..

í'i:j":' '"-,,
- --- - ._;_: 't; i
,- -,Í ,-.. i',-.-
-''¡ .l:1" i
:,
, 'i,-- CHAPTER 4
' -.-- f-"',r.i. j ,
\'-- t-t t,

--
I -
:-=,-; o, : '
.' |
j:
Abdomen
ffiffi supERFtctAL ANTTROLATERAL ABDOMTNAL WALL
The anterotateratabdominalwatl is bounded by the 7th to 10th ln this ímage, the skin and most of the subcutaneous tis-
ribs and xiphoid process of the sternum atong with Ínguinal sue have been removed, except for two smalt areas atong the
ligament, ítiac crests, pubic crests, and pubic symphysis. From inferíor aspect of the right abdaminalwall. The subcutaneous
superficial to deep, the watl is composed of skin, subcutane- layer is shown reflected on the inferior aspect of the left ab-
ous tissue, muscte and aponeurosis, deep fascia, and parietal dominalwall. The anterior layer of the rectus sheath has been
peritoneum. reftected on the left side.

4 colofr e ach of the followíng structures using a different calor for each:
lnferior to the umbilicus, the subcutaneous tissue is arranged cont¡nue to run superficial (anterior) to the rectus ab-
in two layers: dominis muscle to the linea alba.

Q 1
" Fatty layer of subcutaneous#ssue {Camper fascia):
Variable amount of fatty tissue immediately deep to the skin
Q ?. Membranous layer af subcutaneous fissue (scarpa
fascia): Thin membranous layer deep to superficiai fatty
layer and superficiaI to muscutoaponeurotic layers
The muscles of the anterolateralwaltare arranged simitarty
to the musctes of the thoracic watl Three muscles compose
the anterotateral wall, with their fibers coursing in varying
orientation to each other,
Q 3. Externaloblique muscle: The most superficial of the
three anterotatera[ muscles on each side, primarily courses
in an inferomedialdirection ([ike "hands in a pocket").
Superolateratty, fibers interdigitate with the serratus
anteriar. The rnuscte fibers become the aponeurosis
of the erternal oblique at the midctavicular line and
Unlike the thoracic region, there is no anterior rnidline
vertical bone equivalent to the sternum. lnstead, one primary
vertical muscle reinforced with the aponeurotíc layers of the
anterotateral musctes exists in its ptace to allow for mobitity
of the intestines and for greater expansion of the abdomen
after a large meal or during pregnáncy.
9 4" Rectus abdominis muscle: Paired, princípal vertica[
muscte of the anteríor abdominatwatt. Wider superiorly
than inferior§ and separated by the tínea alba from
each other.
C5. Anteríor rectussheafá: Covers the anterior aspect of
the rectus abdominis muscte
06. Tendinous intersections: Attachment of the rectus
abdominis muscte to the anterior rectus sheath at
three or more transverse rows, creating butging muscles
between when tensed ("six pack")

External obtíque ; External surfaces of i Linea alba, pubic ThoracoabdominaI nerves Compresses abdominal
i sth-lZth r;bs i tubercle, and anterior (T7-I1 1 spinat nerves) and I viscera and rotates trunk
r)
i ' .,-*;-I hatf of iliac crest subcostal nerve
I Pubic symphysis and r Xiphoid process and
i-..
Rectus abdominis Thoracoabdominal nerves ¡ Flexes trunk and
"
i pub¡c crest i 5th-7th costal cartilages (anterior rami f6-f11) and compresses abdominal
subcostal nerve viscera

Neurovasculatt¡re of Anterotateral Abdominat Watt

@ 10. Lateralabdaminalcataneousbranches: Sensory branches
ü 7. Superficial epigastric artery and vein: Branch of the fromTT to T11 that emerge from the muscutature of
femoralarteryltributary of great saphenous vein running the anterotateral wa[[ to run through the subcutaneous
in subcutaneous tissue to/from the umbilicus tissue
ry 8. Superficíal circumflex íliac arteryr and vein; Branch of @tt. Anterior abdominal cutaneeus branches: Sensory
femoraIartery/tributary of great saphenous vein running branches from T7 to T1 1 that plerce the rectus sheath
in subcutaneous tissue along inguinal ligament to enter the subcutaneous tissue. T7-T9 suppty the skin
@ 9. §xternalpudendalarteryandvein: Branch of femoral súperior to the umbiticus; T10 suppties the skin around
artery/tributary of great saphenous vein ruhning in the umbilicus and T1 1 supplies the skin immediatety
subcutaneous tissue tolfrom the pubic bone inferior to the umbiticus.
 SUPERFICIAL ANTEROIáTERAL ABDOMINAL WAIL : ABDOMEN

