ABDOMINAL WALL

Layers ( from ANTERIOR WALL

superficial to deep)
◼Skin
◼Superficial fascia
◼Anterolateral
muscles(ex. Oblique,
int. oblique & trans.
abdominis)
◼Transversalis fascia
◼Extraperitoneal fat
◼Parietal peritoneum
Layers of the Abdominal Wall

Skin
Superficial fascia－
divisions below
umbilicus
• Superficial fatty
layer (Camper’s)
• Membranous layer
(Scarpa’s)
 MUSCLES OF ABDOMEN
Anterolateral group
◼ external oblique
absominis
◼ Internal Oblique
abdominis
◼ Transversus
abdominis
◼ Rectus
abdominis
Posterior group
◼Quadratus lumborum
Origin: post. Border of iliac crest
Insertion: trans. Process of L1-L5, lower border
of rib 12th
Action: unilateral; lat. flexion of spine.
bilateral: extension of spine.
◼Psoas major
Origin: trans. Process of L1-4.
Insertion: lesser: trochanter of femur
Action: lat. Flexion of spin (unil.),
 EXTERNAL OBLIQUE ABSOMINIS
General direction of fibers:
downward, forward and
medially (run down and
inward)
Origin: ribs 5-12
Insertion: iliac crest,
rectus sheath and
linear alba
Structures
• Inguinal ligament
• Lacunar ligament
• Superficial inguinal ring
－triangular-shaped
defect in aponeurosis
of external oblique
above pubic tubercle
 INTERNAL OBLIQUE ABDOMINIS
◼ Deep to external
oblique abdominis
◼ General direction of fibres:
upwards, forwards and
medially
◼ Origin: lat. 2/3 of ing. Lig.,
iliac crest, thoracolumber
fascia,
◼ Insertion. Lower 4 costal
cartilages Linear alba,
pubic crest and pectineal
line.
 TRANSVERSUS ABDOMINIS

