Lecture - 2

Anatomy of the anterior

abdominal wall part II

Dr .Raya Abdul Ameer

MBCHB,CABHS-RAD

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 Rectus sheath
A long fibrous sheath formed by aponeurosis of the three
anterior abdominal muscle ( external oblique , internal
oblique and transversus abdominis muscle )
encloses the rectus abdominis and pyramidalis muscles and
forms an important component of the anterior abdominal
wall
Boundaries of the rectus sheath
Two walls
Anterior wall
Posterior wall
Two margins
Medial margin
Lateral mrgin

• Formation of the rectus sheath

From superior to inferior, the composition of the rectus
sheath walls changes
For description it consider at three levels
1-At the level of the xiphisternum /above the costal
margin
2-from costal margin to mid point between umbilicus
and symphysis pubis ( arcuate line )..upper three quarter
of the rectus abdominis
3-from arcuate line to symphysis pubis

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 Level 1 ..above costal margin
• Ante wall …apponeurosis of external oblique
only
• Posterior wall ..by thoracic wall and 5th , 6th
and 7th costal cartilages

At level 2 ..upper three quarters of rectus

abdominis muscle
At level above arcute line
The internal oblique aponeurosis split to enclose
the rectus mm ( anterior and posterior lamella )
Anterior wall … aponeurosis of the external
abdominal oblique and internal abdominal
oblique muscles

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• Posterior wall ..
• aponeurosis of the internal abdominal
oblique and transversus abdominis
muscles.

At level 3 Inferior to the arcuate line, the lower quarter of the

rectus abdominis muscle
is covered by the rectus sheath on its anterior surface only,
while the posterior surface is in direct contact with the
transversalis fascia.
The rectus sheath here is made of aponeuroses of all three
muscles – external and internal abdominal oblique muscles
and the transversus abdominis muscle

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The function of the rectus sheath
1) to protect the muscles and vessels which it encloses.
2)keeping the rectus abdominis and pyramidalis muscle together helps in
providing maximal compression of and support to abdominal viscera

Arcuate line : or semicircular line

It is located one third the distance from pubic crest
to the umbilicus .
It is the demarcation where the internal oblique and
transverse abdominis aponeuroses of the rectus
sheath start to pass anteriorly to the rectus
abdominis muscle leaving only the transversalis
fascia posteriorly

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Contents of rectus sheath
1) 2 muscles (rectus abdomins , pyramidalis )
2) 4 vessles superior . Epigastric a &v

inferior. Epigastric a&v

3) 6 nerves (5 lower intercostal T7-T11 &

subcostal T12 )
4) Lymphatic vv

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 Linea alba
(Latin white line ) ..is tendineous fibrous raphe that run
vertically down at the mid line of the abdomen ,
separating rectus abdominis muscles
-It is thickening of the anterior wall of the rectus sheath.
Formed by aponeurosus of external oblique, . Internal
oblique and transversus abdominis
-This entire thickening extends from the xiphoid process
of the sternum to the pubic symphysis
.

linea alba generally lacks blood supply and innervation

, but few small blood vessels cross to other side over its
anterior surface ,due to this it is a common site for
incision in abdominal surgery and puncture site for
suprapubic bladder catheterization

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Linea semilunaris =spigelian line
It is a vertical curved fibrous connective tissue structure ,
run along the lateral edge of rectus abdominis muscle , it is
site of union of lateral abdominal mm (external ,internal
,transverse abdominis ) and lateral aspect of rectus sheath
-it runs between 9th costal cartilage and pubic tubercle
bilaterally
-hernia at linea semilunaris
called Spigelian hernia

Inguinal canal anatomy

Its oblique intramuscular passage in the
lower part of anterior abdominal Wall
-It presents in both sexes
-It is about 1 ½ inches or 4 cm in length
-extend from deep inguinal ring down
ward and medially to the superficial
inguinal ring

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• -it lies parallel to and immediately above the
inguinal ligament

Deep inguinal ring

• Its is oval opening in the fascia transvesrsalis
• Lies above inguinal ligament between Anterior
superior iliac spine and pubic tubercle
• Margin of the ring give origin of the internal
spermatic fascia

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• Superficial inguinal ring
-Triangular in shape
-Defect in the aponeurosis of external oblique muscle
-Lies immediately above and medial to the pubic
tubercle
-Its margin give attachment to the external spermatic
fascia

Walls of inguinal canal

• Anterior wall
• It is formed by aponeurosis of external oblique and
re enforced at lateral third by fleshy part of the
internal oblique
• Posterior wall
• It is formed by fascia transversalis and reinforced at
medial part by conjoint tendon

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• Inferior wall /floor
• By inguinal ligament and lacunar ligament
• Superior wall / roof
• Internal oblique and transverses abdominis muscle

Function of inguinal canal

• It allows structures of spermatic cord to pass to
and from the testis to the abdomen in male
• Allows passage of round ligament of uterus
from the uterus to the labia majora in female

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Contents of inguinal canal in male

• 1-spermatic cord and its contents

• 2-genital branch of genitofemoral nerve
• 3-ilio inguinal nerve

• Contents in female
• 1- round ligament of uterus
• 2-genital branch of genitofemoral nn
• 3-ilio inguinal nerve

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Spermatic cord
• It is a cord like Collection of structures that pass
through inguinal canal to and from the testis
• It is covered by three concentric layers of fascia
developed from layers of the anterior abdominal wall
• It begin at the deep inguinal ring lateral to the inferior
epigastric artery and ends at the testis