sft costal caftilago

§en¿tus anterior

n-*E?ntar

,o
$gos-
crhncoJ
obdonrinolct
tt*cralrs

a. htuqilln t*stñ &il

«b&lr*¿*
6. I ¡ri*,y ,:* ,:,.: i ,. ?.T.
*er*'§i*fu,*',

Umbilieus

:;¡i{ tr.g¡i
r'*r[*rudrqu.$
§\N! Aponsurosi§ of
extemal ohlique
ar*s:v'r.¡¡#ji

A¡lc'¡o Y
t-
rt¡U¡ ¿[c¡a úrrnr;
ic,¡e(,
1. ,{-, § i '* :.$'É \\.
t+ t.. t ,.t:
_ ,1, ü'
,i D

, Ar+E i.t y- z. *]+á:¡-¿l¿-il-{ t ¡Era. ¿

*ft* egXoilr*o i..:*,!,,[. ) *"¡-,.- 1Íü#¡

gltr€¡$r$oI Spermat¡c cord

(ira¡:th
i1.1. ; ri I,r'¡ i::-.
1?,2 Abdomen DEEP ANTEROLATERAL ABDOMINAL WALL

ffi DEEr ANTERoIATERAL ABDoMtNnr w¿d

On the right side, the muscular portion of the externalablique to demonstrate the posterior [ayer of the rectus sheath. ln
has been removed, with íts aponeurosis and contribution to the addition, the muscular portion of the internat obtique muscte
anterior rectus sheath [eft intact. On the left side, the anterior has been cut vert¡catry to reveal the deeper structures of the
rectus sheath and rectg§._§bdoulni§lnus§le have been removed anterolateraI abdominaI wat[.

m CO¿OR e ach of the fol,lowing structures using a different color for each:

Q 1. lntemal oblique muscle: lntermediate muscle of the
anterolateral abdominal watl The muscle fibers spread
out superornediat§ perpendicular to ths externat oblique
fibers. lnferior to the level of the anteríar superior iliac
spine (AgSl,the muscle fibers course in a more horizontal
direction. The fibers become aponeurotic at the midcla-
vicular line and continue mediatly to the fineaaláa.
Q 2. Transversus abdaminis muscte: lnnermost muscle of
the anterotateralabdominatwatt. The muscle fibers run
transverse§" The fibers, like the external and internal
obtique, become aponeurotic at the midclavicutar line
and continue mediatty to the linea alba.

lnternal oblique Thoracotumbar fascia, lnferior borders of the 10th-1Zth Thoracoabdominal Compresses and
anterior two-thirds itiac crest ribs, tinea alba, pecten pubis nerves (T6-T1Z) supports abdominat !

Transversus lnternal surfaces of!th-1Zth Linea atba, pubic crest, pecten and L1 viscera ,

abdominis costal cartilaqe¡, itiac crest, pubis

thoracolumbar
»ar. fascia i

Rectus §heath Neurovasculature

Q 3. Anfario r ractus sheaúá: Runs the vertical distance between
the costal margin and the pubic bone. The superior two-
thirds of the anterior rectus sheath is composed of the
interdigitating fibers of the external obtique aponeurosis
and hatf of the internal oblique aponeurotic fibers. The
inferior one-third of the anterior rectus sheath is composed
of the aponeurotic fibers of allthree anterolateral muscles.
abdominís muscle; and unlike the anterior layer of the
rectus sheath, onty extends the superior two-thirds
of the distance between the costal margin and pubic
bone. The posterior rectus sheath is composed of hatf
of the internal obtique and the transversus abdominís
aponeurotic fibers.
{}5. Arcuate{ine: Demarcates the inferior edge of the pos-
terior rectus sheath. Below the arcuate line, there are
no aponeurotic fibers from the anterotateralmuscles
posterior to the rectus abdominis.
§ 6. Iransuersaúifascia: Named portion of endoabdominal
fascia, a serous membrane [ining the internat aspect of
the musctes of the abdominalwall. lnferior to the arcuate
tine, the transversatis fascia lies immediatety posterlor
to the rectus abdominis. Superior to the arcuate [ine,
the transversatis fascia lies immediatety posterior to
the posterior rectus sheath.
$ 7. lnfariorepigastricarteryr Arises from the external iliac
artery superior to the inguinal lígament and courses
superior§ in the transversatis fascia to run between the
posterior rectus sheath and rectus abdominis muscle
to anastomose with the superior epigastric artery
S A. Superiorepigastricartery: Direct continuation of the
interna[ thoracic artery coursing between the poste-
rior rectus sheath and the rectus abdominis muscte to
anastomose with the inferior epigastric artery
(l 9. lliohypúgastric newe; Termina[ superior branch of L1
anter¡or ramu§. Pierces transversus abdominis to course
between transversus abdominis and internal obtique
muscles and then pierces externa{obtique aponeuroses
of the inferior anterior abdominalwall
(11O. llioinguinal nerue (cut): Terminat inferior branch of
the L1 anterior ramus. Courses between transversus
abdominis and internatobtique musctes and then tra-
verses the inguinal canpl to emerge via the superficial
inguinatring.
 ABDOMEN

