Dr.

Ágoston Szél
Abdominal wall, rectus-sheath,
subinguinal opening, inguinal canal,
femoral and adductor canals

Department of Anatomy,
Histology and Embryology
Semmelweis University
November, 2019
The abdominal
wall
 External abdominal oblique muscle

Origin: 5-12. ribs

Insertion: iliac crest,

linea alba, inguinal lig.,
pubic tubercle.
 Internal abdominal oblique muscle

Origin: iliac crest,

thoracolumbar
fascia, inguinal lig.

Insertion: 9-12. ribs,

linea alba.
 Transverse abdominal muscle

Origin: 6 lower ribs,

thoracolumbar fascia,
proc. costarius, iliac
crest, inguinal lig.

Insertion: linea alba.

 Rectus abdominal muscle

Origin: 5-7. ribs,

xyphoid process.

Insertion: iliac crest,

symphysis, linea
alba.

Pyramidal
muscle
 Structure of the abdominal wall, rectus sheath
Skin Superficial fascia
Pectoralis major muscle
Rectus abd.
Aponeurosis of ext.
abd. obl.

Xyphoid process Intercostal muscles

Rectus abd.
Ext. abd. obl.

Linea alba Int. abd. obl.

Transv. abd.

Extraperitoneal fat Transversalis fascia

Peritoneum

Ext. abd. obl.

Int. abd. obl.
Transv. abd.

7
Transversalis fascia
Ext. abd. Broad abdominal muscles
obl.

Int. abd.
obl.

Iliac crest
Inguinal lig.
Lumbar

(v)
fascia
Inguinal lig. Transv.
(v) abd.
Lumbar
fascia
Pubic tubercle

Inguinal lig.
8
 Structure of Wall of Trunk

Layers of thoracic wall Layers of abdominal wall

Skin Skin
Subcutaneous adipose tissue Subcutaneous adipose tissue

Serratus anterior, etc. (Rectus abdominis)

External thoracic fascia – Superficial abdominal fascia

Periosteum of ribs

9
 Structure of Wall of Trunk

External intercostal External abdominal oblique

(V-shaped) (V-shaped)
(Anterior intercostal membrane) (Aponeurosis)

Internal intertercostal Internal abdominal oblique

(A-shaped) (A-shaped)
(Posterior intercostal membrane)

Space of vessels and nerves Space of vessels and nerves

10
 Structure of Wall of Trunk

Transversus thoracis Tranversus abdominis

(horizontal) (horizontal)

Endothoracic fascia Transversalis fascia

Parietal pleura Parietal peritoneum

Pleural cavity Peritoneal cavity

Pulmonary pleura Visceral peritoneum

Lung Visceral wall

11
 Structure of abdominal wall
Linea alba

Xyphoid process
Skin
Transv.
abd. m.
Fascia abd. spf. Apo. of obl.
Arcuate int. abd. m.
line Intersections
Apo. of obl. Apo. of transv.
Inf. epigastric Fascia
ext. abd. m. abd. m.
artery transv.
Conjoint Fascia transv.
Rectus abd. m.
tendon Arcuate line
Adipose tissue
Funiculus
spermaticus Peritoneum

Symphysis

12
Inguinal ligament. The
anatomical basis of
herniation
Exits of the pelvis
Greater sciatic foramen Sacrotuberal ligament
Inguinal ligament Sacrospinal ligament

Obturator canal*

Obturator membrane
Lesser sciatic foramen
Subinguinal opening*

14
 Exits and openings of pelvis
intervertebral foramen
L5

lumbosacral joint

sacrum
iliac crest
iliac fossa

ant. sup. iliac spine

sacroiliac joint

INGUINAL LIGAMENT
1. subinguinal opening
ant. inf. iliac spine
2. greater sciatic foramen
arcuate line
linea terminalis SACROSPINOUS LIGAMENT

pecten of pubic bone

coccygeal bone

pubic tubercle 3. lesser sciatic foramen

SACROTUBEROUS LIGAMENT
symphyseal surface 5. inferior pelvic aperture
4. obturator foramen
15
Openings and muscular components of pelvis

intervertebral foramen
iliacus
psoas maj. & min.

suprapiriform opening
2. greater sciatic foramen

1. subinguinal opening piriformis

muscular and nervous, infrapiriform opening
lacunae, vascular lacuna, ischiococcygeus
lymphatic lacuna
4. obturator foramen
3. lesser sciatic foramen
4a. obturator canal
int. obturator
tendinous arch 5. inferior pelvic aperture

(levator ani
removed) gluteus max.

