia."

The inferior epigastric occasionally provides the dorsal artery of the penis/clitoris, circumflex iliac, superficial epigastric, and medial femoral circumflex arteries.

The deep inferior epigastric artery was present in all bodies bilaterally, most frequently as a single-stem vessel lying on the posterior aspect of the rectus femoris muscle, and enters the substance of the muscle in its middle third according to Milloy, Anson and McAfee (1960).

The superior epigastric artery is occasionally not seen on the dorsal surface of the rectus muscle, being either absent or buried in the muscle tissue. When present, it is usually a single stem that enters the medial portion of the muscle after a short course on the surface. According to Milloy, et al. (1960), in only 1 instance of 162 specimens examined, did the superior and inferior epigastric arteries anastomose on the surface of the rectus muscle in the pattern frequently depicted in anatomy texts. When muscle fibers were dissected away from the arteries, only 40% of the superior and inferior epigastric arteries were found to have any gross anastomoses.

Image 23, Image 128A, Image 215

Inferior Epigastric:

See Image 23

Superior Epigastric:

See Image 23


References

Anson, B.J., Ed. (1966) Morris' Human Anatomy, 12th ed. The Blakiston Division, McGraw-Hill Book Company, New York.

Bergman, R.A., Thompson, S.A., Afifi, A.K. and F.A. Saadeh. (1988) Compendium of Human Anatomic Variation: Catalog, Atlas and World Literature. Urban & Schwarzenberg, Baltimore and Munich.

Delitzin, S. (1896) über eine complicierte Anomalie im Gebiete der Arteria obturatoria und epigastrica inferior. Arch. Anat. Physiol. Wissen. Med. 1896:413-422.

Dubreuil-Chambardel, L. (1925) Variations des Arteries du Pelvis et du Membre Inferieur. Masson, Paris.

Duclaux, H. (1902) Anomalies de l'épigastrique et de l'obturatrice. Bulls. et Méms. de la Soc. Anatomique de Paris 4:58-59

Henle, J. (1868) Handbuch der Systematischen Anatomie des Menschen. Von Friedrich Vieweg und Sohn. Braunschweig.

von Hochstetter, A. (1961) Eine Schleife der Arteria epigastrica inferior im Canalis inguinalis. Anat. Anz. 109:221-224.

Houel, -. (1848) Cas de double artére epigastrique. Bulletins et Mem. de la Société Anatomique de Paris XXIII(9-10):259-260.

Houel, -. (1848) Un cas de double artère épigastrique. Bulls. et Méms. de la Soc. Anatomique de Paris 1848:259-261.

Latarjet, A. (1948) Testut's Traite d'Anatomie Humaine, 9th ed., G. Doin & Cie., Paris.

Michaux, -. (1840) Naissance de l'artère épigastrique de l'obturatrice. Bull. de l'Academie Nationale de Medecine 6:103.

Milloy, F.J., Anson, B.J. and D.K. McAffee. (1960) The rectus abdominis muscle and the epigastric arterias. Surg., Gynecol. Obstet.. 110:293-302.

Petrali, G.N. (1857) Distribuzione arteriosa meritevole di nota, riscontrata durante l'operazione di un'ernia inguinale congenita. Gazzetta Medica Italiana, Lombardia 2:53-55.

Pick, J.W., Anson, B.J. and F.L. Ashley, (1942) The origin of the obturator artery. A study of 640 body-halves. Am. J. anat. 70:317-344.

Thomson, A. (1883) Origin of the internal circumflex from the deep epigastric artery. J. Anat. Physiol. 18:379-383.

Poynter, C.W.M. (1922) Congenital anomalies of the arteries and veins of the human body with bibliography. University Studies of the University of Nebraska. 22:1-106.

Ramsay, A. (1813) Account of unusual conformation of some muscles and vessels. Edinburgh Medical and Surgical Journal 8:281-283.

Redfern, P. (1850) Origin of the epigastric and obturator arteries by a common trunk from the internal iliac; with an inquiry into the amount of danger occasioned by various positions of arteries in the ordinary operations for femoral and inguinal herniae. Monthly Journal of Medicine, Edinburgh 9:203-222.

Schaefer, E.A., Symington, J. and T.H. Bryce., Eds. (1915) Quain's Anatomy, 11th ed., Longmans, Green and Co., London.

Shepherd, F.J. (1883) On some anatomical variations: Common iliac arteries. Annals of Anatomy and Surgery. 8:175-177.

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