Xiaoming Zhang
Department of Human Anatom
School of Medicine of Zhejiang University



Formation: Abdominal wall, Abdominal cavity and contents
Boundaries
Superior boundary
Inferior boundary

Abdominal wall
Anterior Abdominal Wall
 posterior abdominal wall
Abdominal cavity
Division

right epigastric region left epigastric region right hypogastric region left hypogastric region

hypogastric region

Ⅲ.The abdominal wall
The layers of the anterior abdominal wall: skin superficial fascia muscles transverse fascia extraperitoneal fascia parietal peritoneum

I
Anterior Abdominal Wall
Superficial structures
1.skin
2.superficial fascia
 superficial layer — Camper‘s fascia
 deep layer — Scarpa‘s fascia, Colles’ fascia
3.superficial vessels and cutaneous nerves

 superficial arteries ： three groups
•
The branches of posterior intercostal A., subcostal A., and lumbar A.
；
•
Superior and inferior epigastric A.
；
•
Superficial epigastric A. and superfical iliac circumflex.

the superficial veins:
 —umbilical venous network
 above the umbilicus
 below the umbilicus
Superficial lymphatic vessels:
 upper → axillary lymph nodes
 lower → superficial inguinal lymph nodes
 anastomise with the lymphatics of the liver the cutaneous nerves

Deep Structures
 Deep fascia
 Muscular layers
 rectus abdominis
 the sheath of rectus abdominis

anterior layer of the sheath is formed by the aponeurosis of the obliquus externus and the ant. layer of the aponeurosis of the obliquus internus.
The linea alba is extending between the xiphoid process and the pubic symphysis, formed by the decussating of the aponeuroses of the three flat muscles.

The posterior layer of the sheath is formed by the aponeurosis of the transversus and the post. Layer of the aponeurosis of the obliquus internus.
The posterior layer of the sheath is lack of at the arcuate line (about 4cm below the omphalo )

Deep Structures

Muscular layers
 obliquus externus abdominis
 linea alba)
 superficial inguinal ring
 reflected ligament
 external spermatic fascia

Inguinal ligament
 lacunar ligament
 pectineal ligament(Cooper
）

( 3) The internus abdominis
—arises from the lateral 2/3 of the inguinal lig.,the iliac crest and the thoracolumbar fascia.The
muscular fibers is replace by the aponeurosis(ant. And post. layers) at the lateral margin of the rectus.
—cremaster
—inguinal falx

(4) The transverse abdominis
—arises from the lateral 1/3 of the inguinal lig.,the iliac crest and the thoracolumbar fascia and internal aspect of lower 6 costal cartilage.
—cremaster
—inguinal falx

1. position — parallel to,and above the inguinal lig.
Immediately.
About 4cm long.
2. Structures
— two orifices
(1) the deep inguinal ring lies a transverse finger breadth(2cm)above the midpoint of inguinal lig.
formed by the transverse fascia.
(2)sup. Inguinal ring formed by the aponeurosis of the obliquus externus.
triangular defect in shape.
medial and lateral crus

—four walls
(1) ant. wall is mainly formed by aponeurosis of the obliquus ext.,and laterally is reinforced by the beginning part of the obliquus internus.
(2) inf. wall is formed by the inguinal ligament
(3) Post.wall is formed by the transverse fascia, inguinal falx and the reflected lig..
(4) Sup. wall is formed by the arched fibers of the obliquus internus and transverse abdominis
The contents male spermetic cord, ilioinguinal nerve female round ligament and ilioinguinal nerve

The inguinal triangle
—boundaries inf. boundary medial half of the inguinal ligament medial boundary lateral border of the rectus abdominis lateral boundary inf. epigastric a..
**direct inguinal hernia

Deep Structures
 extraperitoneal fascia
 parietal peritoneum

Five longitudinal folds

Median umbilical fold

Medial umbilical fold
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Lateral umbilical fold
 inguinal medial fossa and inguinal lateral fossa

Summary of anterior abdominal wall
Superficial structures
 skin
 superficial fascia : Camper and Scarpa
 superficial vessels and cutaneous nerves
Deep Structures
 Deep fascia
 Muscular layers

The vessels and nerves
 transversalis fascia
 extraperitoneal fascia
 parietal peritoneum

 Boundaries
 Superior boundary—from anterior iliac spine to lateral margin of rectus
 Medial boundary—lateral margin of rectus


Inferior boundary—inguinal ligament inguinal trangle(Hesselbach trangle ）
 laterally —inferior epigastric A.
 medially —the lateral border of the rectus abdominis
 inferiorly —medial half of the inguinal ligament

Rectus incision
Median incision
Inferior median incision
McBurney’s incision