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Age-related changes in inguinal region anatomy from 0 to 19 years of age
Sean J Botham1, Erin P Fillmore1, Thomas S Grant1
1Warwick Medical School, University of Warwick, Coventry, United Kingdom.
Insights
Pediatric inguinal anatomy changes with age. The deep inguinal ring and femoral vessels shift position relative to the inguinal ligament as the pelvis grows from birth to 19 years.
Area of Science:
- Anatomy
- Pediatric Surgery
- Radiology
Background:
- Understanding age-related changes in pediatric inguinal anatomy is crucial for surgical procedures.
- Limited published data exists on the dynamic anatomical shifts in the inguinal region during childhood and adolescence.
Purpose of the Study:
- To investigate the positional changes of inguinal structures and the growth of the pelvis and inguinal ligament in individuals aged 0 to 19 years.
- To establish normative data for pediatric inguinal anatomy relevant to surgical planning.
Main Methods:
- Analysis of anonymized contrast-enhanced CT scans from 103 pediatric patients (0-19 years).
- Three independent observers assessed anatomical landmarks, including the deep inguinal ring and femoral vasculature, relative to the inguinal ligament.
- Pelvic and inguinal ligament growth were quantified using bony reference points.
Main Results:
- Pelvic and inguinal ligament dimensions exhibited a positive polynomial growth relationship with age, without a pubertal growth spurt.
- The deep inguinal ring migrated superolaterally, and the femoral artery and vein moved medially relative to the inguinal ligament.
- Positional changes of the deep inguinal ring and femoral vasculature followed a logarithmic relationship with age, with no significant side or sex differences.
Conclusions:
- The femoral vasculature and deep inguinal ring undergo significant positional changes from infancy to young adulthood due to pelvic growth.
- These findings provide essential anatomical data for pediatric urological and abdominal surgery, improving surgical outcomes.
Abstract:
Knowledge of the age-related changes in inguinal region anatomy is essential in pediatric urological and abdominal surgery, yet little is published. This study aimed to determine the position of inguinal region structures and growth of the surrounding pelvis and inguinal ligament in subjects from 0 to 19 years of age. Anonymized contrast-enhanced CT DICOM datasets of 103 patients (63 male: 40 female) aged from 0 to 19 years had left and right sides analyzed by three independent observers. Exclusion criteria were applied. Growth of the pelvis and inguinal ligament were determined using fixed bony reference points. The position of the deep inguinal ring and femoral vasculature were determined as ratio of inguinal ligament length, measured from the anterior superior iliac spine. Growth of the pelvis in vertical and horizontal dimensions and of the inguinal ligament followed a positive polynomial relationship with increasing age, with no observed increase in growth rate during puberty. From 0 to 19 years, the deep inguinal ring moved superolaterally with respect to the inguinal ligament (from 0.74 to 0.60 of the distance along the inguinal ligament) and the femoral artery and vein moved medially (from 0.50 to 0.58, and 0.61 to 0.65 of the distance along the inguinal ligament, respectively). The position of the femoral artery, vein, and deep inguinal ring followed a logarithmic relationship with age. No significant left:right side or male:female differences were observed. From 0 to 19 years of age the femoral vasculature and deep inguinal ring change position as the pelvis grows around them. Clin. Anat. 32:794-802, 2019. © 2019 Wiley Periodicals, Inc.
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