RECTUS SHEATH

INTRODUCTION: This is an aponeurotic sheath covering the rectus abdominis muscle.

It has 2 walls, anterior wall and posterior wall.
Anterior wall is complete, covering the muscle from end to end.
Posterior wall is incomplete, being deficient above the costal margin and
below the arcuate line.

FORMATION: Anterior wall:

above the costal margin:
B/w the costal margin &
the arcuate line:
below the arcuate line:
External oblique aponeurosis.
a. External oblique aponeurosis,
b. Anterior lamina of the aponeurosis
of the internal oblique muscle.
Aponeurosis of all the 3 flat muscle of the
abdomen. The aponeuroses of the trans-
versus and unternal oblique are fused, but
the external oblique aponeurosis remains
separate.

Posterior wall:
Above the costal margin:
B/w the costal margin &
the arcuate line:
below the arcuate line:
It is deficient: the rectus muscle rests
directly on the 5th, 6th and 7th costal
cartilages.
a. Posterior lamina of the aponeurosis of
the internal oblique muscle.
b. Aponeurosis of the transversus muscle.
It is deficient. The rectus muscle rests on the
fascia transversalis.

CONTENTS: Muscles: 1 The rectus abdominis is the chief and largest contents
2 The pyramidalis lies in front of the lower part of the rectus
abdominis.

Arteries: 1 The superior epigastric artery.

2 The inferior epigastric artery.

Veins: 1 The superior epigastric vein.

2 The inferior epigastric vein.

Nerves: These are the terminal parts of the lower six thoracic nerves,
including the lower 5 intercostal nerves and the subcostal nerves

FUNCTIONS: 1 It checks bowing of rectus muscle during its contraction and thus increases
the efficiency of the muscle.
2 It maimtain the strength of the anterior abdominal wall.
CLINICAL ANATOMY:
1 Epigastric hernia or hernia through the linea alba:
In multiparae and chronically weak children, the upper part of the linea alba
becomes stretched out and weak may be hernate.
The extraperitoneal fat may also protrude out b/w the interlacing fibres, it may
drag out a peritoneal tube in which a part of the greater omentum may herniated.

2 supraumbilical median incisions through the linea alba have several advantages through
the linea alba have several advantages as being bloodless; safety to muscle and nerves but
tend to leave a postero-perative weakness through which a ventral hernia may develop.

THE FASCIA TRANSVERSALIS

INTRODUCTION: The inner surface of the abdominal muscles is lined by fascia which is
separated from peritoneum by extraperitoneal connective tissue. That part
of the fascia which lines the inner surface of the transversus abdominis
muscle is called the fascia transversalis.

EXTENT: Anteriorly: Its adherent to the linea alba above the umbilicus.
Posteriorly: It merges with the anterior layer of the thoracolumbar fascia and is
continuous with the diaphragmatic fascia.
Superiorly: It is continuous with the diaphragmatic fascia.
Inferiorly: A= It is attached to the inner lip of the iliac crest and to the lateral
half of the inguinal ligament, at both these places it is continuous
with the fascia iliaca.
B= medially, it is attached to the pubic tubercle, the pubic crest and
the pectineal line.
C= It is prolonged into the thigh as the anterior wall of the femoral
sheath.

OPENING OF DEEP INGUINAL RING:

About 1.2 cm above the midinguinal point there is an oval opening in the fascia transversalis.
This opening is the deep inguinal ring. The ring lies immediately lateral to the inferior
epigastric artery.
It transmits the spermatic cord in males, and the round ligaments of the uterus in females.

PROLONGATIONS:
1 A tubular prolongation of the fascia transversalis surrounds the spermatic cord
forming the internal spermatic fascia.
2 Over the femoral vessel, the fascia transversalis is prolonged into the thigh as the
anterior wall of femoral sheath.

RELATION TO VESSELS AND NERVES:

The main arteries of the abdominal wall and pelvis lie inside the fascia transversali, while the
main nerves are outside. That is why the femoral vessels are inside the femoral sheath,
while femoral nerve is outside the sheath.