Yonsei Med J.  2008 Dec;49(6):1004-1007. 10.3349/ymj.2008.49.6.1004.

Morphologic Variations of the Umbilical Ring, Umbilical Ligaments and Ligamentum Teres Hepatis

• Oh CS
• Won HS
• Kwon CH
• Chung IH

• KMID: 1782950
• DOI: http://doi.org/10.3349/ymj.2008.49.6.1004

Abstract

PURPOSE
The varied morphology of the umbilical ring and its surrounding structures, such as the ligamentum teres hepatis, and the median and medial umbilical ligaments, has not been thoroughly investigated. Hence, this study was undertaken to clarify the morphologic variations of these structures. MATERIALS AND METHODS: The anterior abdominal walls were removed en bloc from 57 adult cadavers and dissected under a surgical microscope. RESULTS: One case of umbilical hernia was observed, and the remaining 56 umbilical rings were classified into 3 types: oval or round in 33 cases (Type A, 59.0%), obliterated or slitted in 12 cases (Type B, 21.4%), and completely covered by a connecting band between the ligamentum teres hepatis and umbilical ligaments in 11 cases (Type C, 19.6%). The median and medial umbilical ligaments were classified into four types based on their interrelationships. The most common type was the median umbilical ligament terminated by joining one or both medial umbilical ligaments (Type II, 41.1%). The ligamentum teres hepatis frequently ended by dividing into several branches in the area cranial to the umbilical ring, some of which crossed the umbilical ring. The umbilical fascia covered the umbilical ring in 50.0% of cases, and the rest either not covering the ring or not existing. CONCLUSION: These results are expected to improve our understanding of the anatomy of the umbilical area, and further improve treatments of the umbilical hernia.

Keyword

Umbilical ring; umbilical ligament; ligamentum teres hepatic; umbilical fascia; umbilical hernia

MeSH Terms

Adult
Aged
Aged, 80 and over
Autopsy
Female
Hernia, Umbilical/pathology
Humans
Ligaments/anatomy & histology/pathology
Male
Middle Aged
Umbilicus/*anatomy & histology/pathology

Figure

• 

  Fig. 1 Three types of umbilical ring (UR) identified in this study. Classification was based on the presence of the hole of the ring, and whether the ring is covered by the ligament.

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  Fig. 2 Photograph showed an umbilical ring (UR) of Type A and umbilical ligaments of Type II. The ligamentum teres hepatis (LTH) divided into 3 branches (arrows), 1 of which attaches lateral to the oval UR and another that crosses the UR and joins the medial umbilical ligament (MdU). The median umbilical ligament (MnU) joins the MdU that is on the right side.

• 

  Fig. 3 Photograph of a backlit section showing an umbilical ring (UR) of Type B and umbilical ligaments of Type II. No light is transmitted in the area of the UR because the ring is obliterated. The median umbilical ligament (MnU) joins the medial umbilical ligament (MdU) that is on the right side, and the ligamentum teres hepatis (LTH) divides into 2 branches. The umbilical fascia (UF) is reflected.

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  Fig. 4 Photograph showing an umbilical ring (UR) of Type C and umbilical ligaments of Type III. The median umbilical ligament (MnU) and medial umbilical ligament (MdU) fuse into a band that continues to the ligamentum teres hepatis (LTH), covering the UR. A connecting branch (arrow) is evident between the LTH and the MdU that is on the left side.

• 

  Fig. 5 Four types of umbilical ligaments identified based on their interrelationships.

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