Triangle of Doom is bounded by all of the following except:
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Correct Answer:
Cooper's ligament
Description:
Triangle of doom is an important anatomical area in the inguinal region when seen laparoscopically from inside.
In both open and laparoscopic preperitoneal approaches to hernia repair, a good understanding of the anatomical structures in the inguinal region from a reversed perspective is very necessary. The preperitoneal space is bounded internally by the peritoneum and externally by the transversalis fascia. There are 3 potentially dangerous areas : 2 triangles and one circle.Triangle of doom :Triangle of doom is formed by the gonadal vessels laterally and the vas deferens medially. Both these entities meet at the deep inguinal ring and the base of triangle is formed by the peritoneal reflection. This triangle contains external iliac artery and vessels. So no dissection or other activity whatsoever should be performed
in this area, as an injury to either of these vessels could be fatal. Moreover the genital branch of the genitofemoral nerve lies in this area and is equally in danger in case of careless dissectionTriangle of pain :Triangle of pain lies lateral to the triangle of doom and is defined as gonadal vessel medially, the iliopubic tract laterally and inferiorly the inferior edge of skin incision. This triangle contains femoral branch of the genitofemoral nerve, lateral femoral cutaneous nerve and anterior femoral cutaneous nerve of thigh. Stapling in this area during laparoscopic hernia repair may cause nerve entrapment and result in painful neuralgias.Circle of death :This is also called as corona mortis and refers to vascular ring formed by an arterial network, the common iliac artery, internal and external iliac arteries, Obturator artery, abberant Obturator artery, and inferior epigastric artery. The venous counterparts are similar in name, course, and position.
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