16
 Subinguinal opening
Iliopectineal arch
Inguinal lig.
Muscular lacuna

N. cut. fem. lat.

Lymphatic (hernial)
M. iliopsoas lacuna
Femoral nerve Lymphatic
vessels and node
(Femoral ring)

Vascular lacuna
*Lacunar lig.
Genitofemoral nerve
of Gimbernat
Femoral a. & v.
M. pectineus

*Ext. abd. obl. m.

 Inguinal canal
Skin Peritoneum
Ext. abd. obl. m.
(aponeurosis) Transversalis fascia

Transv. abd. m.
Int. abd. obl. m.
Femoral septum

Inguinal canal Iliac fascia

Inguinal ligament M. iliopsoas

Lymph node Femoral vein

Cribriform fascia Superior ramus

of pubic bone
Great saphenous vein,
saphenous opening Pectineal fascia

Fascia lata M. pectineus

 Inguinal canal
Internal abdominal
oblique muscle
Transverse
abdominal muscle
Superficial Parietal
abdominal fascia peritoneum
External abdominal Transversalis fascia
oblique muscle
(aponeurosis) Subserosa
Ilioinguinal nerve Pectineal ligament
(Cooper)
Spermatic cord Lacunar ligament
Superior ramus of
Inguinal ligament
os pubis
(Poupart)

M. pectineus
Fascia lata
 Horizontal section of the abdominal wall

Median umbilical Medial umbilical fold

fold (urachus) (umbilical artery)
Lateral umbilical fold
(epigastric artery) Transversalis fascia

Transv. abd. m.

Lat. inguinal fossa Int. abd. obl. m.

Supravesical Ext. abd. obl. m.

Rectus abd. m.
Med. inguinal fossa fossa
(Hesselbach)
Abdominal layers building the inguinal
region
Lat. inguinal fossa Med. inguinal fossa (Hesselbach)

A. Peritoneum

Median
Anterior superior umbilical
iliac spine fold
(urachus)
Lateral umbilical
fold (epigastric a.)
M. iliopsoas
Inguinal lig.
Medial umbilical Supravesical
fold (umb. artery) fossa
Subinguinal opening
Pubic
M. pectineus tubercle
Abdominal layers building the inguinal
region Inf. epigastric a. Trigone of Hesselbach

B. Transversalis fascia
fascia transversalis

Linea
alba

Ant. sup. Rectus

iliac spine abd. m.

Deep inguinal ring

Line of
Spiegel
M. iliopsoas

Inguinal ligament

Subinguinal opening
Pubic
M. pectineus Lacunar lig. tubercle
(Gimbernat)
Abdominal layers building the inguinal
region
C. Int.
m. abd. obl.abd.
obl. int. m.

Lower
edges of
Int. abd.
obl. &
Transv.
abd.
muscles
Transv. abd. m.

Transversalis fascia

Conjoined
tendon

Pectineal fascia Lacunar

ligament
Abdominal layers building the inguinal
region
Rectus
Ext. abd. obl. m.
D. abd. m.

Superior
crus

Superficial
ing. ring. In
the depth:
transv. &
Inguinal lig. int. abd.
obl. m.
(conjoined
tendon)

Intercrural fibers Reflected

ligament
Lacunar
Inferior crus ligament
Deep inguinal Slit between lower Slit between lower Superficial inguinal
ring (hole on edge of transv. abd. edge of int. abd. ring (hole on apo. of
trasversalis m. and inguinal lig. obl. m. inguinal lig. ext. abd. obl.)
fascia)

A B C D
Inguinal canal in four paramedian sagittal
sections
Iliac
fascia Transversalis fascia
Ext. abd. obl. m. Transverse abd. m.
Int. abd. obl. m.
Inguinal canal *
Femoral
Fascia lata B artery
M. ilio-
A
psoas
M. pectineus

Femoral
Femoral vein septum Conjoined
tendon
C * *
Cribriform fascia Superior ramus
D of pubic bone
Great saphenous vein
Fascia lata
Inguinal canal and subinguinal opening
 Large inguinal hernia

Incarcerated abdominal hernia

(obstruction or strangulation)
 Direct and indirect inguinal hernia

Ext. abd. obl. m.

Int. abd. obl. m.

Transv. abd. m.
Deep inguinal ring
(lateral inguinal Transversalis
fossa) fascia

Superficial Medial inguinal

inguinal ring fossa
(medial inguinal Preformed opening
fossa) Lig. inguinale
(indirect hernia)

Pressed against the

abdominal wall
(direct hernia)
 Inguinal and femoral hernia
Inguinal ligament

Musculus iliacus Inferior epigastric a. & v.

