16.posterior Abdominal Wall

Posterior Abdominal Wall
Sylvia Santos
Sylvia Santos
Posterior Abdominal Wall
Bears the following structures
● Five lumbar vertebrae and intervertebral discs between them
● Muscles of the posterior abdominal wall and thoracolumbar
fascia
● Diaphragm superiorly
● Inferior vena cava
● Abdominal aorta
● Abdominal parts of the azygous and hemiazygous veins
● Lymph nodes of posterior abdominal wall and cisterna chyli
● Nerves of the posterior abdominal wall including lumbar
plexus and the abdominal part of the autonomic nervous
system
Relations of Psoas Major e
● Anterolateral surface
- medial arcuate ligament, psoas fascia
- peritoneum and extraperitoneal connective tissue
- kidney and ureter
- renal and gonadal vessels
- genitofemoral nerve
- psoas minor
- IVC and terminal ileum on the right
- colon on the left
● Posterior surface
- transverse processes of lumbar vertebrae
- lumbar plexus
● Medial surface
- sympathetic chain
- aortic lymph nodes
- obturator nerve
- IVC on right side
- aorta on left
- external iliac vessels along the pelvic brim
Relations of Psoas Major
● In the thigh :
- Anteriorly - femoral artery, fascia lata
- Posteriorly - capsule of hip joint separated by bursa
- Medially - pectineus, femoral vein
- Laterally - femoral nerve, iliacus
Psoas Fascia / Psoas Sheath
● The psoas fascia covering the psoas major (psoas sheath) is

attached medially to the lumbar vertebrae (their
intervertebral discs) and pelvic brim .
● The psoas fascia (sheath) is thickened superiorly to form the
medial arcuate ligament .
● The psoas fascia fuses laterally with the quadratus
lumborum and thoracolumbar fascias.
● Inferior to the iliac crest, the psoas fascia is continuous with
the part of the iliac fascia covering the iliacus.
● The psoas fascia also blends with the fascia covering the
quadratus lumborum.
Thoracolumbar fascia
● Thoracolumbar fascia is an extensive fascial complex attached to the vertebral
column medially that, in the lumbar region, has posterior, middle and anterior
layers with muscles enclosed between them.
● It is thin and transparent where it covers the thoracic parts of the deep muscles but
is thick and strong in the lumbar region
● The enclosure of the vertical deep back muscles (erector spinae) by the posterior
and middle layers of the thoracolumbar fascia on the posterior aspect of the trunk
● The lumbar part of this posterior sheath, extending between the 12th rib and the
iliac crest, attaches laterally to the internal oblique and transverse abdominal
muscles, and latissimus dorsi (not to external oblique)
● Anterior layer of the thoracolumbar fascia (quadratus lumborum fascia), covering
the quadratus lumborum, a thinner, more transparent layer than the other two layers,
attaches to the anterior surfaces of the transverse processes of the lumbar vertebrae,
the iliac crest, and the 12th rib.
● The anterior layer is continuous laterally with the aponeurotic origin of the
transverse abdominal muscle. It thickens superiorly to form the lateral arcuate
ligament and is adherent inferiorly to the iliolumbar ligaments
Posterior layer
Clinical Anatomy
Psoas abscess
● An abscess resulting from
tuberculosis in the lumbar region
tends to spread from the vertebrae
into the psoas sheath, where it
produces a psoas abscess.
● Pus from the psoas abscess passes
inferiorly along the psoas muscle
within this fascial tube over the
pelvic brim and deep to the inguinal
ligament.
● The pus usually surfaces in the
superior part of the thigh (in the
femoral triangle)
Lymphatic System
● Preaortic - around 3 anterior branches of abdominal aorta
- divided into celiac, superior mesenteric, and inferior mesenteric nodes and
receive lymph from the organs supplied by the similarly named arteries
- form intestinal trunk
● Lateral aortic or lumbar nodes (Paraaortic nodes) - on either side of the

abdominal aorta
- receive lymphatics from the body wall, the kidneys, the suprarenal glands and
the testis, ovaries
- form right and left lumbar trunk
● Iliac nodes - drain pelvic viscera except for testis, ovaries and parts of rectum
drained by
● The trunks confluence to form saccular dilation called cisterna chyli

● Lies posterior to the right side of abdominal aorta and anterior to the bodies of
L1 and L2 and continues upwards as thoracic duct
Clinical Anatomy
Posterior Abdominal Pain
● The iliopsoas has extensive and clinically important relations to the kidneys,
ureters, cecum, appendix, sigmoid colon, pancreas, lumbar lymph nodes, and
nerves of the posterior abdominal wall.
● When any of these structures is diseased, movement of the iliopsoas usually
causes pain.
● When intra-abdominal inflammation is suspected, the iliopsoas test is
performed.
● The person is asked to lie on the unaffected side and to extend the thigh on
the affected side against the resistance of the examiner's hand. The elicitation
of pain with this maneuver is a positive psoas sign. An acutely inflamed
appendix, for example, will produce a positive right psoas sign.
● Because the psoas lies along the vertebral column and the iliacus crosses the
sacroiliac joint, disease of the intervertebral and sacroiliac joints may cause
spasm of the iliopsoas, a protective reflex.
● Adenocarcinoma of the pancreas in advanced stages invades the muscles and
nerves of the posterior abdominal wall, producing excruciating pain because
of the close relationship of the pancreas to the posterior abdominal wall
Lumbar Plexus
• Location : in the posterior part of the
substance of the psoas major muscle.
• Formed by : ventral rami of L1-L4
• L1 receives contribution from T12
• L4 gives contribution to the lumbosacral