Rectusabdominis (cr0

7Sr costal cartllage

Arletra
r¡
ó
J- 1 :L"l;r' t_; ñ'
+'- u

Hprgnrtmem
$ uP*r*on

o Votnn de t rcc{o
Extemal oblique (cut sdqes) po*erior

:ó

i,t'- i. t"

slímo¡+rda

, Adt'ro Q*#rb*
s.-[ktvo hftq*r
rliohrpp*tito Rectus abdominis
(cul)

( -ir¿urtls
. ;:i'":l'ilr,
,-: ....r ,,t I i::it.
 .-..::.,-i:..:.]...':.i.:.,].....:.:

SUPERFICIAL |NGU|NAL REctON (MALE) I

,
.:1, ,.-,. .-,:, SUPERFICIAL INGUINAL REGION (MALE) ! "
The inguinal region extends from the Anteu§upüoL-üle§ enter and exit the abdominat cavity via the inguinal canal.
spine (eflilto the pubictuber-cle The inguinat canal is the obtique passageway conneeting the
Structures, such as the testis and spermatic cord in the abdominat cavity and perineum through thÁ inferior poition
male and the round ligament of the uterus in the female, of the anterotatárat muscutoaponuuroi. tayers.

" cotoR e ach af the following structures using a different color for each:
The externaloblíque aponeurosis is expansive in the inferior and bypassing the pubic tubercte. This ligament crosses
aspect CIf the anterior abdominaI wall and forms many of the the linea aláa and btends with fibers of the contratateral
structures of the inguinaI region: externaI obtique aponeurosis.

Q 1. lnguinatligament; lnferiormost fibers of the externai
obtique aponeurosis running from the ASlSto the pubic
tubercte. The inguinat canaI lies parattel and superior to
the medial hatf of the inguinal ligament.
() 2. l-acunartigament: Composed of fibers from the in-
guinal ligament that pass posteriorly to the superior
pubic ramus instead of attaching to the pubic tubercle.
Lacunar tigament forms the medial boundary of the
subinguinaI space. Some fibers wil[ continue lateraüy
atong the pecten pubis, forming the pectineat ligament
(of Cooper).
Q 3. Reffectedinguinalligament: Composed of fibers from
the inguinaltigarnent that pass superiorly, fanning upr,vard
Thesuperficialinauinalrinq is the exit point forthe spermatíc
cord/round ligament of uterus from the inguinaI cana[ located
superolateraI to the pubic tubercle. The ring appears as a split
in the externaI obtique aponeurosis and not as a prominent
"ring" structure.
Q 4. Lateraf crus." Forms the lateral margin of the superficial
inguinaI ring attachíng to the pubic tubercle
$ 5. Medialcrus; Forms the medíal margin of the superficial
inguinal r¡ng attaching to the pubic crest
Q 6. tntercruralfibers: Fibers that pass between each crus
across the superolateraI part of the superficia[ inguinat
ring to hetp prevent the crura from spreading apart
 supERFrcrAL rNcurNAr RrcrcN (MArE) r

€xbrnal oblique

Moriorsupcrior
iliac spine (ASl§)

Superfi cial inguinal ring

s $ilor nod'ol

Pubic ürbercle

lr
Pubic symBhysis
Pubic crest

(*la,r"rt¡
7

126 Abdomen SUPERFICIAL INGUINAL REGION (MALE) ll

I suPERFlclAL INGUINAL REGIoN {unu} tt

cut into
On the right side, a large rectangularwindow has been
the externil oblique muscle afd apaneurosis with the edges
pinned into ptace. The mediatand latera[ crura along with the

