From Big Medical Encyclopedia

ILEAL AREA (regio iliaca) — the part of a front abdominal wall located knutr from an ileal comb of an ileal bone and a lateral half of an inguinal sheaf. From above P.'s border of the lake passes across the horizontal line drawn through front upper ileal awns, and from the inside — on the line corresponding to the outer edge of a direct muscle of a stomach. Allocate the right and left P. to the lake. As within P. of the lake there is a pakhovy channel, it often call ilioinguinal or inguinal area (see).

Fig. 1. Right ileal pole of the man and anatomic educations, adjacent to it (anterior aspect; the front abdominal wall, a part of a peritoneum and intestines are removed): 1 — an ureter, 2 — a genitocrural nerve, 3 — the general ileal artery and a vein, 4 — an ileal muscle, 5 — a big lumbar muscle, 6 — a lateral cutaneous nerve of a hip, 7 — a femoral nerve, 8 — an outside ileal artery, 9 — a yaichkovy artery and veins, 10 — a bladder.

In an abdominal cavity of the right and left P. of the lake there correspond the right and left ileal poles, in to-rykh are located: part intestines (see) — on the right caecum (see) with a worm-shaped shoot (see. Appendix ) and terminal department of an ileal gut, at the left sigmoid gut (see) and loops of a small bowel; general and outside ileal arteries and veins; nerves of a lumbar texture; ureters, their average departments (fig. 1). A frequent object of surgical interventions are diseases of an ileocecal corner therefore islands quite often call the right P. ileocecal area.

The wing and partly a body of an ileal bone create a flat hollow — an ileal pole, from a cut the ileal muscle originates. Together with the big lumbar muscle beginning from the lateral surface of bodies and cross shoots of the XII chest and all lumbar vertebrae, it forms a uniform iliolumbar muscle (highway of iliopsoas) in an ileal pole. Both muscles are covered with an ileal fascia. As a result of it the osteofibrous bed of an iliolumbar muscle forms, a cut stretches from the XII chest vertebra to a trochantin of a femur; it is important in dynamics of development and distribution of purulent processes, e.g. psoas abscesses and congestive abscesses. Dense fixing of an ileal fascia to an ambit of a basin serves as an obstacle for transition of abscesses from an ileal pole in a cavity of a small pelvis owing to what natechnik or psoas abscesses have tendency to extend on the course of an iliolumbar muscle through muscle compartment to the anteromedial surface of a hip. On this way abscesses sometimes break in a synovial ileal and edge bag (bursa iliopectinea) located on a front surface of a hip joint. In the presence of the message of an ileal and edge bag with a cavity of a joint there can be acute purulent coxitis (see).

Blood vessels and nerves of an ileal pole are located partly inside and partly out of the mentioned osteofibrous bed. Out of a bed (in retroperitoneal cellulose) there pass the general and outside ileal arteries and veins (and. et V. iliacae communes et ext.), y of men yaichkovy artery and vein (and. et v. testiculares), at women — an ovarian artery and a vein (and. et v. ovaricae), and also genitocrural nerve (n. genitofe-moralis); large ileal vessels are put into the case formed by an ileal fascia. In an osteofibrous bed there pass several small blood vessels — lumbar arteries (aa. lumbales), iliolumbar artery (and. iliolumbalis), femoral nerve (n. femoralis), lateral cutaneous nerve of a hip (item cutaneus femoris lat.), and also number of small muscular branches of a lumbar texture. In nek-ry cases nerves of a lumbar texture — ilioinguinal (n. ilioinguinalis), additional femoral (n. femoralis accessorius), etc. are located here.

The outside ileal artery passes to an inguinal sheaf and near it gives two branches: the deep artery which is bending around an ileal bone, and the lower epigastriß artery (and. circumflexa ileum profunda et a. epigastrica inf.).

