Surgical anatomy of Anterior abdominal wall

by Wichien Sirithanaphol

Anterior abdominal wall

Anterolateral part
External oblique muscle Internal oblique muscle Transverse abdominis muscle

Middle part (or midline)

Rectus abdominis muscle Pyramidal muscle Rectus sheath

External Oblique Muscle

Origin : inferior border of lower 8th rib Insertion : linea alba , iliac crest , ASIS Fibers pass inferiorly and medially " Hands in the front pockets " The external oblique fascia
Innominate Fascia of Gallaudet Inguinal ligament spermatic cord : external spermatic fascia

External oblique m.

Aponeurosis of external oblique

Internal Oblique Muscle

Origin : thoracolumbar fascia and the iliac crest Insertion : Lower border of ribs 9-12 , linea alba Fiber pass upward and medially " Hands in the back pockets " The lowest fibers arch
spermatic cord or round ligament : cremasteric layer

Internal oblique m.

Cremaster m.

Transversus Abdominis Muscle

Origin : Iliac crest , thoracolumbar fascia , lower ribs Insertion : linea alba , pecten pubis The deepest of the three flat anterior abdominal muscles Fibers pass medially Transversalis fascia Extraperitoneal fat

Transversus Abdominis m.

Transversalis fascia

Transversalis fascia Transversus abdominis aponeurosis Rectus abdominis m.

Inferior fiber of internal oblique

Pyramidalis m.

Lateral border of rectus

Rectus Abdominis muscle

Origin : pubis and pubic symphysis Insertion : Cartilages of ribs 5-7th , xiphoid process 3 tendinous lines
the xiphoid process the umbilicus halfway between these points

Pyramidalis muscle
inserts into the linea alba 3-4 cm above pubic creast its insertion into the linea alba : landmark for an accurate midline incision

Tendinous line

Linea semicircularis

Rectus sheath
Anterior rectus sheath Posterior rectus sheath The semicircular line of Douglas (linea semilunalis)

A above arcuate line

B below arcuate line

Umbilical Area
A midline fusion of the medial borders of both rectus abdominis aponeurosis around the umbilical cord This fusion may take place around the 10th week Structures associated with the Umbilical Cord and Umbilicus umbilical vein

round ligament of the liver 2 umbilical arteries medial umbilical ligaments Urachus median umbilical ligament

Falciform lig Umbilical v.

Umbilical a.

Umbilical a & v.

Round ligament (obliterated umbilical v.)

Median umbilical ligament Medial umbilical ligament (obliterated umbilical a.) (obliterated urachus)

Artery of the Anterior Abdominal Wall

Superior epigastric artery (internal thorasic artery) Inferior epigastric artery (ext.illiac artery) Deep circumflex illiac artery (ext.illiac artery) 3 branches of Femoral artery superficial circumflex iliac artery superficial epigastric artery superficial external pudendal artery

Superior epigastric a. External oblique perforators

Deep circumflex iliac a. Inferior epigastric a. Superficial circumflex iliac a. Superficial inferior epigastric a.

Superficial circumflexiliac a.

Superficial inferior epigastric a. superficial external pudendal artery

Lymphatic of anterior abdominal wall

Nerve Supply to the Anterior Abdominal Wall

Intercostal n. Subcostal n. Iliohypogastric n. Ilioinguinal n.

A: Seventh to twelfth thoracic n.

B: First lumbar n.

Surgical anatomy of Posterior abdominal wall

Posterior abdominal wall

Lumbar vertebrae Paravertebral gutters
Psoas major Quadratus lumborum Iliacus Erectoe spinae

Fascia of posterior abdominal wall

Thoracolumbar fascia (lumbodorsal fascia)

Thoracolumbar fascia

Thoracolumbar fascia
3 layers of connective tissue
Anterior lamella Middle lamella Posterior lamella

Muscle
External oblique

Origin
Inf border of lower 8 ribs

Insertion
linea alba iliac crest ASIS Lower border of ribs 9-12 linea alba Pecten pubis linea alba Pecten pubis

Internal oblique

Iliac fascia Anterior iliac crest Lumbar aponeurosis Iliac crest Lumbodorsal fascia Cartilages of lower ribs pubis and pubic symphysis

Transversus abdominis

Rectus abdominis

Cartilages of ribs 5-7 Xiphoid process Linea alba

Pyramidal

Pubis Anterior pubic ligament

Muscle

Origin

Insertion
12th rib Transverse processes L1-4

Quadratus lumborum Iliolumbar ligament Posterior iliac crest

Internal oblique

Transverse processes L1-5 Bodies/fibrocartilages T12-L5

Lesser trochanter

Iliacus

Upper of iliac fossa Inner lip of iliac crest Ant sacroiliac ligament Base of sacrum

lesser trochanter