Q 1. tnguinalligament: Acts as a retinaculum over the subin- Q 7. Cremasfernruscle: Composed of slips of internal oblique
guinal space and its contents including the hip flexors, muscle fibers and is carried with the testis and sper-
inauinal lvmph nodgs, and fefiaral3fi94¿, velh, and matic cord as they descend through the internaloblique
nerve muscle. Forms the intermediate layer of the spermatic
2. Reflectedinguinalligament: Superiorfibers of the inguinal cord coverings
@
tigament that do not attach at the pubic tubercle and @ 8. Con¡o inttendan: Merged inferiormost aponeurotic fibers
instead pass upward to the linea alba and blend with of the internal obtique and transversus abdorninis su-
the contralateral externaI oblique aponeurosis peroposterior to the ref[ected inguinat Ligament' Fibers
3. Lateralcrus: External obtique aponeurosis fibers that from the internaI oblique forming the conjoint tendon
Q attach to the Pubic crest.
form the {aterat margin of the superficial inguinat ring
Q 4. Media I crus: External obtique aponeurosis fibers that Q 9. ttiohypogastricnerve: Pierces through the internaloblique
form the rnediat margin of the superficiaI inguinaI ring muscle and courses in an inferornedial direction
5. /nterc ruratfibers: Fibers from the external oblique apo- C10. ttioinguina! nerve.' Pierces through the internaI obtique
@ muscle and courses through the inguinaIcanat, emerging
neurosis that connect the medial and latera[ crura and
prevent thenr from splitting apart via the suPerficia[ inguinal ring

Q 6. lnternatobliguemuscle: Remains rnuscutar in the infe-

rior anterolateral abdominai watl (uniike the external
obtique)
 u. -Mrirtulo Obliruo
Anterior layer of r$tus sheath
lnfuurc

External oblique

'd

a ne¡don [nsunttr

i,.:,
z. uicnrrerrh ln qt^thol
' re{\e\odo '
Aponeur0sis of
extemal-oblique
s. FrbraÉ inttttvwfolu

d P,lqv lqterol
Femoral art€ry and vein
128 Abdomen DEEP TNGUTNAL REGION (UALE)
ffi DEEP INGUINAL REGtoN {nanr-r} r
The externalgáIrqueaponeurosis has been cut and the superficial
i ngui nal ring and cru ra d isrupt ed. The i nternal ablique m uscl,e
has been cut and reflected to reveal the under§íng transversus
abdo m i n is. T he i liohv poq a stri c and ili oi nq u i n a l_0 :'jrr¿És h av e
res u si ng a d iffe re nt
ffi coron ea ch of th e fo llowi ng structu
{) 1. Iransvercus abdaminis muscle: Fibers pass superior to
the deep inq!ínal rinq and do not participate in the
formation of the inguinal canal or the layers of the
spermatic cord
p 2. Iransversus abdaminis aponeurosis: Courses inferomed i-
alty to the inguinatcanal, participatíng in the formation
of the conjoint tendon
@ 3. Conjo int tandon : lnferiormost fibers of the transversus
abdom n is m e rge with the i ntarn al qbüg ue ¿pstrg ura§!!.
i
Fibers from the transversus abdominis attach to the
pectineattine.
$ 4. Iransversalisfascia: Named portion of endoabdomi-
nal fascia that lines the abdominal cavity. First layer
r
been cut as they traveted in the neurovascular ptane between
the internatobtique and transversus abdominis. The spermatic
cord has been retracted inferoiateratty with string.
color fo r e ach:
penetrated by the descending testes and spermatic
cord (or round ligament of uterus in the femate) during
embryonic devetopment and becomes evaginated. Forms
the deep inguinatring'internatty at the opening of the
evagination.
o 5, I nternal sperm atic fascia: Conti n uation of the transver-
satis fascia covering the testis and spermatic cord
e 6. lnferiorepigastricvessels: Course mediatto the deep
ingu i naI ring f rom/to externa I itiac artery/vein, respectivety
o 7 . Deepchcumflexr'liacvessels: Course paralletto the inguinal
ligament on the deep aspect of the anterior abdominal
wall f romlto external i liac artery/vein, respectively
 :it:;.t'il

PEEP INGuINAL REgtoN (MAIE).I" ABDOMEN I*S

a
rt.¡

, A[nnttrEous, abdu,sim*
*rqfi(v{rsl

lnternal oblique {cut and reflscted)

llioinguinal nerve

lntemaloblique
(cut and reillected)

Aponeurmis of
external obliqué
(cut)