Deep inguinal ring
Femoral nerve
Superficial inguinal ring
Femoral artery
Femoral vein
Pubic tubercle
Sac of femoral
hernia

Sac of inguinal
(indirect) hernia
 Direct and indirect inguinal hernia
Medial inguinal fossa Lateral inguinal fossa

Superficial inguinal ring Deep and superficial inguinal ring

(acquired) (inherited or acquired)
 „P Con
eri jo
ton ine
ea d te
lc
av ndon
ity Peritoneum
”

Inf. epigastric
vessels

Testis
Deep
ing. ring

Superficial
Extraperi-

inguinal ring
toneal fat

Co
njo
ine
d ten
do
n
Peritoneum
Extraperi-
toneal fat
Inf. epigastric
Testis
Direct and indirect inguinal hernia

vessels

Depp
Superficial
inguinal ring

ing. ring
„peritoneal cavity”
 Femoral and
adductor canal
 Femoral canal
Femoralis nerve

Iliopsoas
muscle

Ant. sup. iliac

spine Iliopectineal arch
Iliac fascia
Lymph node
Inguinal lig.
Femoral canal
Femoral artery Pectineal ligament
Femoral vein Femoral ring
Lacunar ligament
Fascia lata
Fascia lata
Femoral sheath
Lymphatic vessel
Saphenous opening
Great saphenus vein
Saphenous opening: exit of femoral canal

Inguinal lig. Ext. abd. obl. m.

(aponeurosis)
Fascia lata Medial crus
(lamina libera) Intercrural fibers
Superior horn Lig. reflexum
Lateral crus
Lymph node
Iliopsoic fascia Pectineal fascia
Iliopectineal fascia
Falciform margin

Inferior horn Femoral a. & v.

Fascia lata
Fascia lata (M.
(M. sartorius)
adductor longus)
 Femoral sheath, femoral canal

Femoral artery
Femoral vein
Femoral canal
Genitofemoral
nerve (femoral Lymph node
branch) (Cloquet/Rosenmüller)

Femoral sheath
(derivative of
transversalis
fascia)
Adductor canal, femoral and popliteal vessels

Femoral vein
Femoral Superficial
sheath femoral ring
Femoral Femoral canal,
artery lymph node

Adductor canal

Popliteal
Popliteal artery
vein

Hiatus adductorius
 Adductor canal, cross section of thigh

M. rectus femoris

M. vastus intermedius
M. sartorius

Adductor canal M. vastus medialis

M. adductor longus
M. vastus lateralis
M. gracilis

M. semimembranosus M. biceps femoris

M. semitendinosus
 Entrance and exit of
adductor canal: femoral
trigone and hiatus
Inguinal lig.
Symphysis
adductorius
Femoral trigone
M. pectineus
M. adductor longus
M. gracilis
M. adductor magnus
M. sartorius
M. adductor Femorale
magnus trigone
(flesh) Hiatus adductorius
(tendineus)

M. adductor
Adductor
magnus (tendon)
canal
Dangerous anastomosis („corona mortis”
or ”crown of death”)

Internal iliac artery

External iliac artery Pubic branch

(corona mortis)
Obturator branch
(Corona mortis)

Obturator
artery

Inf. epigastric
artery
Pubic branch
 Femoral canal
Virtual canal in the medial part of iliopectineal fossa (does not exist in
healthy individuals, only allows for its distension in case of increased
venous return of femoral vein).
Content: connective tissue, lymphatic vessels and nodes.
Femoral nerve, artery and vein do not take their course in it.

Clinical significance: Potential canal for herniation (femoral hernia).

Shape: inverted pyramid (cone-shaped). Length: 1-2 cm.

Entrance: femoral ring (lymphatic or hernial – lacuna), subinguinal opening

Femoral septum (part of transversalis fascia) closes it towards the
peritoneal cavity.
Exit: saphenous opening (fascia lata, cribriform fascia)

Borders:
Superior: Inguinal ligament, Anterior: fascia lata (cribriform fascia)
Posterior: M. pectineus, pectineal fascia
Lateral: Femoral vein, Medial: Lacunar ligament
 Adductor canal

Nerve-vessel canal (subsartorial canal, Hunter’s canal)

Leads from iliopectineal fossa (femoral trigone) into popliteal fossa.
Shape: conical, 15 cm in length.

Femoral trigone: inguinal lig. (above), m. adductor longus (med.), m.

sartorius (lat.)

