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
