TOPOGRAPHIC ANATOMY OF THE ABDOMEN

Topographic anatomy of the abdominal walls

Anterolateral abdominal wall

Department of Human Anatomy, Operative

surgery and Topographic Anatomy
YHU
 Anterolateral abdominal wall
Orientation Lines:
· Horizontal orientation lines
1. Superior horizontal line (linea costarum, linea bicostalis):
It joins the lowest points of the costal arches.
Area superior to this line is the epigastrium.
2. Inferior horizontal line (linea spinarum, linea bispinalis):
It joins the anterior superior iliac spines of both sides.
Area inferior to this line is the hypogastrium.
Area between these 2 lines is the mesogastrium.
· Vertical orientation lines:
1. Right midclavicular line (linea clavicularis media, linea mamillaris dextra):
It joins the middle point of the right clavicle to the middle point of the right inguinal
ligament.
2. Left midclavicular line (linea clavicularis media, linea mamillaris sinistra):
It joins the middle point of the left clavicle to the middle point of the left inguinal
ligament
Anterolateral abdominal wall
 Anterolateral abdominal wall
Regions:

The abdomen is divided into 9 regions by the orientation lines:

1) Right hypochondriac region (regio hypochondrica dextra).
2) Proper epigastric region (regio epigastrica propria).
3) Left hypochondriac region (regio hypochondrica sinistra).
4) Right lateral abdominal region (regio abdominalis lateralis dextra).
5) Umbilical region (regio umbilicalis).
6) Left lateral abdominal region (regio abdominalis lateralis sinistra).
7) Right inguinal (ilioinguinal) region (regio ilioinguinalis dextra).
8) Hypogastric (suprapubic) region (regio suprapubicalis).
9) Left inguinal (ilioinguinal) region (regio ilioinguinalis sinistra).
 Projection of organs on the abdomen
(holotopy of the abdominal organs)
· Right hypochondriac region:
- Right lobe of the liver, gall bladder, superior pole of the right kidney, right suprarenal gland and right colic
flexure of the large intestine.
· Proper epigastric region:
-Left lobe of the liver, stomach, body of the pancreas, superior part of the duodenum, inferior vena cava,
abdominal aorta, coeliac trunk, coeliac plexus and lesser omentum.
· Left hypochondriac region:
- Part of the stomach, left colic flexure of the large intestine, spleen, superior pole of the left kidney, left
suprarenal gland, tail of the pancreas.
· Right lateral abdominal region:
- Ascending colon, right kidney (except the superior pole), right ureter and loops of the small intestine.
· Umbilical region:
- Duodenum (except the superior part), head of the pancreas, transverse colon, loops of the small intestine
and inferior vena cava.
Left lateral abdominal region:
- Descending colon, left kidney (except the superior pole), left ureter and loops of the small intestine
· Right inguinal region:
- Caecum, vermiform appendix, right ureter, right external iliac artery and vein.
· Hypogastric region:
-Distal part of the sigmoid colon, supraampular part of the rectum, abdominal part of the ureter, distended
urinary bladder and uterus after the I trimester.
· Left inguinal region:
- Sigmoid colon, left ureter, left external iliac artery and vein.
Anterolateral abdominal wall
Regions:
 Anterolateral abdominal wall
Layers:
Skin:
- This thick skin with numerous hair follicles especially in the hypogastric region (especially
in males).
- Subcutaneous tissue:
It is a thick layer of fatty tissue which is the primary site of adipose depot for the body,
especially in males.
- The thoracoepigastric vein and tributaries of the paraumbilical veins are found in this layer.
- The thoracoepigastric and great saphenous veins form the cavocaval anastomosis.
- The paraumbilical veins, superior and inferior epigastric veins form the portocaval anastomosis.
Superficial fascia:
- It is a continuation of the superficial fascia of the thorax.
- It is divided into 2 laminae:
- Superficial lamina (Camper’s fascia);
- It is a fatty layer.
- It continues with the thigh as the fascia lata.
- It is not attached to the inguinal ligament.
Deep lamina (Thompson’s fascia. Scarpa’s fascia):
- It is a membranous layer.
- It continues to form a superficial fascia of the penis and scrotum in males or perineal
fascia in females.
- It is attached to the inguinal ligament.
Anterolateral abdominal wall
Muscles
 ANTEROLATERAL ABDOMINAL WALL

External Oblique

The external oblique is the largest and most superficial flat muscle in
the abdominal wall. Its fibres run inferomedially.

