The rarity of coccygeal hernia is comprehensible when the density of the anatomic structures involved is considered. The supporting mechanisms of the pelvic and anal diaphragms and associated ligaments practically preclude the occurrence of hernia in the anococcygeal area. In main, the structures to be considered are the gluteus maximus muscles and their investing sheath of fascia lata, which lies beneath the skin, and the two layers of the superficial fascia. In this region the gluteus maximus arises from the lateral portion of the lower sacral and coccygeal vertebrae and the posterior aspect of the sacrotuberous ligament. These attachments blend with the superficial and deep layers of the supraspinous ligament, the superficial sacrococcygeal ligaments and the deep posterior longitudinal ligament of the spine. These structures provide an exceptionally strong fibrous support to the pericoccygeal region. Between the tip of the coccyx and the anus lies the fibrous raphe of the
Nichols RA, Herring AL. COCCYGEAL HERNIA. JAMA. 1933;101(9):674–675. doi:10.1001/jama.1933.27430340001007
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