Anterior Abdominal Wall

Anterior Abdominal Wall
By Harshali Pawar
Devyani Patil
Akshada Pawar
Ruchi Pandit
Divya Sakpal
Sanjivani Pawar.
Introduction

Anterior Abdominal Wall includes both front as well as side walls of abdomen and needs to be
called as “ANTEROLATERAL ABDOMINAL WALL”.

Musculoaponeurotic Structure.

Firm, Elastic & Distensible.

It constitutes a hexagonal area.
1. Superiorly – by the costal margins and xiphoid process
1. Laterally – by the midaxillary line, and
1. Inferiorly – by the iliac crests, pubis and pubic symphysis, include Inguinal Region also.
Surface Landmarks
1. Xiphoid Process. At level of 9th thoracic vertebra
2. Costal Margin.
3. Tip of the ninth costal cartilage.
4. Tendinous intersections.
5. Umbilicus.
6. Iliac crest. At 4th lumbar vertebra
7. Anterior Superior iliac spine.
8. Linea Semilunaris.
9. Linea alba.
10. Inguinal Iigament.
11. Pubic tubercule.
12. Pubic crest.
13. Spermatic cord.
Abdominal Planes
Horizontal Planes :-
1. At the level of L1 - Transpyloric plane
1. At the level of L2 - Subcostal plane
1. At the level of L3 – Transtuberclar plane – L5
Vertical Planes:-

Right and Left lateral plane

Extent : From midclavicular to mid inguinal point
( Anterior Superior Iliac spine to inguinal liagament.
Planes
Transpyloric Plane

Passes through lower border of L1 & tips of 9th costal cartilage.

Midway between suprasternal notch & symphysis pubis/ Xiphisternal joint & umbilicus.

Structures present :-
A. Pylorus of Stomach
B. Fundus of gall bladder
C. Hilum of both kidneys
D. Origin of superior mesenteric artery.

Linea Alba : is a vertically running midline fibrous
band that extends from symphysis pubis to xiphoid
process. It is formed by fusion of aponeuroses of
anterior abdominal wall muscles.

Tendinous Intersections of the Rectus Abdominis :
are three in number running across rectus abdominis
muscle at the level of tip of xiphoid process,
umbilicus and halfway between them.

Linea Semilunaris : is the lateral edge of rectus
abdominis muscle & crosses costal margin at tip of
ninth costal cartilage.
Anterior Abdominal Wall – Layers
1. Skin
1. Superficial Fascia
1. External Oblique Muscle &

Aponeurosis
1. Internal oblique muscle & aponeurosis
1. Transverse abdominis & aponeurosis
1. Fascia Transversalis
1. Extra peritoneal tissue
1. Parietal peritoneum
Umbilicus

Introduction

Normal scar
i. Dense Fibrous Tissue
ii. Foetal end of umbilical cord

Position

Between L3 & L4
Anatomical Importance of Umbilicus


Watershed Line

Portocaval Anastomosis
Watershed Line

Axillary Lymph Node

Superficial Inguinal Lymph Node
Superficial fascia
# Superficial fascia of anterior abdominal wall is composed of 2 layers..
1.CAMPER'S FASCIA-[Fatty layer]
2.FASCIA OF SCARPA-[Membranous layer]
*These parts of superficial fascia are more prominent in lower abdominal wall
(below the level of umbilicus)
1} CAMPER'S FASCIA :- (1) INNER membranous layer..

(2) Both srotum and penis receive a covering from membranous Layer to form
a) fascia
b) fundiform ligament of penis
c) dartos muscle of scrotum
(3) Floor of superficial perineal space is formed by membranous layer..
2} FASCIA OF SCARPA :- (1)It is loosely connected to aponeurosis of external oblique muscle

But in middle it is more intimately adherent to linea alba and pubic
symphysis.

