This plexus drains superiorly and medially to the internal thoracic vein. It drains superiorly and laterally to the lateral thoracic vein. Further, the plexus drains inferiorly to the superficial epigastric vein and the inferior epigastric vein which are tributaries of the femoral vein and external iliac vein, respectively. A layer of connective tissue lining the abdominal cavity namely the extraperitoneal fascia lies deep to the transversalis fascia and contains varying amounts of fat.
The vasculature extending into mesenteries is located in this extraperitoneal fascia which is abundant on the posterior abdominal wall, especially around the kidneys, and continues over organs covered by peritoneal reflections. The veins of the anterolateral wall carry deoxygenated blood into the systemic venous circulation and back to the lungs for oxygenation. The superficial abdominal veins dilate and provide a collateral circulation when the portal vein, superior vena cava, or the inferior vena cava get obstructed.
Veins of the systemic circulation are derived from the cardinal veins, and a portion of the inferior vena cava IVC along with the portal venous system are derived from the vitelline veins of the abdominal wall, which drain into systemic veins. The veins of the anterolateral abdominal wall accompany the arteries supplying the anterior abdominal wall.
The venous drainage of the anterior abdominal skin around the midline is by branches of the superior and inferior epigastric veins. The skin of the flanks is drained by branches of the intercostal, lumbar, and deep circumflex iliac veins. Also, the skin in the inguinal region is drained by the superficial epigastric, the superficial circumflex iliac, and the superficial external pudendal veins, tributaries of the femoral vein. The superior epigastric vein and musculophrenic vein are the two terminal tributaries of the internal thoracic vein inferior epigastric vein.
The anterior intercostal veins carry deoxygenated blood from the diaphragm, the anterior abdominal wall and the seventh, eighth, and ninth intercostal spaces and continue upward and laterally along the deep surface of the diaphragm as far as the tenth intercostal space of the abdominal wall. The inferior epigastric vein drains into the external iliac vein near its lower end just above the inguinal ligament.
It runs upward and medially in the extraperitoneal connective tissue, passes just medial to the deep inguinal ring, pierces the fascia transversalis at the lateral border of the rectus abdominis and enters the rectus sheath by passing in front of the arcuate line. Within the sheath, it drains the rectus muscle and ends by joining with the superior epigastric vein.
The venous drainage from the lateral abdominal wall drains above mainly into the axillary vein via the lateral thoracic vein and below into the femoral vein via the superficial epigastric and the superficial circumflex iliac vein. The level of the umbilicus is a watershed. Venous blood and lymphatic fluid drain upward above the plane of the umbilicus and downward below this plane.
Veins of the anterolateral wall can get dilated due to multiple causes. Obstruction of the superior vena cava or inferior vena cava by a mass or thrombus can present as dilated, tortuous veins over the abdomen.
Urgent surgery may be required in such situations. Supra-umbilical median incisions through the linea alba have several advantages such as being bloodless as most vasculature courses lateral to the linea alba. Furthermore, these incisions are safe to muscles and nerves but tend to leave a postoperative weakness through which a ventral hernia may form.
Among the sites at which tributaries of the portal vein anastomose with systemic veins portocaval anastomoses , the umbilicus is one of the important sites.
Cutaneous veins surrounding the umbilicus tributaries of the superficial and inferior epigastric veins anastomose with small tributaries of the portal vein called paraumbilical veins.
Elevated pressures of the portal venous system cause these anastomoses to recanalize to create dilated veins radiating from the umbilicus called caput medusae and can also result in esophageal and rectal varices. The portal vein carries blood to your liver from your intestines, gall bladder, pancreas, and spleen. The liver processes the nutrients in the blood and then sends the blood along to the heart. Caput medusae is usually related to liver disease, which eventually causes liver scarring, or cirrhosis.
This scarring makes it harder for blood to flow through the veins of your liver, leading to a backup of blood in your portal vein. The increased blood in your portal vein leads to portal hypertension. With nowhere else to go, some of the blood tries to flow through nearby veins around the bellybutton, called the periumbilical veins. This produces the pattern of enlarged blood vessels known as caput medusae. In rare cases, a blockage in your inferior vena cava , a large vein that carries blood from your legs and lower torso to your heart, can also cause portal hypertension.
A CT scan or ultrasound can show the direction of blood flow in your abdomen. This will help your doctor narrow down the cause. Caput medusae is usually a sign of more advanced cirrhosis, which requires immediate treatment. Depending on the severity, this can include:.
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