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Antero-Lateral Abdominal Wall
Abdominal Wall
Skin  Fascia  Muscle  Special fascia (Transversalis)
Anterior
Lateral (Rt. & Lf.)
Posterior
Ant & Lat walls boundary is:
Linea Semilunaris
Muscle fascia & nerves are
continuous within lat. & ant.
Walls
 Antero-lateral abdominal wall
Linea Semilunaris
Antero-Lateral Wall
Boundaries:
Superior
Xiphoid process
& costal margin
(7th-10th CC)
Inferior
Inguinal Ligament:
C.T. ligament extends from
ant. sup. iliac spine  pubic tubercle
Fascia of Abdominal Wall
• Superficial
fatty layer (Camper’s fascia)
membranous (Scarpa’s fascia)
• Deep
enclosing the muscles
(muscle fascia)
divided into:
superf., intermediate & deep layers
• Transversalis
continuous with endothoracic
fascia in the thorax
• Extra peritoneal fat
Linea Semilunaris & Linea Alba
Semi
Alba
Semilunaris
Alba
Layers of Abdominal Wall
Muscles of Antero-Lateral Wall
Read The Table in Your Textbook
5 muscles
3 lateral: (flat broad m)
Named by layer & fibers direction
external oblique
internal oblique
transversus abdominis
2 anterior: (vertical m)
Named by shape
Rectus Abdominis
Pyramidalis
External Oblique
Read The Table in your textbook
From:
outer surfaces of lower ribs (??)

Inferomedially

Inserted to:
Linea alba
Pubic crest & tubercle
Ant. ½ of iliac crest
Inferior free border is thickened to
become: Inguinal Ligament
Inguinal Ligament & Superficial Ring
Inguinal Lig.: Thickened backward reflection of the inferior border
of external oblique aponeurosis that extends from anterior superior
iliac spine to pubic tubercle
Superficial Inguinal Ring: a triangular split (opening) in the
aponeurosis of external oblique muscle, above pubic crest &
medial to inguinal lig.
Structure passing through:
Spermatic cord in male or ? In female
Internal Oblique Muscle
Read your textbook
• Main Origin:
lumbar fascia
ant. 2/3 of iliac crest
??
• Insertion
lower 3 ribs & Costal margin
xiphoid process
Linea alba
symphysis pubis
Transversus Abdominis
• Runs horizontally
• Main origin ??
• Main Insertion:
Linea alba
Read Your Textbook
Rectus Abdominis
Long strap like muscle
Extends vertically over ant. Wall
4 Fleshy parts run between
3 tendinous intersections:
xiphoid
umbilicus
halfway between ?
Enclosed by rectus sheath
(deep fascia)
Pyramidalis
• NOT always present
• Base from pubis
• Apex inserted into linea alba
• Anterior to rectus abdominis
& within Rectus sheath
• Function ??
Rectus Sheath
Long fibrous sheath that encloses rectus
abdominis m.
It is formed by the three lat. Muscles
aponeuroses
Starts from linea semilunaris
in both sides
Splits into 2 parts:
- Ant. to rectus abdominis
ext. oblique + ½ of internal oblique
- Post. to rectus abdominis
transversus + ½ of internal oblique
Merges in midline as ???
Exception
At level of ant. sup. Iliac spine
(midway between umbilicus and ?)
 All aponeuroses go anterior
 NO posterior part
- Rectus abdominis become lined by
transversalis fascia
The infero-posterior disappearance is
marked by: arcuate line
Contents of Rectus Sheath
• 2 muscles ??
• 4 bld. Vessels
Sup. & Inf. epigastric arteries
Sup. & Inf. epigastric veins
• 6 nerves
T7 –T11 intercostals (5 nerves)
Subcostal n. (T12)
2–4-6
Blood Vessels of Abdominal Wall
• Superior epigastric a.
continuation of ??
posterior to rectus abdominis m.
• Inferior epigastric a.
from external iliac artery
Route & location ?
• 10th & 11th Post. intercostals & Subcostal a. (12th)
• Lumbar arteries (between which layers?)
• Deep Circumflex iliac (origin?)
Nerves of Abdominal Wall
• Lower intercostal nerves:
T7 – T11
• Subcostal n.
T12
• 1st lumbar nerve:
2 divisions:
iliohypogastric n.
ilioinguinal n.
does NOT enter the rectus sheath
Surface Anatomy
9 regions classification
Subcostal plane:
lowest costal margin,
10 cc, L3
Transtubercular plane:
iliac tubercles
what vertebral level?
Midclavicular planes:
mid clavicle

mid inguinal lig.
9 Regions
Rt. & Lf. Hypochondriac
Rt. & Lf. Lumbar
Rt. & Lf. Inguinal
Epigastric
Umbilical
Hypogastric (pubic)
4 Regions classification
Transumbilical plane
IV disc L3-L4
Midsagittal line
symphesis menti

symphesis pubis
Abdominal Surgical Incisions
Surgeons use various incisions to gain access to abd. cavity
Rules:
1. Provide adequate exposure
2. avoid damage to major vital str. (van)
3. best possible cosmetic effect
Common surgical incisions:
1. Median (Midline) Incisions:
common
3 types
2. Paramedian Incision:
2-5 cm lat. To midline
spleen or kidney
3. Kocher’s (Subcostal) Incision:
 oblique incision
runs parallel & below (2.5cm)
the Rt. costal margin
 cholecystectomy
4. McBurney’s Incision:
 oblique incision
Parallel to ext. obliq. M. fibers
at Mcburney’s point (??)
 Appendectomy
McBurney’s Point
On a straight line : 1/3 from ant. sup. iliac spine
2/3 from the umbilicus
Corresponds to the base of the appendix
The incision site during appendectomy (removal of the appendix)
5. Pfannenstiel (Suprapubic) Incision:
 transverse, slightly curved incision (Smile Incision)
 5cm above pubic symphysis
* most frequent incision used by
urologists & gynecologists
 c-section, hystrectomy
urinary bladder & prostate
surgeries