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Anatomical topography of the inferior lumbar triangle for transversus abdominis block: comment on the article by Chatzioglou et al.

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in all the ILT, an arterial vessel was present, in particular, the second lumbar branch in 9%, third in 67%, or fourth in 8% [3]. Furthermore, we have documented on… Click to show full abstract

in all the ILT, an arterial vessel was present, in particular, the second lumbar branch in 9%, third in 67%, or fourth in 8% [3]. Furthermore, we have documented on the oblique coronal images the presence of a ‘lumbar canal’, which can be useful clinically as a route to the deep planes. It shows an oblique course, with a postero-anterior direction, from deep layer corresponding to the superior lumbar triangle (deep lumbar ring), to the superficial layer corresponding to ILT (superficial lumbar ring). The walls of the tunnel would be formed by the latissimus dorsi superficially and the thoracolumbar fascia deeply [2]. There is analogy between the inguinal canal and the lumbar canal: the two canals are both located at the level of the inferior part of the abdominal wall, being one anterior and the other posterior. Both canals do not have own walls and they develop for moving away of the two rings due to the passage of anatomical structures (for the inguinal canal, the deferens duct/round ligament, for the lumbar canal intercostals, ileoinguinal, ileoipogastric nerves, and vessels). During the development of the abdominal wall, the morphogenesis of the muscles shows fixed bone attachments such as 12th rib, the lumbar column, iliac bone: the external oblique muscle is attached to 12th rib and iliac bone, whereas the internal oblique and the transverse muscles are attached to the lumbar column, constituting a posterior fixed point, with subsequent different spatial arrangements of the muscular fibers. The consequence is the moving away of the deep ring, corresponding to the entrance of the vasculo-nervous structures and their exit at the level of the superficial ring. Testut [5] stated that the inguinal canal models in analogy of the vessels and nerves that create their space between the muscular structures to reach their own territories. To the Editor

Keywords: topography; lumbar; lumbar triangle; inguinal canal; lumbar canal

Journal Title: Surgical and Radiologic Anatomy
Year Published: 2017

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