Anatomy Anatomy of of Anterio Anterio r r Abdomin Abdomin al Wall al Wall Mohammed El-Matary Lecturer of General Surgery Lecturer of General Surgery Ain Shams University Ain Shams University
Jan 20, 2016
AnatomAnatom
yy of of AnterioAnterio
r r AbdomiAbdominal Wallnal Wall
Mohammed El-MataryLecturer of General SurgeryLecturer of General Surgery
Ain Shams UniversityAin Shams University
Anterior Anterior Abdominal WallAbdominal Wall
• Layer of anterior abdominal wall:Layer of anterior abdominal wall: A- Lateral:A- Lateral: 1- Skin. 2- Subcutaneous tissue. 3- External oblique muscle. 4- Internal oblique muscle. 5- Transversus abdominis muscle. 6- Fascia transversalis. 7- Peritoneum.
Anterior Anterior Abdominal WallAbdominal Wall
B- Medial:B- Medial: 1- Skin.1- Skin.
2- Superficial fascia.2- Superficial fascia.
3- Anterior wall of rectus sheath.3- Anterior wall of rectus sheath.
4- Rectus muscle.4- Rectus muscle.
5- Posterior wall of rectus sheath.5- Posterior wall of rectus sheath.
6- Peritoneum.6- Peritoneum.
1 -Skin
A- Lateral
2 -Subcutaneous tissue
A- Lateral
3 -External Oblique m.
A- Lateral
4 -Internal Oblique m.
A- Lateral
5 -Transversus abdominis m.
A- Lateral
6- Fascia Transversalis m
A- Lateral
7- Peritoneum
A- Lateral
Anterior Anterior Abdominal WallAbdominal Wall
• Layer of anterior abdominal wall:Layer of anterior abdominal wall:
B- Medial:B- Medial: 1- Skin.1- Skin.
2- Superficial fascia.2- Superficial fascia.
3- Anterior wall of rectus sheath.3- Anterior wall of rectus sheath.
4- Rectus muscle.4- Rectus muscle.
5- Posterior wall of rectus sheath.5- Posterior wall of rectus sheath.
6- Peritoneum.6- Peritoneum.
1 -Skin
B- Medial
2 -Subcutaneous tissue
B- Medial
3 -Ant. Wall of Rectus sheath
B- Medial
4 -Rectus Muscle
B- Medial
B- Medial
5 -Post. Wall of Rectus sheath
B- Medial
6 -Peritoneum
External Oblique MuscleExternal Oblique Muscle
OriginOrigin
Fleshy digitations from the lower 8 ribs
External Oblique MuscleExternal Oblique Muscle
The muscle is inserted by fleshy fibers as well as aponeurosis, as follows:
A- Fleshy fibers:Outer lip of the iliac crest
B- Aponeurosis:1. Medial part → linea alba from xiphoid process to
symphysis pubis
2. Lateral part → folded upwards & backwards upon itself to form the inguinal ligament (ASIS → pubic tubercle)
InsertionInsertionXiphoid
Process
Symphysis Pubis
External Oblique MuscleExternal Oblique Muscle
Direction of fibersDirection of fibers
DownwardDownward
Forwards Forwards
MediallyMedially
External Oblique MuscleExternal Oblique Muscle
Nerve SupplyNerve Supply
Intercostal nerves (TIntercostal nerves (T7 7 -T-T1111) & ) &
Subcostal nerve (TSubcostal nerve (T1212))
Internal Oblique MuscleInternal Oblique Muscle
OrigiOriginn
InsertionInsertion
1. Anterior 2/3 of the intermediate line of the iliac crest2. The lateral 2/3 of the inguinal ligament3. Lumbar fascia
1. Lower 6 costal cartilages 2. Xiphoid process 3. Linea Alba 4. Pubic crest
Internal Oblique MuscleInternal Oblique MuscleDirection of fibersDirection of fibers
UpwardsUpwards
Forwards Forwards
MediallyMedially
Nerve SupplyNerve SupplyTT77-T-T1212
Iliohypogastric n. Iliohypogastric n.
Ilioinguinal n.Ilioinguinal n.