Aponeurosi§ of
intsrnal obllque

i
1

Cremaster muscle
1l

Locaüon of deep inguinal ring

s etterl
$l$ef,itr,g§
s. + .. .; -
_ L, i',*¡ f;
r:,
{ iltl¡úh
"i. 1", . ;
 DEEP TNGUTNAL REGTON (MALE) ¡r
ffi DEEP TNCUTNAL REGToN (MALE) u
S i m i lar to Secti on 4.4A, the external obliq ue a pone u ro sis has
been cut and the superficial inguinal ring and crura disrupted.
The internal oblique muscle has been cut and reftected to
reveal the underlying transversus abdominis. The transversus
fu§"ioionááitaf iiálat¡;úni;itiiilliili'*ii;dlii;;;;;¿;üi.ili"áiiit)
§ 1. Iransversusabdominismuscle: Fibers pass superior to
the deep inquinal rinq and do not parlicipate in the
formation of the inguinal canal or the layers of the
spermatic cord
() 7. n f e ro med -
Tra nsve rs u s a b d o m i nis a po n e u rosis: Cou rses i i
ally to the inguinalcana[, participating in the formation
of the conjoint tendon
§ f. Conlo inttendan: lnferiormost fibers of transversus ab-
dominis merge with the internal oblique aponeurosis.
Fibers from the transversus abdominis attach to the
pectineattíne.
Q 4. Transversalisfascia: Named portion of the endoabdominal
fascia that lines the abdominal cavity and comprises
the deep inguinatring
5. Spermaticcord: Composed of the úeslicularyessels and
@ the,spermatic cord coverings, and exits vía fhe superficial inguinat ring
the dscts§4g&ts!§
Q 6. lnferiorepigastricvesseÍs: Course medialto the deep
inguinaI ring from/to external itiac artery/vein, respective§
@ 7. Deep chcumflex iliac yessels: Course paratlel to the inguinal
[igament on the deep aspect of the anterior abdominal
watt from/to externa[ iliac artery/vein, respectively
abdominis and transversatis fascia have been parliatty cut away,
revea ling extraperita¡rea{ fat and the external iLac ?rteryfl,Qs!
vgin. The spermatic cord has been cut and its components tied
together with string.
The external itiac artery and vein change names to the
femorala{tervandvein- as they pass deep to the inguinat
Iigament.
,Abdorninal wall hernias are one of the most common surgical problems,
with almost 75% orcurring in the inguinat region. Of alt inguinat hernia
tepairt;90% ate perforrned in men. Two types of inguinal hernias exist:
indlre'ct and.direct, lndirect hernias account for two-thirds of inguinat
hern¡as ¿nd'are common in younger per,§ons, especial§ in men. An indi-
reet herñia tr:avels through lhe deep inqainll riltq (tateral to the inferior
epiqaj-tileve!¡glsl and then to the inguinat canal, where it is covered by
insJderthe,sper,matic cord. Direct hernias are l¿ss common and typicalty
occur in,adult men because of a weakness in the anterior abdorninalwatl
in the inguinai region" A direct hernia travets media[ to inferiar epigastric
vesseis:th¡ough the parietal peritoneum ard transversalis fascia to enter
through e¡ near the distat inguinal canal, and exits via the superficial
inguina[ ring lateral to the spermatic cord.
 DEEP TNGU|NAL REGTON (MALE) il ABDOMEN 131

t-lrÍ*¿.t^ ^Ltl"*.i¡vrl
ffciffrfrf#

-l á
'
Testicularvessels
ls. Lr¡*g}*sr
.§

J c"sperryi&m
,Ductusdeferens

Locaüon of deep inguinal ring

lnternal obl¡que
(cut and reflected)

Aponeurosls of
extemal obrlique

r&*ts lHo",
@ Extemal iliac artery

Eñemal iliac vein

Femoral artery and vein

-Itndot'
fo$rr,\r0

E*rs:t
ilarúio
i" r'-a't l
 : :1:

!t.,,

1$ ' Abdomen FEMALE INGUINAL REGION

TEMAI,E }NGUINAI. R§GIO}I

SimiLar to the mate, the female inguinat region extends from the inguinat structures are tess pronounced than those in the
the A§15 to the pubictubercle. The structures and retation- mate. ln addition, the round ligament of the uterus traver§es
ship of the femate anterotateral abdominat watt and inguinal the inguinat canal instead of the testis and spermatic cord.
region are similar to those of the mate, with the exception that

COLORtlach of ih¿ following struúures uslng a dlfferent color for each:

6 1. Fatty layerof subcutaneoustissue: lmmediatety deep | 5. Roun d ligamentof uüerus: Traverses the ¡nguína[ canal
to skin from the deep inguinat ring to the superficiat inguinal
2. MembranouslayerofsubcutanaossÚissue; Deep to fatty ring fans out to insert into the lablum maius
)-
layer and superficial to externatobtique aponeurosis in
the inguinatregíon
*
Q 3. Lateralcrus: External obtique aponeurosis fibers forming
latera[ boundary of superfidalinquinalring
J 4. Madiaf crus; Externaloblique aponeurosis fibers forming
medial boundary of superficial inguinal ring
@ 5. lntercrura I fibers: External obtique aponeurosis fibers
crossing from one crus to the other

