Reflected Inguinal Ligament

ligamentum inguinale reflexum

The reflected inguinal ligament (triangular ligament) is a triangular expansion of the aponeurosis of the external oblique that reflects upward and medially from the lateral crus of the superficial inguinal ring across the posterior wall of the inguinal canal to attach to the linea alba. It reinforces the medial posterior wall of the superficial inguinal ring and contributes to the posterior wall of the inguinal canal alongside the conjoint tendon.

Region: Abdomen

Biomechanics

Function & Actions

Reinforces the medial posterior wall of the superficial inguinal ring, preventing herniation through the medial ring opening, and contributes to the structural integrity of the posterior inguinal canal wall.

Clinical Relevance

Clinical Notes

The reflected inguinal ligament is identified during open inguinal hernia repair as the medial reinforcement of the ring. In Bassini and Shouldice repairs, the reflected ligament is incorporated into the posterior wall reconstruction. Its weakness combined with conjoint tendon attenuation underlies direct inguinal hernia formation. In the mesh-free McVay repair, the conjoint tendon and reflected ligament are brought to the pectineal ligament to reconstruct the floor.

Pathology

Common Injuries & Conditions

Direct Inguinal Hernia

Weakness of the posterior inguinal canal floor, involving the reflected inguinal ligament and conjoint tendon, allows protrusion of abdominal contents medial to the inferior epigastric vessels (Hesselbach triangle), producing a reducible medial groin bulge managed with mesh reinforcement in open or laparoscopic hernia repair.