 The rectus sheath is a long fibrous sheath

 Formed mainly by the aponeuroses of the three lateral

abdominal muscles.
 Encloses the rectus abdominis muscle and
pyramidalis muscle (if present) and contains the
anterior rami of the lower six thoracic nerves and the
superior and inferior epigastric vessels and lymph
vessels.
The rectus sheath is considered at three levels.
Above the costal margin,
 Anterior wall # Aponeurosis of the external oblique.
 Posterior wall # Thoracic wall that is, the fifth, sixth,
and seventh costal cartilages and the intercostal
spaces.
Transverse section
 Between the costal margin and the level of the
anterior superior iliac spine, the aponeurosis of the
internal oblique splits to enclose the rectus muscle;
the external oblique aponeurosis is directed in front of
the muscle, and the transversus aponeurosis is
directed behind the muscle.
Transverse section
 Between the level of the anterosuperior iliac spine
and the pubis,
 the aponeurosis of all three muscles form the anterior
wall. The posterior wall is absent, and the rectus
muscle lies in contact with the fascia transversalis.
Linea alba

• Is a tendinous median raphe between the two rectus

abdominis muscles, extending from the xiphoid
process to the pubic symphysis.
• Is formed by the fusion of the aponeuroses of the
external oblique, internal oblique, and transverse
muscles of the abdomen.
• The posterior wall of the rectus sheath is not attached
to the rectus abdominis muscle. The anterior wall is
firmly attached to it by the muscle's tendinous
intersections
Linea semilunaris
 Is a curved line along the lateral border of the rectus
abdominis.
Linea semicircularis (arcuate line)
 Is a crescent-shaped line marking the inferior limit of
the posterior layer of the rectus sheath just below the
level of the iliac crest.
Hematoma of the Rectus Sheath

uncommon but important, since it is often

overlooked.
It occurs most often on the right side below the level
of the umbilicus.
The source of the bleeding is the inferior epigastric
vein or, more rarely, the inferior epigastric artery.
These vessels may be stretched during a severe bout of
coughing or in the later months of pregnancy, which
may predispose to the condition.
The cause is usually blunt trauma to the abdominal
wall, such as a fall or a kick.
The symptoms that follow the trauma include
midline abdominal pain. An acutely tender mass
confined to one rectus sheath is diagnostic.
THANKS