.i!," .::' i :1¡:-];'i,i:ii'1, Ír.li-¡.,,,i:,i". i:".r ;.-l I :i.-i|:l,i':'r,.i lrir ]li':i:! -li ¡:
 FEMALE INGUINAL REGION ABDOMEN

Antsrior süperior ¡liac spine (ASIS)

Corrr rrwrr{frmrnw
I &t'q*l tuktilí?to
I
li
Superficial inguinal ring

Pubic lubercle

Site of ¡nguinal l¡gament

, Wtár to*srd Labium malus

¿ Pilov l&dial

"tuo
(l'¿urt-i
,.i -
i-. *, ,l i; it;:': i. i:-. l' 'r'-1 "'
I34 Abdomen SPERMATIC CORD AND TESTES
,,,-.'..,'.'..'' . '1 ., SPERMATIC CORD AND TESTES
Figure A depicts the inguinat region, spermatic cord, and testes.
On the right, the aponeurosis af the eñernal oblique has been
cut to reveal the bternal abliqlte and conjoj!.LÍeaglg8. On
the [eft, the external oblique and internatoblique have been
cO¿on áac h of the fo'tlowiig struciiuret using a different color for each:
Coverings of the Testes and Spermatic Cord
@ 1. lnternalspermaticfascia: Forms as the testis and sper-
matic cord descended through the transversalis fascia
of the anterolateraI abdominatwat[. Covers the extent
of the testis, epididymis, and spermatic cord.
$ 2. Cremastericmuscleandfascia: Forms as the testis and
spermatic cord descended through the interna[obtique
muscle and muscte. Covers the extent of the testis, ep-
ididymis, and spermatic cord superficiatto the internaI
spermatic fascia.
@ 3. Éxternatspermaticfascia: Forms as the testis and
spermatic cord descended through the superficia[ ring
of the externaI obtique aponeurosis. Covers the extent
of the testis, epididymis, and spermatic cord superficial
to the cremaster muscle and fascia"
During the descent of the testis, a portion of the peritoneat
cavity is putted inferiorly with the testis. The connection to the
peritoneal cavity regresses and a separate, closed sac is left
surrounding the testis.
Q 4. Parietal.layeroftunicavaginafis: Eeep to the internal
spermatic fascia at the [eve[ of the testis and inferior
spermatic cord
@ 5. Visce ral layer of tunica vaginalis: Covers the surface of the
testís, except where the testis attaches to the epididymis
and spermatic cord and a portion of the epididymis
cut to expose the fransversusalbafo4[]lt.{§ and fjaq§,ygfsalis
fascia along with the layers of the spermatic cord,
Figure B depicts the internal structures of the testis with
the epididymis and ductus deferens.
@ 6. Cavity of tunica vaginalis; Potential space between the
parietaI and visceral layers of tunica vaginalis typicatty
fitled with a smal[ amount of ftuid to atlow the testis
to move freety in the scrotum
Testes and Epididymis
Q 7. Tunica albuginea: Tough, fibrous outer surface of the
testes
Q 8. Serniniferaustubules; Loqg, highly coiled small tubes
arranged into lobules comprising a majority of the in-
ternat structure of the testes. Developing sPerm travel
along the seminiferous tubutes to the straight tubutes.
Q 9. Refe festis; Cottection of canals from the straight tubutes
in the mediastinum of the testis
@10. Efferent duct¿¡les: Transport newty devetoped sperm
to the epididymis from the rete testis
(}11" Head af epididymis: Superior expanded portion rest-
ing on the superior pole of the testis that receives the
efferent ductuies
@"12. Bodyof epididymis; Main component of the tightty
coiled duct of the epididymis
e)13. Tail af epididymís; Tapering continuation of the duct
of the epididymis leading to ductus deferens
Q14" Duefus deferens: Duct of the spermatic cord that trans-
ports sperm from the epididymis to the ejaculatory duct
Apon6ur0§¡s 0f exbrnal 0blique (cut)

lntemal oblique
(refl€ctcd)