Transversus Abdominis MuscleTransversus Abdominis MuscleOriginOrigin
1- Lower 6 intercostal cartilages1- Lower 6 intercostal cartilages
2- Lumbar Fascia2- Lumbar Fascia
3- Ant. 2/3 of inner lip of iliac crest3- Ant. 2/3 of inner lip of iliac crest
4- Lat. 1/3 of inguinal ligament4- Lat. 1/3 of inguinal ligament
Transversus Abdominis MuscleTransversus Abdominis MuscleInsertionInsertion
1- Xiphoid Process1- Xiphoid Process
2- Pubic Crest2- Pubic Crest
3- Linea Alba3- Linea Alba
Direction of Direction of fibersfibers
Transversus Abdominis MuscleTransversus Abdominis Muscle
HorizontallyHorizontally
Nerve SupplyNerve Supply
Transversus Abdominis MuscleTransversus Abdominis Muscle
TT77-T-T1212
Iliohypogastric n. Iliohypogastric n.
Ilioinguinal n.Ilioinguinal n.
Rectus Abdominis Rectus Abdominis MuscleMuscle
OriginOrigin
From the pubic crestFrom the pubic crest
InsertionInsertion
7th, 6th, 5th costal cartilages7th, 6th, 5th costal cartilages
Xiphoid processXiphoid process
Rectus Abdominis Rectus Abdominis MuscleMuscle
The muscle is divided into segments The muscle is divided into segments by tendinous intersections, Which by tendinous intersections, Which indicate that the muscle arises from a indicate that the muscle arises from a number of myotomes, fused togethernumber of myotomes, fused together
1- Segmental nerve supply.1- Segmental nerve supply.
2- Hematoma of rectus m. is localized2- Hematoma of rectus m. is localized
2- In paramedian incision 2- In paramedian incision displace m. displace m.
laterally (n. supply comes from lateral)laterally (n. supply comes from lateral)
Surgical ImportanceSurgical Importance
Pyramidalis Pyramidalis MuscleMuscle
It is a landmark of linea It is a landmark of linea alba intraoperativealba intraoperative
Actions of Anterior Abdominal Actions of Anterior Abdominal Wall MusclesWall Muscles
• They assist in raising the intra-bdominal pressure (so, They assist in raising the intra-bdominal pressure (so, they help in vomiting, cough, delivery, etc….)they help in vomiting, cough, delivery, etc….)
• Keep the abdominal viscera in position.Keep the abdominal viscera in position.• Rectus abdominis flexes the trunk, while the 2 oblique Rectus abdominis flexes the trunk, while the 2 oblique
muscles bend the trunk laterally.muscles bend the trunk laterally.• Act as accessory expiratory muscles.Act as accessory expiratory muscles.• Lower midline & paramedian incisions.Lower midline & paramedian incisions.
MediallyMedially
LaterallyLaterally
Rectus SheathRectus Sheath
Linea AlbaLinea Alba
Linea SemilunarisLinea Semilunaris
Arcuate LineArcuate Line
Rectus SheathRectus Sheath
Falciform LigamentFalciform Ligament
External ObliqueExternal Oblique
Internal ObliqueInternal Oblique
Transversus AbdominisTransversus Abdominis
Ant. Layer of Rectus SheathAnt. Layer of Rectus Sheath
Post. Layer of Rectus SheathPost. Layer of Rectus Sheath
Rectus Abdominis Rectus Abdominis
Above Arcuate LineAbove Arcuate Line
SKINSKIN
PeritoneumPeritoneumTransverslais FasciaTransverslais Fascia
Rectus SheathRectus SheathExternal ObliqueExternal Oblique
Internal ObliqueInternal Oblique
Transversus AbdominisTransversus Abdominis
Ant. Layer of Rectus SheathAnt. Layer of Rectus Sheath
Rectus Abdominis Rectus Abdominis
Below Arcuate LineBelow Arcuate Line
Urachus in Median Umbilical FoldUrachus in Median Umbilical Fold
Medial Umbilical Ligament Medial Umbilical Ligament
Transverslais FasciaTransverslais Fascia
SKINSKIN
PeritoneumPeritoneum
Superior epigastric a.Superior epigastric a.
Subcostal a.Subcostal a.
Inferior epigastric a.Inferior epigastric a.
Deep circumflex iliac a.Deep circumflex iliac a.
- I -- I -Internal Mammary a.Internal Mammary a.
- III -- III -External Iliac a.External Iliac a.
- II - - II - Descending AortaDescending Aorta
1010thth, 11, 11thth intercostal a. intercostal a.