Content: femoral artery & vein, branch of femoral nerve (saphenous

nerve). At the exit: popliteal artery & vein

Entrance: apex of femoral trigone

Exit: hiatus adductorius (tendineus)

Borders:
Anterior: M. sartorius, M. vastus medialis, vastoadductor membrane
Posterior: M. adductor longus et magnus
Lateral: M. sartorius, M. vastus medialis
Medial: M. adductor longus, M. adductor magnus
 Bibliography
• Drake: Gray’s Anatomy for Students, Churchill Livingstone,
Elsevier, 2009
• Lippert H: Lehrbuch Anatomie, Urban & Fischer, München, 2000
• Mac Kinnon P, Morris J: Oxford Lehrbuch der klinischen Anatomie,
Hans Huber, Bern, 1997
• Moore KL, Dalley AF: Clinically Oriented Anatomy, Lippincott, 1999
• Putz R, Pabst R: Sobotta. Alliter, Budapest, 2004.
• Patel R: Applied Peritoneal Anatomy, www.myESRorg.
• Renz-Polster H, Krautzig S, Braun J: Innere Medizin, Urban &
Fischer, München, 2004
• Snell RS, Clinical Anatomy, Little, Brown & Co, Boston, 1995
• Tirkes T et al: Peritoneal Anatomy. Gastrointestinal Imaging,
https://doi.org/10.1148/rg.322115032.
• https://www.kenhub.com/en/start/anatomy.
Inguinal canal and subinguinal opening
 Inguinal canal
superior: Int. abd. oblique, anterior: Ext. abd. oblique
transverse abd. (aponeurosis)

inferior: Inguinal posterior:

ligament Transversalis fascia
Content: Ilioinguinal nerve,
spermatic cord, round ligament of
uterus
 Ext. abd. obl. m.
Layers of the abdominal Int. abd. obl. m.
wall Transv. abd. m.
Transversalis fascia
Peritoneum
 Superficial fascia of abdominal wall: (adipose
fascia) and connective tissue (fascia fibrosa)

Int. abd. obl. (apo.)

Superficial fascia
Fibrous fascia
(Scarpa)
Adipose fascia
Line of unification (Camper)

Penis
Fascia lata

Scrotum Spermatic cord

 Structure of lower abdominal fasciae

*Adipose fascia Perineal

(Camper) Symphysis membrane

*Fibrous fascia
(Scarpa)
urethra

Superficial
perineal fascia
(Colles)

Tunica dartos

*Superficial fascia
 Position of abdominal muscles in
mantaining the loop-system of
the skeletal muscles

Rhomboideus
Serratus ant.
Pectoralis major
Int. abd. obl. m.
Gluteus maximus
Ext. abd. obl. m.
Adductors
Sartorius

49
 Functions of the abdominal muscles

Movements of the trunk

Bending of the trunk (forwards, sideways), rotation of the
trunk – in collaboration with the muscles of the back.
Stiffening the abdominal wall
Fixation of internal organs in position – according to the
variation of the content of the stomach, urinary bladder
and bowels.
Breathing
Diaphragm + abdominal muscles.
Maintaining the abdominal pressure
Expiration, urination, defecation, coughing, sneezing,
vomiting, exertion of high muscular force, birth.
50
Maintenance of the intraabdominal
pressure

thoracic
diaphragm

abdominal wall
pelvic
diaphragm
51
Maintenance of the intraabdominal pressure
thoracic diaphragm

abdominal wall
pelvic diaphragm

52
 Inguinal canal
Transv. abd. m.

Int. abd. obl. m. Peritoneum

Ext. abd. obl. m. Transversalis fascia

Inguinal ligament
Femoral artery

Femoral vein
Spermatic cord
 Internal iliac artery

common iliac
internal iliac
uterine
umbilical iliolumbal
(sup. vesical) superior gluteal

external iliac lateral sacral

inferior gluteal
internal pudendal
obturator
middle rectal
inf. vesical
54
 Internal pudendal artery

internal pudendal (greater

sciatic foramen)
common iliac
lateral sacral laterales
internal iliac (pelvic sacral foramens)
external iliac

femoral
internal pudendal (lesser
external pudendal sciatic foramen)
dorsal penile
(subarcuate hiatus)
inf. rectal
deep penile (uro- a. of bulb of penis
genital diaphragm) perineal
post. scrotal
ant. scrotal
55
 Rectus-sheath

Rectus abdominis
muscle

Broad Inferior epigastric

abdominal A&V
muscles

Urinary bladder

Vagina

External iliac
artery

Rectum