LAYERS OF ABDOMINAL WALL

Mr. Mickey Banda

Texila American University
 Introduction
• cylindrical chamber
• B/n inferior thoracic
aperture and pelvic inlet
 FUNCTIONS
• Houses and protects major
viscera
• Includes; gastrointestinal
• System, liver, gallbladder,
stomach, and spleen and
parts of the urinary system
 Nine Regions of the Abdomen

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 The 4 quadrants of the Abdomen
• Sometimes, divided into 4
quadrants defined by 2
planes:
• One vertical = median
• One horizontal=
transumbilical
- Right upper quadrant
- Left upper quadrant
- Right lower quadrant
- Left lower quadrant

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 A line between the
anterior superior iliac
spine and the pubic
Surface anatomy
tubercle marks the
position of the inguinal
ligament
separates the anterior
abdominal wall above
from the thigh of the
lower limb below.
The iliac crest
separates the
posterolateral
abdominal wall from the
gluteal region of the
lower limb
 Layers of the abdominal wall
1. skin
2. subcutaneous tissue consisting of
a fatty layer known as Camper’s
fascia
3. membranous layer known as
Scarpas fascia
4. External oblique
muscle/aponeurosis
5. Internal oblique
muscle/aponeurosis
6. Transverse
abdominis/aponeurosis
7. Extraperitoneal fascia
 Superficial layer: Camper's fascia
• Camper's fascia contains
fat and varies in thickness
• Continues below the
inguinal ligament as
superficial layer of the
thigh
• In men it forms dartos
muscle in the scrotum
• In women, this layer
retains some fat and is a
component of the labia
majora
 Deep Layer: Scarpa's fascia
• Scarpa's fascia is thin and
membranous
• fuses with the deep fascia
of the thigh (fascia lata)
• In the perineum it is known
as superficial perineal
fascia (Colles' fascia)
• In the scrotum it forms the
dartos fascia
Scarpa's fascia
 Anterolateral muscles
5 muscles
1. external oblique
2. internal oblique
3. transversus abdominis
4. rectus abdominis
5. pyramidalis muscles
 External oblique
Origin: ribs V to XII
Fibers run from the outer
surfaces of the lower eight
ribs (in inferomedial
direction)
Insert: on lateral lip of
iliac crest and aponeurosis
ending in linea alba
Nerve supply: anterior
ramus of the lower 6
intercostal nerves
Action: compresses
abdominal contents and
 Internal oblique
Origin: From Thoracolumbar
fascia; iliac crest; on lateral two-
thirds of inguinal ligament
Fibers in superomedial
direction
Insertion: on Inferior border
of the lower three or four ribs ;
linea alba; pubic crest and
pectineal line
Nerve supply: lower 6
intercostal nerves
Action: compresses the
abdominal contents and flexion
 Transversus abdominis
Origin: Thoracolumbar
fascia; medial lip of iliac crest;
lateral one-third of inguinal
ligament; costal cartilages
lower six ribs (ribs VII to XII)
Insertion: on aponeurosis
ending in linea alba; pubic
crest and pectineal line
Nerve supply: Anterior
ramus of the lower 6
intercostal nerves
Action: Compresses the
abdominal content
 Rectus abdominis
Origin: From the
pubic crest, pubic
tubercle, and pubic
symphysis Costal
cartilages of ribs V
Insertion: 5th, 6th and
7th; xiphoid process
 Rectus abdominis

• Nerve Supply
– Lower six thoracic nerves
– Subcostal nerve

• Action:
• Compresses abdominal contents
• Flexes vertebral column
• Accessory muscle of expiration
 Linea Alba

• Fibrous band

• Separates rectus sheath

from its fellow on the
opposite side

• Extends from the

xiphoid process to the
symphysis pubis
 Pyramidalis
• Pyramidalis
• Origin: Front of pubis and pubic symphysis
• Insertion: linea alba
• Nerve supply: Anterior ramus of T12
• Action: Tenses the linea alba
 Rectus Sheath
• a flat sheet tendon
(aponeurosis)
• multilayered aponeurosis
• anterior and posterior wall
(Lamina)
• walls are composed of a
fusion of the aponeuroses
of the external abdominal
oblique, internal abdominal
oblique, and transversus
abdominis muscles
Rectus Sheath
 Rectus Sheath

