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.