Transversus
aMomini§

Transvorsalis
fascia

(hrcr
+. Frri¿{nl de lo
7r, {úniu vogino\

u V¡sr ¿rql tavtr of

tuntccr vogtncrliS
ir, f obezO drel epidrcttwno

/. Fosc{o Y w{r¡rr.^}o o«uastCrico

Q+d "l¡tlirtrlor
Cnvi¿l.'A dc ln lrínirn \,oqt,\ot

+. Cnpo ?üvislc'l de lq {dhllm Vogihcrl

\li rrurnl lnvf* aF
4tinfto vogtnütu !
-Iúbr rlnS s¿r¡f níF+ rClS

i i¡a¡rt
136 Abdomen TNTERNAL AspEcr eF ANTERoLATERAL ABDoM¡NAL wALL
INTERNAL ASPECT OF ANTEROLATERAL ABDOMINAL WALL
The anterolateral abdominal wall has been removed and the
internatáspect disptayed. On the left side of the specimen, the
layers of the anterotaterat abdominal wa[[ from superflcial to
deep are visibte in the cut edges: extqrltalobligue, int?lna!
o b liq u e, tr? nsve fsus a \dS mi n i s, tra nsv e rsa l! s
fasci a, and
íQLOR each of the fotlowíng structures usiing a different color for each:
Q 1. Parietalperitoneurr: Lies deep (internat)to the trans-
versatis fascia
@ Z. Falr{ormligamentr Double layer of peritoneum coursing
from the liver to the parietaI peritoneum, covering the
anterior abdominaI wa[[
Q 3. Roundligamentof the fiver: EmbryoLogicat remnant
of the umbitical vein coursing in the inferior free edge
of the falciform ligament from the umbilicus to the
liver
Along the internal aspect, three structures course from
the inferior antero[ateral abdominat wal[ toward the umbilicus:
@ 4. I nfe rior epigastric vessels; Most lateral structures
() 5" Umbilicalartery: Lies medialto the inferior epigastric
vessels and is typicatty obliterated as it travels along
the anterior abdominaI wall
The urachus is an embryotogical remnant that lies in the
midline, traveling superiorly frorn the urinarv bladder.
As the parietal peritoneum falls over structures on the
deep aspect of the anterolateral abdominat watt, three rídges
and three depressions form:
@6. laferaf srnbilicalfatd: Forms as the parietal peritoneum
lies over the inferior epigastric vessels on each side
LaíSrplíqqqilalf'pSsa lies lateralto the lateral um-
bilica[ ligament.
07. Medial umbilicalfold: Forms as the parietal peritoneum
lies over the umbilical artery on each side
Medlal inquinal fqsSA lies between the lateral and
medial umbiiica[ ligaments.
parietal peritoneum. On the right side of the specimen, the
parietai peritoneum has been removed and a verticatct¡t made
in the tfa[sversalis fascia deep to the rectus abdominis to
reveal the arcuate line.
@8. Medían umbílicalfold: Forms as parietatperitoneum
lies over the urachus
Supravesicalfossa [ies between the mediatand median
umbiticaL Iigaments.
() 9. Transversalrifascia; Lies superficia[ to the parietal
peritoneum and imrnediateiy deep to the muscles of
the anterolateral abdominal wa[t.
Forms the deep iflquinal rinqas the structures of the
spermatic cord descend through-the inguinal region:
C10. Iestrcularyessels
C'11. Ductus deferens
$lZ. tliapubictract: lnferiormost thickening of the fibers of
the transversatis fascia running parallel and deep to the
ingrrinalligament
() 13. Deep cí rcu mf lex i liac yessels: Pa ra llel th e cou rse of the
iliopubic tract on the deep aspect cf the antero{ateral
abdominatwa[[
$ 1 4. Recúu s abdom i nis muscle : nferior one-thi rd is directty
I
covered by transversaIis fascia posteriorty
Q15. Posteriorrectussheatfr: Directly retated to the posterior
aspect of the superior two-thirds oi the rectus abdominis
muscIe
Q16. Arcuate line: lnferior margin of the posterior rectus
sheath
 ABDOMEN

tjn.¡lr, ndondo
Fqici Forrüe ¿ál
- híh#
r, uBpnragm
n. Fon*Ésr 4bfrs*r¡E

Umb¡licus

Extemaloblhue
{cut edge) rs.Ldnriner pos{
lntemalobllque
(out €dg6) úta,t r¿dú
Transversus abdominis
(cut e{rge) ro tirtq e¡$lt*
Transversalis fascia
{eut edge)

r¿. t,{ trerk tL:!

ütrr*.elrr{¡i
4.