Coverings of spermatic cord

• Internal spermatic fascia derived from the fascia
transversals and attached to the margin of the deep
inguinal ring
• Cremastric fascia and mm derived from the internal
oblique
• External spermatic fascia derived from external
oblique aponeurosis and attach to the margin of
superficial inguinal ring

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Anatomical Course of spermatic cord
• Begin at the inferior abdomen and end at
scrotum
• It is formed at the deep inguinal ring the pass
through inguinal canal and enter the scrotum
via superficial inguinal ring
• It continue in the scrotum ending at the
posterior border of the testes , here its contents
disperse to supply various structured of the
testes and scrotum

Contents of spermatic cord

1) three arteries
1-testicular artery …branch from aorta
2-crematris artery ..branch from inferior
epigastria artery
3-artery to vas deferens …branch from vesical
artery from internal iliac artery

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2) Three nerves
1-Genital branch of genitofemoral nn
2-Cremastric nn
3-Sympathetic nn fibers ./autonomic nn
3)Three other structures
1-pampinofroma plexus of testicular v drain
venous blood from the testis in to testicular vein
2-Vas deferens
3-Lymphatic vessles

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Round ligament
• Its is one of the supporting structures of the uterus
• It is rope like fibro muscular band extend from the
anterolateral aspect of the uterus just below the origin
of fallopian tube and pass through the deep inguinal
ring into the superficial inguinal ring to labia majora

Scrotum
Its fibro muscular cutaneous sac located
between the penis and anus
Its divided into Rt & Lt portions by septum

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Layers of scrotum :
Extension from layers of abdominal wall
From superficial to deep
1-Skin :- brown , thin , rogues
2-Dartos m:- .. fatty layer of superficial. fascia •
3-Membranous layer of superficial fascia
4-Ext, spermatic fascia …from external oblique
5-Cremasteric muscle &fascia …from .internal
oblique + transversalis abd.
6-Internal layer of spermatic f transversalis f
7-Parietal layer of tunica veginalis

Contents of scrotum
Three major paired structures
1-testis
2-epididymis
3-spermatic cord
Blood supply
• Anterior scrotal artery …branch from external
pudendeal artery
• Posterior scrotal artery branch from internal
pudendal artery

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Veins
• Scrotal veins ..drain to external pudendal vein
…to great saphenous vein
Nerves
• Anterior and anterolateral aspect
Anterior scrotal nn derived from genital branch
of genitofemoral nn and ilioinguinal nn
• Posterior aspect …
Posterior scrotal nn derived from perineal
branches of pudendal nn and posterior femoral
cutaneous nn

• Lymphatic drainage
Superficial inguinal lymph nodes

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Testis
Its male primary organ, located in scrotum,
oval in shape ,
Two poles upper & lower(spermatic cord
attached to upper pole)
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its function :-
-spermatogenesis  production of sperms
-Hormonal production testesteron

Covering of testis 3 special coats from inner to

outer
1-tunica albugenea( fibrous capsul)
2-visceral layer of tunica vaginalis
3-parietal layer of tunica vaginalis

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Abdominal wall hernia
Hernia : is abnormal protrusion of visira out of the wall of
its containing cavity as a result of weakness in these walls
Anterior abdominal wall hernia
• Epigastric hernia
• Umbilical hernia
• Spigelian hernia
• Paraumbilcal hernia
• Supraumbilcal hernia
• Groin region hernia :
• Inguinal hernia
• Femoral hernia

Inguinal hernia
1) Direct inguinal hernia
• Due to weakness in the abdominal wall behind
or lateral to superficial inguinal ring .
• Protrude through inguinal triangle (Hesselbach
triangle )
• Passes directly through abdominal wall to
superficial inguinal ring
• Does not extend to the scrotum
• More common in old men
• Located medial to inferior epigastric artery

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Hesselbach triangle (inguinal triangle )
• Is region of the lower anterior abdominal wall
• It represent potential area of weakness in the anterior
abdominal wall through which direct inguinal hernia
protrude
Boundaries
• Medially …rectus abdominis
• Laterally… inferior epigastric artery
• Inferiorly .inguinal ligament

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In direct inguinal hernia
• Traverse deep and superficial inguinal rings and
inguinal canal
• May descend to the scrotum
• More common than direct
• More in boys and young men
• May be con genital
• Located lateral to inferior epigastric artery

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Femoral hernia
-Herniation through femoral canal
-More common in female
-It lies lateral and inferior to pubic tubercle
-The femora Canal located at anterior thigh
Its is the smallest and most medial part of femoral
sheath

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Boundaries of femoral canal
• Medially …lacunar ligament
• Laterally femoral vein
• Anterior ..inguinal ligament
• Posterior pectineal ligament , superior ramus of
pubic bone

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Surface anatomy
Abdominal quadrants
• By two intersecting lines at the umbilicus
• Rt upper quadrant
• Lt upper quadrant \
• Rt lower quadrant
• Lt lower quadrant

Abdominal regions
Divided in to nine regions by two pairs of plain
• Vertical planes
Lt and R lateral plane =mid clavicular line
• Horizontal planes :
• Trans pyloric plane …L1 level
• Inter tubercular plane ..through tubercle of iliac crest
…L5 level

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• Epigastric , umbilical and hypogastric
• RT hypochondrial ,RT lumbar, RT iliac region
• LT Hypochondrial , LT lumbar , LT iliac regions

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