◼ Deep to internal
oblique
◼ Origin: lat.1/3 of ing.
Lig., thoracolumbar
fascia, lower six
costal cartilages.
◼ Insertion: linear
alba, pubic crest
and pectineal line.
◼Inguinal falx: arch
over spermatic
cord, inserted
with transversus
abdominis fiber
into medial part of
pecten of pubis
◼Cremaster :
around the
spermatic cord
and testis
 RECTUS ABDOMINIS
◼Position: lie on to either
side of midline
◼Origin: pubic crest and
symphysis
◼Insertion: xiphoid and
5th-7th costal cartilages
◼Has 3-4 tendinous
intersections
◼linear semilunaris: forms
the lateral borders of the
two recti muscles
SIMILAR FUNCTIONS FOR ABOVE FOUR PAIRS
OF MUSCLES
◼Support and compress the abdominal
viscera
◼Increase intra-abdominal pressure, aid in
expulsive efforts such as vomiting,
coughing, sneezing, defecation, urination
and childbirth.
◼Depress ribs, assist in (the act of
force(4)expiration.
◼Flex, lateral flex, and rotate vertebral
column
 SHEATH OF RECTUS ABDOMINIS
Ant layer－formed by fusion of
aponeurosis of obliquus
externus abdominis and
anterior leaf of aponeurosis of
obliquus internus abdominis
Post layer
• Formed by fusion of posterion
leaf of aponeurosis of obliquus
internus abdominis and
aponeurosis of transverses
abdominis
• Absent in about 4-5cm below
the umbilicus, where
aponeuroses of all three
muscles form anterior layer the
lower free border named
arcuate line
• Below this line rectus abdominis
in contact with transverse
fascia
Linea alba
－tendinous raphe between right and left recti from xiphoid
to pubic symphysis.
 INNERVATIONS AND BLOOD SUPPLY
OF ANTERIOR ABDOMINAL MUSCLES
▪ Rectus abdominis and external Oblique:
• by T7-T12
• Lumbar and deep circumflex iliac arteries
▪ Internal oblique and transversus abdominis:
T7-T12 + L1(Iliohypogastric and Ilioinguinal)
Blood supply
• Intercostal arteries
• Epigastric arteries
• Lumbar and deep circumflex iliac arteries
 FOLDS OF ANTERIOR ABDOMINAL
WALL
❑Six folds of peritoneum on the posterior surface
of ant. Abd. Wall
❑One above and five below the umbilicus
• Falciform ligament; inferior margin contains
the ligamentum teres, the obliterated remain of
the left umbilical vein
• Median umbilical fold- contains the median
umbilical ligament, the obliterated remains of
the urachus
• Medial umbilical fold(paired)- contains the
medial umbilical ligament, the obliterated
remains of the umbilical artery.
• Lateral umbilical fold (paired)- contains the
inferior epigastric vessels
 LUMBER TRIANGLE (of Petit)
❑Boundaries
• Anterior: free posterior border of ex.
Oblique muscle
• Posterior: ant. border of latissimus dorsi
muscle
• Inferior: iliac crest
• Floor: internal oblique
❑Clinical: Rare site for lumber hernia.
 INGUINAL REGION
Boundaries
◼Inguinal ligament
(0f Poupart)
◼Lateral margin of
rectus abdominis
◼A horizontal line
stretching from
anterior iliac
spine to lateral
margin of rectus
abdominis
Fetus at 28 week the testis passing
through the inguinal canal
Newborn
 INGUINAL CANAL
Position: oblique passage, 4cm long, located
1.5cm above medial half of inguinal
ligament (midpoint of inguinal ligament).
Boundaries
◼ Ant wall
❑ Aponeurosis
of external
oblique
❑ Reinforced
laterally by
the internal
oblique
(lateral third
of wall)
• Post wall
• Transversalis
fascia (Weak)
• Conjoint tendon
(Inguinal falx)
medially
• Roof－arched
lower fibers of
internal oblique
and transversus
abdominis
• Floor－inguinal
ligament．
• Two openings
• Superficial inguinal
ring
• Deep inguinal ring
－defect in
transversalis
fascia 1.5cm above
midpoint of
inguinal ligament.
◼Structures passing through the inguinal canal
❑Spermatic cord and ilioinguinal nerve in
males
❑Round ligament of uterus and ilioinguinal
nerve in females
 CONTENT OF SPERMATIC CORD
❑Vas deferens- lower and post part of the
cord
❑Arteries: testicular artery (largest), artery to
vas deferens(from sup. or inf. vesical) and
cremasteric artery.
❑Veins: pampiniform plexus of veins.
❑Lymphatics : from testes draining into para-
aortic node and from the covering into the
external iliac node
❑Nerves: genital branch of the genitofemoral
nerve to the cremaster muscle.
❑Processus vaginalis- the obliterated remain
of peritoneal connection with the tunica
vaginalis.
 COVERINGS OF SPERMATIC CORD
❑ Internal spermatic fascia- derived
from transversalis fascia
❑Cremasteric muscle and fascia- derived
from internal oblique aponeurosis
❑External spermatic fascia-derived
from- external oblique aponeurosis
 INGUINAL TRIANGLE (OF HESSELBACH)

Boundaries
◼Inguinal ligament
inferiorly
◼Lateral border of
rectus abdominis
medially
◼Inferior epigastric
artery laterally
• Indirect inguinal hernia- viscera passes
through the deep inguinal ring along
spermatic cord into scrotum. Usually
lateral to the inferior epigastric vessels.
• Direct inguinal hernia- through the
weakness in the transversalis fascia
and emerge through the superficial
inguinal ring. Rarely descend into the
scrotum.
 SUPERFICIAL VESSELS AND CUTANEOUS
NERVES
◼Arteries
❑Superficial
epigastric art.
❑Superficial iliac
circumflex art.
◼Veins
❑Thoracoepigastric v.
❑Superficial
epigastric vein
◼Cutaneous nerves
❑Anterior and lateral
cutaneous nerve of
lower six thoracic
nerves.
❑Iliohypogastric nerv
(first lumb nerves)
 DEEP VESSELS AND NERVES
Arteries
◼Superior and inferior
epigastric arteries
◼Lower posterior
intercostal artery.
◼Subcostal artery.
◼Four lumbar arteries.
Nerves
◼Iliohypogastric nerve.
❑Arises from lumbar plexus
❑Passes forward in the
interval between internal
oblique and tranversus
abdominis
❑Pierces the internal
oblique 2.5 cm medial to
anterior superior iliac
spine
❑Pierces aponeurosis of
external oblique
abdominis about 2.5 cm
above superficial inguinal
ring
◼Ilioinguinal nerve.
❑Runs parallel with
iliohypogastric n. at a
lower level
❑Enters inguinal canal and
emerges through
superficial inguinal ring
◼Genitofemoral n.
 Layer ?

Subcostal incision Median or midline incision

Muscle-splitting incision Left paramedian incision

Transverse incision
Suprapubic incision