• Encloses
• Rectus abdominis
• Pyramidalis muscle (if
present)

• Contains
• Anterior rami of lower six
thoracic nerves
• Superior and inferior
epigastric vessels
• Lymph vessels

• Formed mainly by aponeurosis

of three lateral abdominal
muscles
 For description ; considered at 2 levels:

1. Above the Arcuate

line
2. Below the Arcuate
line
Rectus Sheath
 Rectus Sheath
1. Above the Arcuate line
Anterior
•Full external oblique
• Half internal oblique
aponeurosis
Posterior
• Half internal oblique
aponeurosis
•Full transversus abdominis
 Rectus Sheath

Roughly at the level of the umbilicus or above

1. Above the Arcuate line

Anterior lamina
- Full External oblique
- Half Internal oblique

Posterior lamina
- Half Internal oblique
- Full Transversus abdominis
2 . Below the arcuate line

•Aponeurosis of all
three muscles form
the anterior wall

•Posterior wall is
formed by the
transversalis fascia
 Nerve supply
The abdominal wall is inn. by
the anterior rami of T7 to T12.
T7 to T11 supply skin and
muscle of the abdominal wall,
just like subcostal nerve T12.
T5 and T6 supply upper parts
of the external oblique muscle.
T6 also supplies cutaneous
inn. to skin over the xiphoid.
L1 supplies skin and muscle in
the inguinal and suprapubic
regions of the abdominal wall
 Inn. Lateral & anterior
abdomen

 In the midline, skin over the

infrasternal angle is T6 and that
around the umbilicus is T10.
L1 innervates skin in the
inguinal and suprapubic regions.
Muscles of the abdominal wall
are inn. segmentally in patterns
that generally reflect the patterns
of the overlying dermatomes.
Blood supply to the
abdominal wall
Superficially

musculophrenic artery,
(from internal thoracic
artery) supplies the superior
part of the wall.

superficial epigastric
artery and superficial
circumflex iliac artery (both
from the femoral artery)
supply the inferior part of
the wall
 Blood supply cont’d
At a deeper level:
superior epigastric artery, (from
internal thoracic artery) supply the
superior part of the wall.
10Th and 11th intercostal arteries
and the subcostal artery; supply
branches to the lateral part of the
wall.
The inferior part of the wall is
supplied by inferior epigastric
artery and the deep circumflex
iliac artery, both branches of the
external iliac artery
 Venous drainage
Veins of similar names follow
the arteries and are
responsible for venous
drainage
 Lymphatic drainage

superficial lymphatics
above the umbilicus
pass in a superior
direction to the axillary
nodes,

drainage below the

umbilicus passes in an
inferior direction to the
superficial inguinal
nodes;
 Lymphatic drainage

deep lymphatic
drainage follows the
deep arteries back to
parasternal nodes along
the internal thoracic
artery, lumbar nodes
along the abdominal
aorta, and external iliac
nodes along the
external iliac artery
 The inguinal region (groin)
• It extends between ASIS
(anterior superior iliac
spine) and pubic
tubercle.
• Weakest part of the
abdominal wall.
• Hernias occur in this
area especially in males.
 Mid-inguinal point & Midpoint of the
inguinal ligament
• Mid-inguinal point – halfway
between the pubic symphysis
and the anterior superior iliac
spine
- The femoral pulse can be
palpated here.
• Midpoint of the inguinal
ligament – halfway between the
pubic tubercle and the anterior
superior iliac spine
- The opening to the inguinal canal
is located just above the midpoint
 The inguinal canal
a slit-like passage that
extends in a downward
and medial direction,
just above and parallel
to the lower half of the
inguinal ligament.
It begins at the deep
inguinal ring and
continues for
approximately 4 cm,
ending at the superficial
inguinal ring.
Deep inguinal ring
is the beginning of the
inguinal canal and is at a
point midway between the
anterior superior iliac spine
(ASIS) and the pubic
symphysis.