trunk (joins sacral plexus)
Lumbar Plexus
Branches :
• Iliohypogastric L1
• Ilioinguinal L1
• Genitofemoral L1, L2
• Lateral femoral cutaneous - L2, L3
• Obturator L2 - L4 (anterior divisions)
• Femoral L2 - L4 (posterior divisions)
• Accessory obturator L3, L4

Lumbar Plexus
• Iliohypogastric
- emerges from upper lateral border of psoas major, on the
ant surface of quadratus lumborum, finally medial to
superficial inguinal ring
- Motor - transversus abdominis, internal oblique
- Sensory - posterolateral gluteal, suprapubic skin
Lumbar Plexus
• Ilioinguinal
- emerges from lateral border of psoas major, traverses the
inguinal canal superficial to spermatic cord or round
ligament, exits superficial inguinal ring
- Motor - transversus abdominis, internal oblique
- Sensory - proximal medial thigh,
skin over the root of the penis and upper part of the
scrotum in males
skin covering the mons pubis and adjoining labium majus
in females
Lumbar Plexus
• Genitofemoral
- divides into two
- Genital br enters inguinal canal - supplies cremaster, skin
of scrotum in males , mons pubis and labium majus in
females
- Femoral br under the inguinal ligament - supplies
anteromedial skin of the thigh
Abdominal Part of ANS
• Sympathetic :
- lumbar sympathetic trunk
- celiac plexus
• Parasympathetic :
- vagus
- pelvic splanchnic nerves
Lumbar Sympathetic Trunk
• Lumbar part of each sympathetic trunk
usually contains four interconnected
ganglia
• Superiorly, it is continuous with the

thoracic sympathetic trunk posterior to the
medial arcuate ligament.
• Inferiorly, it passes posterior to the
common iliac vessels and is continuous
with the sacral sympathetic trunk.
Lumbar Parasympathetic
• Vagus to celiac and superior mesenteric
plexus
• Pelvic splanchnic nerves (S2, S3, S4) /

nervi erigentes to inferior mesenteric and
hypogastric plexus
Celiac Ganglion and Plexus
Celiac Plexus / Solar plexus
Formed by :
• Preganglionic sympathetic fibers via
greater and lesser splanchnic nerves

• Postganglionic sympathetic fibers arising
from celiac ganglion

• Preganglionic vagal fibers
• Sensory fibers from diaphragm

Celiac Plexus
• Phrenic plexus
• Hepatic plexus
• Gastric plexus
• Suprarenal plexus
• Renal plexus
• Gonadal plexus
• Superior mesenteric plexus
• Aortic plexus - inferior mesenteric plexus ,
etc
Summary of ANS Innervation of
Abdominal Viscera
Sympathetic Parasympathetic
Greater splanchnic n. (T5 to T9 Vagus - Foregut and Midgut via

thoracic ganglia) - Foregut via celiac and superior mesenteric
celiac ganglion* and plexus plexus (NOT ganglion)
Lesser splanchnic n. (T10, T11) -
Midgut - via superior mesenteric
ganglion and plexus
Least splanchnic n. (T12) - Pelvic Splanchnic n. (S2, S3, S4)
Kidney - Hindgut via inferior mesenteric
and hypogastric plexus
Lumbar splanchnic n. (L1, L2
ganglia) - Hindgut via inferior
mesenteric ganglion and plexus
Orange - Sympathetic ; Purple - Parasympathetic
https://www.youtube.com/watch?v=WXO_nyFY9oM
Thank You

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Posterior Abdominal Wall

● The psoas fascia covering the psoas major (psoas sheath) is

● Lateral aortic or lumbar nodes (Paraaortic nodes) - on either side of the

● The trunks confluence to form saccular dilation called cisterna chyli

• Formed by : ventral rami of L1-L4

• L1 receives contribution from T12

• L4 gives contribution to the lumbosacral

• Lateral femoral cutaneous - L2, L3

• Obturator L2 - L4 (anterior divisions)

• Femoral L2 - L4 (posterior divisions)

• Accessory obturator L3, L4

• Superiorly, it is continuous with the

• Pelvic splanchnic nerves (S2, S3, S4) /

greater and lesser splanchnic nerves

from celiac ganglion

• Sensory fibers from diaphragm

Greater splanchnic n. (T5 to T9 Vagus - Foregut and Midgut via

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