(2) It attaches to fascia of thigh known as fascia of lata..
 The attachments of scarpa fascia of abdomen and colles
Fascia of perineum are such that they prevent the
Passage of extravasted urine due to rupture of urethra
Backwards into ischiorectal fossa and downwards into
Thigh..
CLINICAL ANATOMY:
Membranous layer of superficial fascia of abdomen is
Continuous with superficial perineal pouch via scrotum
And penis.At times urethra may rupture and
Urine extravasates into this space.
ABDOMINAL
MUSCLES
LATERAL FLAT MUSCLES ANTERIOR VERTICAL MUSCLE

1.EXTERNAL OBLIQUE
1.RECTUS ABDOMINIS
2.INTERNAL OBLIQUE
2.PYRAMIDALIS
3.TRANSVERSE ABDOMINIS
1} EXTERNAL OBLIQUE MUSCLE
ORIGIN : OUTER SURFACE MIDDLE of the shaft of lower 8 ribs
INSERTION : inserted above downwards into xiphoid process,linea alba,pubic

symphysis,pubic crest,pectineal region; lower fibres are inserted into anterior
2/3rd of outer lip of iliac crest
NERVE : T7 – T12
DIRECTION : FIBRES runs downwards,forwards,medially.
OTHER POINTS : 1. Between anterior superior iliac spine and pubic

tubercle,aponeurosis has free inferior border folded on itself to form inguinal
ligament.
2.The muscle has 3 posterior and upper borders.
3}TRANSVERSE ABDOMINIS
ORIGIN: MUSCLE has fleshy origin:

1] lateral 1/3rd of inguinal ligament..
2] anterior 2/3rd inner lip of iliac crest..
3] thoracolumbar fascia..
4] inner surface of lower six costal cartilages..
INSERTION: 1] fibres end in broad aponeurosis which is inserted into xiphoid

process,linea alba,pubic crest,pectinealline of the pubis
2] lowest fibres of muscle fuse with lowest fibres of internal
oblique to form conjoint tendon..
NERVE: INTERCOSTAL (T7 – T11),SUBCOSTAL (T12),iliohypogastric And

Ilioinguinal Nerve
DIRECTION : Fibres are directed horizontally forwards..

4} RECTUS ABDOMINIS
ORIGIN: Muscle arises by 2 tendinous heads:

1] lateral head from lateral part of pubic crest..
2] medial head from medial part of pubic crest and
anterior pubic ligament..
INSERTION: passes laterally from Xiphoid process,costal
cartilage of ribs 5-7
NERVE: INTERCOSTAL (T7- T11),SUBCOSTAL T12
DIRECTION: Fibres run vertically upwards..
OTHER POINTS:1] muscle is enclosed in a sheath formed

mainly by aponeurosis of 3 flat muscles of
abdominal wall
2]TENDINOUS INTERSECTIONS: these are
3 fibrous bands which divide muscle into
smaller parts one lies opposite to
umbilicus,2nd opposite to xiphoid process and 3rd between the
two
5} PYRAMIDALIS
ORIGIN : anterior surface of body of pubis..
INSERTION : Linea alba
NERVE : Subcostal nerve T12
DIRECTION: Fibres pass upwards and medially..
OTHER POINTS : 1] Small triangular muscle..

2] it is said to be tensor of linea
alba, but need for such action is
not clear..
RECTUS SHEATH

AN Aponeueotic sheath covering the rectus abdominis..

It has 2 walls
ANTERIOR POSTERIOR
1. Complete, Covering 1.incomplete,deficient above costal
margins and below arcuate line
Muscle end to end
 CONTENTS:
 MUSCLES:- 1. Rectus Abdominis
2. pyramidalis
 ARTERIES:- A. Superior epigastric artery
B. Inferior epigastric artery
 VEINS:- i. Superior epigastric venae
ii. Inferior epigastric venae
 FUNCTION:- 1).Checks bowing of rectus muscle during contraction and increase efficiency of muscle
2).It maintains strength of anterior abdominal wall
 Fusion of aponeurosis in midline is called ''linea alba''.
FORMATION:
ABOVE COSTAL MARGIN
1.ANTERIOR WALL: External oblique aponeurosis
2.POSTERIOR WALL: It is deficient,the rectus muscle rests directly
On 5th,6th,7th,costal margin
BETWEEN THE COSTAL MARGIN AND ARCUATE LINE

1.ANTERIOR WALL: External and Internal oblique muscle aponeurosis
2.POSTERIOR WALL: Posterior lamina of aponeurosis of internal oblique
And aponeurosis of transversus muscle
BELOW ARCUATE LINE

