The insuinal lisament o Formed by the lower border of ext. oblique aponeurosis between pubic tubercle & A.S.l.S. being folded backward upon itself. o lts convex outer surface is attached to the fascia lata (deep fascia of the
Origin: fleshy digitations from the lower I ribs,
The upperS s/rps interdigitate with the serratus antenor$
I n Se ftio n : fleshy fibers as well as aponeuro$is, as follows:
in the outer rip of the iriac crest.
- Forms the anterior boundary of the inferior lumbar triangle.
- Medial ,qqrt: inserted into linea alba from xiphoid process to
- Lateral part: folded upwards & backwardo upon itself to form the
inguinal ligament (ASIS ) pubic tubercle).
Downwards, fonryards & medially.
Nerve Supplv: lntercostal nerves (T7-T11) & subcostal nerve (T12).
2: hLernal olliqup Msrsfpi {rOriqln:
1, Lateral % of the upper surface of ingulnal ligament,
2, Anterior % of the intermediate llne of iliac crest,
Upwards, forwards and medially.
T7 - T12, illo;hypogastric & ilio-inguinal nerveE (11),
3- Transversus Abdominis Muscle:
c. Anterior Ts of inner lip of iliac crest.
d. Lateral T, of the upper surface of inguinal Iigament.
H orizontally (tra nsversa lly forwa rd).
T7 -T12, ilio-hypogastric & ilio-inguinal nerves (L1).
o Formed by fusion of lower parts of both int. oblique & transversus abdominis.
o lt is inserted in pubic crest & llio-pectineal eminence.
o lt forms & strengthens the medial part of the posterior wall of inguinal canal.
o It is continuous medially with the anterior wall of rectus sheath.
o Nerue supplv: ilio-inguinal nerve.
i) lts weakness predisposes to direct inguinal hernia.
ii) lnjury of ilioinguinal n. during appendicectomy ) paralysis of conjoint
tendon ) direct inguinal hernia (paralytic type).
iii) Conjoint tendon prevents direct inguinal hernia from descending to
scrotum. So, its defect ) descent of direct inguinal hernia to the scrotum
From the pubic crest and the symphysis pubis,
ii) 5th, 6th, and 7th costal cartilagee
Lower 5 intercostals (T7 - T11) and subcoEtal nerve (T12),
r ln Kocher lnclelon, rectus abdominis must be divided,
r ln para.medlan lnclslon, we displace the muecle laterally aE it receives its
nerve supply from the lateral eide.
r Embryologlcally, the muecle arlses from a number of myotomes, So:
. The muscle has a segmental nErvE supply (myotomes),
. lt is divided into 4 segments by 3 tendinous intereections which are
adherent to the anterior rectuE sheath,
. Hematoma of rectug abdominiE is localized because of the tendinous
Actions of Anterior Abdominal Wall Muscles
r They assist in raising the intra-abdominal pressure (so, they help in vomiting,
r Keep the abdominal'viscera in position.
r The Rectue abdomlnle flexeE the trunk, while the 2 oblique muecles bend the
r Act as accessory expiratory muscles,
r lt medial border gives linea alba, which is important in lower midline and paramedian incisions,
r lt is innervated by genital branch of genito-femoral nerve,
r This is a thin fascia, which lines the inner surface of the transversus abdominis
r Forms the posterior wall of rectus sheath below the arcuate line (a little above
r Extends as the anterior wall of femoral sheath,
I Prolonged ae internal spermatic fascia
A small opening in the fascia transversalis. lt lies about % inch above the mid
This is layer of areolar fatty tissue, which lies between the fascia transversalis and
DefinitiOn ! lt is envelope-like sheath for rectus muscle.
Site i between linea alba (medially) & linea semilunaris (laterally).
- stn, 6th,& 7th costal cartilages
Absent & is replaced by fascia
1ffitrlliorsrm[uloo#rcltrc&n o - e
Lower 5 intercostal nerves (T7-T11)
- lt is a white line in the midline of the abdomen.
- Formed by decussation of the aponeurosis of ext oblique, internal oblique &
transversus abdominis muscles.
- Extends from xiphoid process to symphysis pubis (it is not attached to pubic tubercle)
- lt is broad in its supra-umbilical part (surgical importance: epigastric hernia).
It is the lateral border of rectus sheath extending from the pubic tubercle below to the tip of
the 9th costal cartilage above,
A crescentic line that is situated between upper T+ &lower % of post. wall of rectus sheath.
oFascia lata causes arching of the inguinal ligament downwards.
Application: You must bend the legs during abdominalexamination to relax
the fascia lata & therefore relax the abdominal muscles.
. lt is the continuation of the fascia transversalis posteriorly below the iliac
crest over the iliacus muscle.
.lt descends forming the posterior wall of femoral sheath behind the
oAny intra-abdominal organ may herniate except pancreas because it is guarded
posteriorly by aorta, IVC & vertebrae.
Arterial supply of anterior abdominal wall:
1) Internal Mammary artery.. (through 2 terminal branches)
o Superior epigastric artery, r Musculo-phrenicartery.
2) Effierual lllac artery: (through 2 terminat branches)
o Deep circumflex iliac artery.
o 1Oth & 11th posterior intercostal arteries.
r Superficial epigastric artery.
o Superficial circumflex iliac artery.
Above umbilicus ) axillary LNs.
Below umbilicus ) Inguinal LNs.
. One median umbilical fold: on the median umbilical ligament
(which in turn, contains the uracfius).
. Two medial umbilical folds on the occluded umbilical artery,
. Two lateral umbilical folds on fhe inferior epigastric yessels.
A.ttrir sEsior ilim spioa Defi n ition :
* llJili ^l::ff,nru,Til:l;:il, i5o"''
na, wa I I extend ins P*iln6t rqmdn
. The internal ring: opening in
transversalis % inch above the
b. Fibers of the internal oblique.
b. Conjoint tendon (in its medial % only).
a. Arching fibers of the internal oblique.
b. Transversus abdominis muscle.
!nguinal ligament (its medial %).
N.B; ln infants, superficial & deep rings are
o The external ring: opening in the external
oblique aponeurosis with 2 pillars; one in pubic
tubercle & the other in the symphysis pubis.
DirectiOn of the canal: downwards & medially.
It is a part of the posterror wall of the inguinal canal.
. Laterally: lnferior epigastric vessels.
. Medially: Lateral border of rectus sheath.
[}Jc[-Edsfrons $uperfubl IEulnC.tE
t lnferior: lnguinal ligament (only medial%).
o lt is divided by the lateral umbilical ligament into medial and lateral parts.
It is the triangle through which direct inguinal hernia passes.
N.B: Direct inguinal hernia is more common in old age,
Normally, 2 mechanisms act to prevent herniation through the inguinal canal while
increasing intra-abdominal pressure:
i) Shuttering mechanism in which contraction of the arching fibers of the
transversus abdominis cover a part of the internal ring with cough.
ii) The attachment of the deep inguinal ring to the posterior surface of the
transversus muscle. So, the contraction of the muscle pulls the ring upwards &
laterally thus increasing the obliquity of the canal.
o Formed by the lower border of ext. oblique aponeurosis between pubic
tubercle & A.S.l.S. being folded backward upon itself.
o lts convex outer surface is attached to the fascia lata (deep fascia of the
Point mid way between A.S.l.S. & symphysis pubis. lt is the surface anatomy of
Mid-point of insuinal lisament
Point mid way between A.S.l.S. & pubic tubercle, Half an inch above it, is the
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