Clinical Anatomy of the

Anterior Abdominal Wall

in its Relation to Hernia
Lawrence M. Witmer, PhD
Professor of Anatomy
Department of Biomedical Sciences
College of Osteopathic Medicine
Ohio University, Athens
witmerL@ohio.edu
Handout download:
http://www.oucom.ohiou.edu/dbms-witmer/gs-rpac.htm
26 April 2011
Anatomical Overview
External
oblique
Internal
oblique
Transversus
abdominis
Rectus
abdominis
inguinal
ligament
tendinous
intersections
Three flat abdominals: attach to trunk skeleton, inguinal lig., linea alba, etc.;
fleshy laterally and aponeurotic medially, forming rectus sheath medially
Two vertical abdominals: rectus abdominis and pyramidalis (not shown)
aponeurotic
portion
rectus
sheath
fleshy
portion
Moore et al. 2010
intramuscular exchange of
contralateral external oblique fibers
intermuscular exchange of
contralateral external & internal oblique
continuity of fibers across midline
digastric muscle with central
tendon
torsion of trunk
continuity of external oblique
fibers across midline
blending of superficial & deep
fibers on opposite side
right
external
oblique
left
internal
oblique
Anatomical Overview
Moore et al. 2010
linea alba
rectus sheath
transv. abd.
int. obl.
ext. obl.
peritoneum
transversalis fascia
aponeuroses of
abdominal mm.
fasciae: Scarpas, Campers
rectus abdominis
tendinous
intersections
Anatomical Overview
semilunar line
Moore et al. 2010
Anatomical Overview
inferior epigastric
vessels
internal
oblique
anterior lamina
of rectus sheath
iliohypogastric n.
ilioinguinal n.
arcuate line
(semicircular)
line of Douglas)
semilunar
line (of Spiegel)
posterior lamina
of rectus sheath
(aponeurotic)
posterior lamina
of rectus sheath
(transversalis fascia)
Moore et al. 2010
Anatomical Overview
linea alba
umbilicus
semilunar line
hernia.tripod.com/types.html
Anterior Abdominal Hernias
rectus sheath
superficial
inguinal ring
femoral
canal
Moore et al. 2010
linea alba
health.enotes.com/images/
medicine/gem_03_img0340.jpg
thachers.org/images/epigastric_hernia.jpg
thachers.org/images/hernia_repair.jpg
hernial sac
repaired hernia
scar
Epigastric (Ventral) Hernia
Skandalakis Surgical Anatomy 2004
hernial sac
peritoneum
posterior rectus
sheath
anterior rectus
sheath rectus
abdominis
1988 Moore Developing
Human 4
th
edition
Omphalocele
Congenital
Umbilical
Hernia
Acquired Umbilical Hernia
incomplete closure of umbilical ring
occur after closure of umbilical ring
2 to obesity, pregnancy, cirrhosis,
ascites, masses
medicine.ucsd.edu/clinicalimg/
abdomen-umbo-hernia4.jpg
2 to ascites
Umbilical (Para-umbilical) Hernia
Skandalakis Surgical Anatomy 2004
www.e-radiography.net/ibase5/Abdomen/
slides/Abdomen_spigelian_hernia_ct.jpg
CT
semilunar
line
arcuate
line
frequent
hernial
site
rectus
abdominis
rectus sheath:
posterior & anterior lamina
transversalis
fascia
Spigelian (Lateral Ventral) Hernia
Skandalakis Surgical
Anatomy 2004
Moore et al. 2010
Case Presentation
A 3-year-old boy presents with a walnut-sized bulge in his left
groin, particularly when he stands, strains, or cries. With the
patient horizontal, the lump disappears. When the skin of the
scrotum is invaginated by a little finger, a definite impact is felt on
coughing. The diagnosis of hernia is made. How would this hernia
be best characterized?
pediatriconcall.com/forpatients/commonchild/images/inguinal_hernia.jpg
upon straining at rest
reducible, congenital, indirect inguinal hernia
testis in
abdomen
Embryological Basis of Indirect Inguinal hernia
Week 7
Moore et al. 2010
testis
descends
Embryological Basis of Indirect Inguinal hernia
Week 28
patent processus vaginalis
Moore et al. 2010
Embryological Basis of Indirect Inguinal hernia
Week 36
testis in
scrotum
processus vaginalis closed
Moore et al. 2010
Embryological Basis of Indirect Inguinal hernia
Cahill 1997
vas deferens
pampiniform
plexus
testis
abdominal
muscles
epididymis
tunica
vaginalis
hernial sac
within
spermatic
cord
partially
obliterated
processus
vaginalis
transversalis fascia
& peritoneum
Inguinal Anatomy
superficial
epigastric
vessels
superficial
circumflex
iliac
vessels
external
pudendal
vessels
great
saphenous
v.
spermatic cord
ilioinguinal
n. (L1)
superficial (external)
inguinal ring
external
oblique
aponeurosis
& Gallaudets
fascia
intercrurual
fibers
medial
crus
lateral
crus &
inguinal lig.
ASIS
Moore et al. 2010
Inguinal Anatomy
inguinal lig.
(of Poupart)
external iliac
vessels
femoral n.
internal
inguinal ring
femoral canal
pectineus lacunar lig.
(of Gimbernat)
pectineal lig.
(of Cooper)
reflected
inguinal lig.
myopectineal orifice
of Fruchaud
Moore et al. 2010
Inguinal Anatomy
EO
IO
TA
TF
P
testicular vessels
vas deferens
Space of
Bogros
internal
ring
ilioinguinal n.
conjoint tendon
external
ring
Moore et al. 2010
Inguinal Anatomy
shelving edge
of ing. lig.
Moore et al. 2010
Inguinal Anatomy
Skandalakis Surgical Anatomy 2004
parasagittal section
through right side
iliopubic tract
shelving edge
of inguinal
ligament
posterior view of
anterior abdominal wall
external
iliac vessels
iliopsoas
lateral umbilical fold
Hesselbachs
Triangle
inferior epigastric vessels arcuate line
iliopubic
tract
femoral canal
vas deferens
testicular
vessels
deep
ing. ring
iliopubic
tract
Moore et al. 2010
Hesselbachs (Inguinal) Triangle
direct inguinal hernia
indirect
inguinal hernia
posterior view
of anterior
abdominal wall
internal
inguinal
ring
Moore et al. 2010
Femoral Hernia
Skandalakis Surgical Anatomy 2004
femoral canal
lacunar lig.
(of Gimbernat)
References
Cahill, D. R. 1997. Lachmans Case Studies in Anatomy, 4th Ed.
Oxford University Press, New York.
Moore, K. L., A. F. Dalley, and A M. R. Agur. 2010. Clinically
Oriented Anatomy, 6th Ed. Lippincott, Williams & Wilkins,
Baltimore.
Moore, K. L. and T. V. N. Persaud. 2003. The Developing Human.
Clinically Oriented Embryology, 7th Ed. Lippincott, Williams &
Wilkins, Baltimore.
Skandalakis, J. E., G. L. Colborn, T. A. Weidman, R. S. Foster, A.
N. Kingsnorth, L. J. Skandalakis, N. P. Skandalakis, P. Mirilas
(Editors). 2004. Surgical Anatomy: The Embryologic And Anatomic
Basis Of Modern Surgery. McGraw-Hill, New York.