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The pelvic diaphragm is one of the four diaphragms in the human body (do you know the other three?) and it represents the lower boundary of the abdominopelvic cavity. This thin and  transversely oriented structure is formed from anterior to posterior by the puboccygeus, the iliococcygeus, and the coccygeus muscles.

The first two anterior muscles overlap, the pubococcygeus muscle being superior to the iliococcygeus muscle. Both of them attach laterally to a thickening of the obturator internus fascia that covers the obturator internus muscle. This thickening is known as the arcus tendineus levator ani (ATLA in the image). Because of the relation of the medial fibers of the puboccygeus muscle to the anal canal (puborectalis muscle), and what happens when these muscles contract, these two anterior muscles are known by one common name, the "levator ani" muscle. Click on the picture for a larger image.

The posterior component of the pelvic diaphragm is the coccygeus muscle, which is found lying on the internal aspect of the sacrospinous ligament.

Image property of: CAA.Inc. Artist: D.M. Klein. 
Word suggested and edited by:Dr. Sanford S. Osher, MTD Contributor 

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The root word [-gyne-] is Greek, from [gynaik] meaning "woman" or "female". The suffix [-ology] is also Greek,  derived from [logos] meaning "study of". [Gynecology] is then "study of a woman or a female". The term refers to the medical specialty that studies and treats the female reproductive system. A separate specialty, obstetrics, deals with the care of the pregnant patient and delivery of the fetus.

Originally, both specialties were the domain of midwives. It was not until the 1600's that male physicians were allowed to treat gynecological problems and attend  births. As the image shows, man-widwifes in Europe were allowed access to the patient only with the use of a "modesty blanket". This is plate XV from the 1681 book "Korte en Bondige Van Der Voortteeling en Kinderbaren" by Samuel Janson.

As an interesting side note in history, the first male physician to work as a man-midwife was Dr. Wertt from Hamburg. Dr Wertt decided to disguise himself as a woman to attend patients. When he was discovered, the punishment was "swift and salutary": He was burned at the stake.

Source:
"The Story of Surgery" by H. Graham, 1939
Word suggested and edited by: Dr. Sanford S. Osher, MTD Contributor

From the Greek word [stoma] meaning "mouth or opening", and the suffix [-y] meaning "process or condition". The suffix [-(o)stomy] refers to the "process of creating an opening". This process can be physiological, without intervention, as in the creation of a spontaneous fistula, or it can be a surgical procedure.

As a working explanation of [-ostomy] in surgery, we like to use the term "drainage". Therefore, an [ileostomy] would be the procedure by means of which a drainage opening is creating an anastomosis between the ileum and the abdominal wall.

The accompanying image shows an early 1900's procedure to create a gastrostomy (Wietzel's gastrostomy). The root term [gastr-] means "stomach".

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From the Greek [kheirurgia], a compound word meaning "a work done by hand". The Greek word [kheir/cheir] means "hand", and [ergon] means "work". The intent of the word is that of a medical treatment that is realized by the use of the hands and/or hand instrumentation.

Technology has advanced the evolution of surgery. Today minimally invasive surgical procedures, videoscopic procedures,  and robotic-enhanced surgery are commonplace.

Images and links in the public domain, courtesy of:www.wikipedia.com

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The arcuate line is the arch-shaped (hence the name) inferior border of the posterior sheath of the rectus abdominis muscle. This structure is seen in a laparoscopic (posterior) view (see image, label "B") and represents the transition from a superior area with well-formed aponeurotic posterior rectus sheath to an area devoid of the posterior rectus sheath.

At this point, the inferior (deep) epigastric vessels (see image, label "C") pass from deep to superficial, under the arcuate line and continue superiorly providing blood to the rectus abdominis muscle.

The arcuate line also represents a transition from a well-formed and stronger wall posterior to the rectus abdominis muscle to a weaker region, covered only by deep muscle fascia and transversalis fascia. This allows a surgeon to enter the preperitoneal region using a Totally Extraperitoneal (TEP) approach for a laparoscopic herniorrhaphy.

Label "A" shows the "corona mortis" anatomical variation. 

Image property of: CAA.Inc. Artist: M. Zuptich

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The inguinal (Poupart's) ligament has always been described as a separate, discrete,  distinctive ligamentous structure. This is not so. The inguinal ligament is the thickened, incurved, lower free border of the external oblique aponeurosis. This structure extends between the anterior superior iliac spine (ASIS) superolaterally, and the pubic tubercle inferomedially. The inferomedial portion of the inguinal ligament send fibers towars the pectineal ligament (Cooper's ligament) and forms the lacunar (Gimbernat's) ligament.

Inferior to the inguinal ligament is an open region (subinguinal space) that allows passage of structures between the abdominopelvic region and the femoral region. Some of these structures are: Iliacus muscle, psoas major muscle.

Although described by Vesalius, Fallopius, and others it was the French anatomist and surgeon Francois Poupart (1661-1708) who described this structure in relation to hernia in his book "Chirurgie Complete" published in 1695.

Image property of: CAA.Inc. Artist: D.M. Klein