It is just above the

inguinal ligament and
immediately lateral to the
inferior epigastric vessels.
 Superficial ring
 is the end of the
inguinal canal and is
superior to the pubic
tubercle.
It is a triangle-shaped
opening in the
aponeurosis of the
external oblique, with its
apex pointing
superolaterally and its
base formed by the pubic
crest.
 Posterior wall of the inguinal canal
• Is formed along its entire
length by the transversalis
fascia and reinforced along
its medial one-third by the
conjoint tendon (Falx
inguinalis)
 Boundaries of Inguinal Canal
• Anterior wall – External oblique muscle

• Posterior wall – Transversalis fascia and internal oblique

and transverse abdominis muscle
• Superior wall (Roof) - formed by the arching fibers of
the Transversus abdominis and Internal oblique muscles
• Inferior wall (floor) - formed by the medial one-half of
the inguinal ligament.
 Contents of the inguinal canal
• spermatic cord in male
- 3 arteries: cremasteric artery, artery of the ductus deferens and
testicular artery
- Ductus deferens
- Testicular veins
- Lymphatics
- Remains of the processus vaginalis
- 3 nerves: ilioinguinal, genital branch of the genitofemoral, sympathetics
• round ligament of the uterus in female
• Genital branch of the genitofemoral nerve
• Ilioinguinal nerve - In both sexes, nerve passes through part of the
canal, exiting through the superficial inguinal ring.
 Embryology
• In early embryonic life testes and ovaries
develop in the posterior abdominal wall.
• The gubernaculum (fibrous cord like structure)
help these structures to descend such that :
• the ovaries become related to the uterus in
the pelvic cavity.
• The testes descend to the scrotum.
 Inguinal canal ctd
A peritoneal
diverticulum, the
processus vaginalis
traverses the
developing inguinal
canal, carrying
muscular and fascial
layers of the
anterolateral
abdominal wall
before it as it enters
the primordial
scrotum.
Descent of the Testis
 Inguinal canal

• In men, the testes and their accompanying vessels,

ducts, and nerves pass through the inguinal canal.

• In women, the ovaries descend into the pelvic

cavity
• the only remaining structure passing through the
inguinal canal is the round ligament of the uterus,
which is a remnant of the gubernaculum
Derivates of the coverings of the testes and spermatic cord
Hesselbac’s Triangle
 Inguinal hernias: Types
• An inguinal hernia is the protrusion of a
peritoneal sac, with or without abdominal
contents, through a weakened part of the
abdominal wall in the groin.
Types
• indirectly - lateral the inferior epigastric
vessels, through the deep inguinal ring
• directly - Medial to the inferior epigastric
vessels
 Indirect inguinal hernia
is the most common of the two
types and is more common in
men than in women.
It occurs because some part, or
all, of the embryonic processus
vaginalis remains open or patent.
It is therefore referred to as
being congenital in origin.
The protruding peritoneal sac
enters the inguinal canal by
passing through the deep inguinal
ring, just lateral to the inferior
epigastric vessels
Indirect inguinal hernia
 Direct inguinal hernias
A peritoneal sac enters the
medial end of the inguinal
canal directly through a
weakened posterior wall.
It is usually described as
acquired because it develops
when abdominal musculature
has been weakened, and
is commonly seen in mature
men.
The bulging occurs medial
to the inferior epigastric
vessels in the inguinal
triangle (Hesselbach's
triangle
 Reference Books
1. Standring, Susan and Standring (2015).Gray's anatomy.
41st International edition, Elsevier Health Sciences. ISBN
9780702052309.
2. Keith L. Moore, Arthur F. Dalley, Anne M. R. Agur (2017).
Moore's Clinically Oriented Anatomy, 8th edition, Walter
Kluwer. ISBN 9781496347213.
3. Alan J. Detton (2020). Grant’s Dissector. 17th edition,
Lippincott Williams & Wilkins. ISBN 9781975134600.
4. Adrian Kendal Dixon, David J. Bowden, Bari M. Logan and
Harold Ellis (2017). Human Sectional Anatomy - Pocket
atlas of body sections, CT and MRI images, 4th edition,
CRC Press. ISBN 9781498708548.
 The End
Thank you