Lateñl inguinal
fossá

unnh*ticn.[ lnhwd oeep inguinal dng

Medial ingt¡inalfosa

,o )hqor terltr,rhrs

Supravesical fossa

Urinary bladder

, Conilurlo &ferenlr

{ iitu ¡t,i
..lrt-':i"
138 Abdomen PIRITCNEAL CAVITY
Íhe antqrylatsralabdominal and anterior thoracic wa[s have
been removed to revealthe contents of the abdominaI cavity.
Erte rn a I ob liq ue, i nte rn a I a b li q ue, tra nsye rsus a bd o m i n is,
and reglg§abcloryinis musc[es are visible atong the cut edges.
The periloneum is a continuous serous membrane that
consists of two layers: parietal peritoneum [ining the internal
aspect of the abdominopelvic cavity and visceral peritoneum
CO{.OR eac h af the following strustures using
() 1. Diaphragm: Separates the abdominal and thoracic
cavities. Superior§ covered by diaphragmatic pteura
except where it is pierced by the inferiarvqla c,aya
and related to the paricardialsac. lnferioriy lined by
peritoneum except at the bare area of the liver where
the peritoneum reflects away from the diaphragm.
Peritoneat Organs
" lntraperitoneal organs invaginated into the peritoneal
cavity during ernbryonic development and are atmost
completely covered with visceral peritoneum in the adu[t.
The first iayer pierced by a pin on an intraperitoneal organ
is the visceraI peritoneum. lntraperitoneaI organs include
the liver, spleen, very proximaland distal duodenum, taiI
of the pancreas, jejunun'1, ileum, cecum, appendix, trans-
verse colon, and sigmoid colon. Two other intraperitoneat
organs are the:
o
()
2. Stomach
3. Gallbladder
. Retroperitoneal organs are located posterior to the peri-
toneal cevity and have the parietal peritoneum covering
their anterior surfaces. Retrcperitoneat organs include the
kidneys, suprarenal gtands, Lireters, and the continuation
of the descendinq aorta and inferior vena cava inferior
to the diaphragm.
. Secondarily retroperitoneal organs invaginated into the
peritonealcavity in the developing embryo, but were then
pushed back to the posterior wat[ because of the developing
gut and the peritoneaI tayers fused. Secondari[y retroperi-
toneal srgans inctude most of the duodenum, most of the
pancreas (except the taii), ascending colon, and descending
colon. Subperitoneal organs are tocated inferion to the
investing certa¡n abdominal viscera. ParietaI peritoneum not
on§ [ines the internal aspect of the anterolateral abdominal
walt (deep to the endoabdominal fascia) but also [ines the
inferior surface of the diaphragm and the anterior or superior
surfaces of the abdominopelvic structures not located within the
peritoneaI cavity (retroperitoneal and subperitoneaI structures),
a different color for each:
peritoneaI cavity and are covered by parietat peritoneum
on their superior surfaces. Subperitoneal organs include
the urinary bladder, uterus, and rectum.
Peritoneal Structures
With multiple organs in one peritoneatcavity, multiple perito-
neaI connections and structures are created within the cavit;v:
. Mesentery: Double layer of peritoneum that connects an
intraperitoneaI organ to the body watl
. Omentum: Doubte tayer uf peritoneum that eonnects the
stomach and pi"oximal duodenum to an adjacent organ
' The greater omentum runs from the greater curvature of
the stomach and proximalduodenum to the diaphragm,
spleen, and transverse colon.
@4. Casfrocolic ligament: Primary component of the
greater omentum that descends like an apron over
the smalt intestine, and then folds back tc attach to
the transverse coton and its mesentery creating a
four-layered peritoneaIstructure. tat is typically de-
posiied within the layers of the gastrocolic ligament.
@5. Gastrosplenicligamenf: Connects the greater curva-
ture of the stomach io the hilum of the spleen; smaller
component of greater omentum
. Ligament: Doub[e layer of peritoneum that connects an
organ to another organ or body watl
() 6. Falcifarm ligament: Courses from the anterior
abdominal watl to the liver dividing the liver into
the following:
() 7. Righttobe
() 8. Lefttabe
@ 9. ñound ligament of tiver $ígamentum teres):
Embryoiogicat remnant of the umbiiical vein (not
composed of parietal peritoneum) located in the
free edge cf the falciform iigament
 De6cending (üioracic) aorta

ulhrn*,h
-
Inftrior vena eava Peficardial sac
' fi¡tciFrrrl
' útulo
hq'

\ innrw, ro
3aíhoetárra

¿. Limrvrr{m
"gstroOio

Antsrolablal
abdominal wafl:

Extemal oblique

ffiemal obliquo

Transvsrsus abdominie

Bectus abdomini§

{ }l'¿¡rrt^\
i. i,;ii'ii-illi
- i: ii-.,.
'.-: !i ii.,. -"r:.1!li
r:,..\ t'.r :-¡
: il: i:tr ::ll:i