Caption: Figure 2: Laparoscopy image showing the mass in the median
umbilical ligament superior to the bladder.
Actually it was a thickened right
umbilical ligament.
Access to the vesical pedicles and bladder was achieved through 2 windows on both sides; the first between the medial
umbilical ligament, round ligament and the pelvic side wall, and the second through the broad ligament inferior to the round ligament.
This vestigial remnant, also known as the median
umbilical ligament, extends in the midline from the bladder apex to the umbilicus.
The persistent allantois communicating from the dome of the bladder to the umbilicus is the urachus, which ultimately undergoes apoptosis and gives rise to the median
umbilical ligament.
The
umbilical ligament is tied up to the diaphragm internally.
During normal development the urachus obliterates to form the median
umbilical ligament at around 32 weeks' gestation.
The paravesical and pararectal spaces are then developed by retracting the
umbilical ligament (the superior vesicle artery) medially and performing blunt dissection between this artery and the pelvic side wall.
Usually, it undergoes complete regression to form the median
umbilical ligament, but incidentally seen in 30% of autopsies in adults.
The dissection was performed along the right iliac fossa, incising the peritoneum overlying the right
umbilical ligament.
This artery courses as the lateral
umbilical ligament in the posterior abdominal wall from the pelvis to the umbilicus.
Urachus or median
umbilical ligament is obliterated allantois.