Outside ileal vein (v. iliaca ext.) within a big basin passes on the right side behind, and on left — behind and knutr from an outside ileal artery; upon transition to a vascular lacuna the vein is located medially from an artery. At the level of bifurcation of the general ileal arteries in front of them cross the ureters going to a small pelvis. In the field of decussation of ureters with ileal vessels the delay of stones of an ureter which is shown the pains irradiating in a scrotum owing to a prelum of a genitocrural nerve a sexual branch to-rogo is quite often observed innervates covers of a seed cord. Lateralno also is slightly higher from the place of decussation of ureters and ileal vessels, ahead of ureters there pass veins of a small egg (or an ovary) (v. testicularis resp. ovarica) which go down a front surface of a big lumbar muscle to a deep abdominal ring (anulus inguinalis profundus).

Between an ileal fascia and a parietal layer of a peritoneum there is a significant amount of a fatty tissue, heavy inflammatory processes quite often develop in a cut — phlegmons (see), arising because of thrombophlebitises of veins of a small pelvis, purulent lymphadenitis or getting P.'s wounds of the lake. It is promoted by accumulation of a significant amount outside ileal limf. the nodes located on the course of ileal vessels, especially veins. The purulent processes which began in an osteofibrous bed of ileal muscles can extend to a hip. The phlegmons developing in retroperitoneal cellulose tend to extend on the course of large ileal vessels to an inner surface of a hip.

At P.'s wounds of the lake phlegmons can develop, as a result to-rykh purulent inflammatory process extends to an iliolumbar muscle (see. Psoitis ). In such cases almost always, though in various degree, the femoral nerve is surprised that it leads to a flexion contracture in a hip joint (a pliakus-symptom across Melnikov).

Phlegmons in retroperitoneal cellulose of an ileal pole can develop also at purulent appenditsita, especially in cases of a retrocecal and retroperptonealny arrangement of a worm-shaped shoot. At the same time they are localized in various layers. V. F. Voyno-Yasenets-ky distinguished 4 types of phlegmons at wounds of a basin: subperiostal phlegmons of a wing of an ileal bone (because of osteomyelitis); phlegmons of friable cellulose between a middle part of an ileal muscle and a periosteum; abscess in the thickness of an iliolumbar muscle (a psoas abscess, a psoitis); phlegmons of retroperitoneal cellulose.

Fig. 2. Diagrammatic representation of vnebryushrshny quick access to an ileal pole: 1 aponeurosis of an outside oblique muscle of a stomach, 2 — a cross fascia, 3 - an outside ileal artery and a vein, 4 — a femoral nerve, 5 — a peritoneum, 6 — edges of internal slanting and cross muscles of a stomach.

Quick access to outside ileal vessels is provided with a vnebryuiiishy section of Pirogov (see. Pirogova section ) — parallel to the upper edge of an inguinal sheaf to the level of an upper front ileal awn; if necessary the section can be continued to the lumbar area. After that cut an aponeurosis of an outside oblique muscle of a stomach (fig. 2). Internal slanting and cross muscles of a stomach are delayed up. After a section of a cross fascia of a stomach get into the space between a peritoneum and an inguinal sheaf filled with friable preperitoneal cellulose. In it there pass the lower epigastriß artery, the deep artery which is bending around an ileal bone, veins accompanying them and bedrennopolovy a nerve. The peritoneum is removed up. In the depth of a wound determine by a finger an inner edge of an iliolumbar muscle and on it an outside ileal artery. Vessels remove in the medial party and get to a suppurative focus in an ileal muscle.

For opening of phlegmon of retroperitoneal cellulose P. of the lake the section can be continued to lumbar area. Gradually otslaivat a peritoneal bag up and knutr, trying not to bare ileal vessels. In a wound find average department of an ureter in the place of transition it in a cavity of a small pelvis. Operation is finished with drainage of an abscess cavity.

Bibliography: Voyno-Yasenetsky V. F. Sketches of purulent surgery, page 410, JI., 1956; Lubotsky D. N. Fundamentals of topographical anatomy, page 456, M., 1953; A. V. Klinik's Millers and prevention of retroperitoneal and pelvic phlegmons at wounded in a stomach, page 65, JI., 1956; Persianinov JI. C. Operational gynecology, M., 1976.

G.E. Ostroverkhov.