[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Abdomen](https://durgical.com/en/anatomy/region/abdomen/) › Epigastric vessels [Cardiovascular system](https://durgical.com/en/anatomy/system/cardiovascular-system/) · [Abdomen](https://durgical.com/en/anatomy/region/abdomen/) # Epigastric vessels The epigastric vessels are arteries and veins that run up behind the rectus abdominis; the lower ones are a key landmark for telling groin hernia types apart. Official name: Inferior epigastric artery [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=abdomen&select=epigastric_vessels&side=r) Opens in the Durgical app, no sign-up needed. ## What it is Arteries and veins running up the inside of the abdominal wall behind the rectus muscles (inferior and superior epigastric) and in the fat (superficial epigastric). ## What it does Supply the abdominal wall. The inferior epigastric vessels are the landmark between direct (inside them) and indirect (outside them) hernias, and laparoscopic ports avoid them. ## Key points - Hesselbach (inguinal) triangle: inferior epigastric vessels laterally, lateral border of the rectus abdominis medially, inguinal ligament below; direct inguinal hernias push through it - The inferior epigastric artery enters the rectus sheath at the arcuate line and climbs behind the rectus abdominis to meet the superior epigastric artery around the umbilicus - Rectus sheath haematoma: bleeding from these vessels, often with anticoagulation or violent coughing; below the arcuate line there is no posterior sheath to contain it - The superior and inferior epigastric arteries link the subclavian and external iliac arteries and enlarge as a bypass in coarctation of the aorta ## Key facts **Origin** Inferior: external iliac artery just above inguinal ligament; superior: [internal thoracic artery](https://durgical.com/en/anatomy/internal-thoracic-artery/) (terminal branch); superficial: [femoral artery](https://durgical.com/en/anatomy/femoral-artery/) **Branches** Inferior: cremasteric and pubic branches; superior and inferior anastomose inside rectus sheath; paired venae comitantes **Supplies** Rectus abdominis and anterior abdominal wall; inferior vessels raise lateral umbilical fold, medial to deep ring (indirect lateral, direct medial) ## Relations **Course** Inferior: from the [external iliac artery](https://durgical.com/en/anatomy/external-iliac-artery/) just above the [inguinal ligament](https://durgical.com/en/anatomy/inguinal-ligament/) it curves up and medially, medial to the deep inguinal ring, pierces the [transversalis fascia](https://durgical.com/en/anatomy/transversalis-fascia/) and enters the [rectus sheath](https://durgical.com/en/anatomy/rectus-sheath/) at the arcuate line, then climbs behind the muscle **Lateral** Deep inguinal ring, with the [ductus deferens](https://durgical.com/en/anatomy/ductus-deferens/) (or the round ligament) hooking around the artery as it enters the canal **Medial** Hesselbach triangle and the lateral border of the [rectus abdominis](https://durgical.com/en/anatomy/rectus-abdominis-muscle/) **Behind** Transversalis fascia and parietal [peritoneum](https://durgical.com/en/anatomy/peritoneum/), raised as the lateral umbilical fold **In front** Rectus abdominis, once inside the rectus sheath ## How to find it It cannot be felt. Its line runs from about the mid-inguinal point toward the umbilicus. At laparoscopy it is seen in the lateral umbilical fold, and Doppler ultrasound can map it before a drain or port is placed. ## Examination - Fothergill sign: a rectus sheath haematoma stays palpable and does not cross the midline when the abdominal muscles are tensed, unlike a mass inside the [abdomen](https://durgical.com/en/anatomy/region/abdomen/) ## On imaging CT shows a rectus sheath haematoma as a spindle-shaped mass in the muscle, with active bleeding on the arterial phase. On CT or at laparoscopy, a hernia sac medial to the inferior epigastric vessels is direct; one lateral to them is indirect. ## Clinical notes - Paracentesis and drains are placed lateral to the rectus sheath, usually in the left lower quadrant, away from the inferior epigastric artery - Deep inferior epigastric perforator (DIEP) flap: lower abdominal [skin](https://durgical.com/en/anatomy/skin/) and fat carried on perforators of this artery to rebuild the breast - The superficial epigastric veins dilate as a collateral in [inferior vena cava](https://durgical.com/en/anatomy/inferior-vena-cava/) obstruction, with flow upward from below the umbilicus ## Anatomical variants - An [obturator artery](https://durgical.com/en/anatomy/obturator-artery/) arising from the inferior epigastric artery and crossing near the femoral ring (corona mortis) is at risk in femoral hernia repair and pelvic fracture surgery; a venous link between the inferior epigastric (or external iliac) and obturator veins over the pubic ramus is even more frequent and bleeds just as readily ## Memory aid MDs don't LIe: Medial to the vessels is Direct, Lateral is Indirect. ## Related conditions - [Inguinal hernia](https://durgical.com/en/conditions/inguinal-hernia/) - [Incisional (ventral) hernia](https://durgical.com/en/conditions/incisional-hernia/) - [Femoral hernia](https://durgical.com/en/conditions/femoral-hernia/) ## Test yourself Think of the answer, then tap the question to see it. ## Where does the inferior epigastric artery arise and where does it enter the rectus sheath? From the external iliac artery just above the inguinal ligament; it enters the rectus sheath at the arcuate line and climbs behind the rectus abdominis. ## Which peritoneal fold do the inferior epigastric vessels raise? The lateral umbilical fold, just medial to the deep inguinal ring. ## Why are paracentesis needles and drains placed lateral to the rectus sheath? To avoid the inferior epigastric artery, which runs behind the rectus abdominis; the left lower quadrant is the usual site. ## Why do the epigastric arteries enlarge in coarctation of the aorta? The superior (from the internal thoracic) and inferior epigastric arteries link the subclavian and external iliac arteries, forming a bypass around the narrowing. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/anatomy/inferior-epigastric-artery/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** arteria epigastrica inferior; arteria epigastrica superior; arteria epigastrica superficialis TA2 4358 **Official Spanish (DeCS)** Vasos epigástricos DeCS D019074 **English (TA2)** Inferior epigastric artery **Also called** arteria epigastrica caudalis ## Related - [Inguinal canal](https://durgical.com/en/anatomy/inguinal-canal/) - [Rectus abdominis](https://durgical.com/en/anatomy/rectus-abdominis-muscle/) Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=32758&filter=ths_termall&q=Arterias%20Epig%C3%A1stricas); [Anatomy, Abdomen and Pelvis: Epigastric Artery](https://www.ncbi.nlm.nih.gov/books/NBK537156/); Tratado de anatomía humana (9.ª ed.), tomo II, Libro IV Angiología, sección 4: Venas (sistemas de las venas cavas superior e inferior, vena porta, venas del raquis). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/inferior-epigastric-artery/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/inferior-epigastric-artery/