1.ANTERIOR WALL: Aponeurosis of all three flat muscles of abdomen
The aponeurosis of transversus and internal oblique
Fused but external oblique aponeurosis remain
Separate
2.POSTERIOR WALL: It is deficient
INGUINAL CANAL
♦ Oblique intermuscular passage in lower part of anterior abdominal wall,situated just above medial half of
inguinal ligament
♦ LENGTH: EXTENDS from deep inguinal ring to superficial inguinal ring,,downwards,forwards and
medially
STRUCTURES PASSING THROUGH:

1} Spermatic cord in males ,
round ligament of uterus in femles enter inguinal canal through inguinal ring and
- Out through superficial inguinal ring
2} INGUINAL NERVE enters the canal between external and internal oblique muscle and
- Pass out through superficial inguinal ring
BOUNDRIES:
A.ANTERIOR B.POSTERIOR C.FLOOR D.ROOF

WALL WALL
It is formed by
1.In whole extent, 1.In whole extent Formed by Fibres of internal
Skin,superficial Fascia Upper surface oblique
fascia transversalis, Of inguinal Muscle and
,external oblique Extra peritoneal ligament transverse
Aponeurosis Tissue, Abdominis
Parietal peritoneum muscle
2.lateral 1/3rd
Fleshy fibres of 2.in medial 2/3rd
internal oblique Reflected part of
muscles Inguinal ligament
Clinical anatomy:
Due to lack of exercise, the tone of musclesof the Anterior Abdominal wall decreses leading to protrusion of the wall.
This is called visceroptosis.
Supraumbilical median incisions through the linea alba have Several advantages as being bloodless; safety to muscles
and Nerves but tend to leave a postoperative weakness through Which a ventral hernia may develop. Infraumbilical
median Incisions are safer beacause the close approximation of recti Prevent formation of any ventral hernia. Parsmedian
incisions through the rectus sheath are more sound Than median incisions. The rectus muscle is treated laterally To
protect the nereves supplying it from any injury. In these cases The subswquent risk of weakness and of incisional or
ventral Hernia are minimal.

Anterior Abdominal Wall

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Anterior Abdominal Wall

1. Superiorly – by the costal margins and xiphoid process

1. Laterally – by the midaxillary line, and

1. At the level of L1 - Transpyloric plane

1. At the level of L2 - Subcostal plane

1. At the level of L3 – Transtuberclar plane – L5

1. External Oblique Muscle &

1. Internal oblique muscle & aponeurosis

1. Transverse abdominis & aponeurosis

1. Extra peritoneal tissue

Anatomical Importance of Umbilicus

1} CAMPER'S FASCIA :- (1) INNER membranous layer..

2} FASCIA OF SCARPA :- (1)It is loosely connected to aponeurosis of external oblique muscle

LATERAL FLAT MUSCLES ANTERIOR VERTICAL MUSCLE

ORIGIN : OUTER SURFACE MIDDLE of the shaft of lower 8 ribs

INSERTION : inserted above downwards into xiphoid process,linea alba,pubic

DIRECTION : FIBRES runs downwards,forwards,medially.

OTHER POINTS : 1. Between anterior superior iliac spine and pubic

ORIGIN: MUSCLE has fleshy origin:

INSERTION: 1] fibres end in broad aponeurosis which is inserted into xiphoid

NERVE: INTERCOSTAL (T7 – T11),SUBCOSTAL (T12),iliohypogastric And

DIRECTION : Fibres are directed horizontally forwards..

ORIGIN: Muscle arises by 2 tendinous heads:

DIRECTION: Fibres run vertically upwards..

OTHER POINTS:1] muscle is enclosed in a sheath formed

ORIGIN : anterior surface of body of pubis..

INSERTION : Linea alba

NERVE : Subcostal nerve T12

DIRECTION: Fibres pass upwards and medially..

OTHER POINTS : 1] Small triangular muscle..

Muscle end to end

BETWEEN THE COSTAL MARGIN AND ARCUATE LINE

BELOW ARCUATE LINE

STRUCTURES PASSING THROUGH:

A.ANTERIOR B.POSTERIOR C.FLOOR D.ROOF

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