Attachments: Originates from ribs 5-12, and inserts into the iliac crest
and pubic tubercle.

Functions: Contralateral rotation of the torso.

Innervation: Thoracoabdominal nerves (T7-T11) and subcostal nerve

(T12).
 ANTEROLATERAL ABDOMINAL WALL

Internal Oblique

The internal oblique lies deep to the external oblique. It is smaller

and thinner in structure, with its fibres running superomedially
(perpendicular to the fibres of the external oblique).

Attachments: Originates from the inguinal ligament, iliac crest and

lumbodorsal fascia, and inserts into ribs 10-12.

Functions: Bilateral contraction compresses the abdomen, while

unilateral contraction ipsilaterally rotates the torso.

Innervation: Thoracoabdominal nerves (T7-T11), subcostal nerve

(T12) and branches of the lumbar plexus.
 ANTEROLATERAL ABDOMINAL WALL
Transversus Abdominis

The transversus abdominis is the deepest of the flat muscles, with

transversely running fibres. Deep to this muscle is a well-formed
layer of fascia, known as the transversalis fascia.

Attachments: Originates from the inguinal ligament, costal

cartilages 7-12, the iliac crest and thoracolumbar fascia. Inserts into
the conjoint tendon, xiphoid process, linea alba and the pubic crest.

Functions: Compression of abdominal contents.

Innervation: Thoracoabdominal nerves (T7-T11), subcostal nerve

(T12) and branches of the lumbar plexus.
 ANTEROLATERAL ABDOMINAL WALL
Rectus Abdominis

The rectus abdominis is long, paired muscle, found either side of the midline in
the abdominal wall. It is split into two by the linea alba. The lateral borders of
the muscles create a surface marking known as the linea semilunaris.

At several places, the muscle is intersected by fibrous strips, known as tendinous

intersections. The tendinous intersections and the linea alba give rise to the ‘six
pack’ seen in individuals with a well-developed rectus abdominis.

Attachments: Originates from the crest of the pubis, before inserting into the
xiphoid process of the sternum and the costal cartilage of ribs 5-7.

Functions: As well as assisting the flat muscles in compressing the abdominal

viscera, the rectus abdominis also stabilises the pelvis during walking, and
depresses the ribs.

Innervation: Thoracoabdominal nerves (T7-T11).

 ANTEROLATERAL ABDOMINAL WALL

Pyramidalis

This is a small triangular muscle, found superficially to the rectus

abdominis. It is located inferiorly, with its base on the pubis bone,
and the apex of the triangle attached to the linea alba.

Attachments: Originates from the pubic crest and pubic symphysis

before inserting into the linea alba.

Functions: It acts to tense the linea alba.

Innervation: Subcostal nerve (T12).

 ANTEROLATERAL ABDOMINAL WALL
Rectus Sheath

The rectus sheath is formed by the aponeuroses of the three flat muscles and
encloses the rectus abdominis and pyramidalis muscles. It has an anterior and
posterior wall for most of its length:

• The anterior wall is formed by the aponeuroses of the external oblique, and of
half of the internal oblique.

• The posterior wall is formed by the aponeuroses of half the internal oblique
and of the transversus abdominis.

Approximately midway between the umbilicus and the pubic symphysis, all the
aponeuroses move to the anterior wall of the rectus sheath. At this point, there is
no posterior wall to the sheath; the rectus abdominis is in direct contact with
the transversalis fascia.
The demarcation point where the posterior layer of the rectus sheath ends is
the arcuate line.
ANTEROLATERAL ABDOMINAL WALL
 Anterolateral abdominal wall
Muscles
- Pyramidalis muscle (musculus pyramidalis).
- Rectus abdominis muscle (musculus rectus abdominis).
- External oblique muscle (musculus obliquus externus abdominis).
- Internal oblique muscle (musculus obliquus internus abdominis).
- Transversus abdominis muscle (musculus transversus abdominis).
Anterolateral abdominal wall
Muscles
Anterolateral abdominal wall
Muscles
Anterolateral abdominal wall
Muscles
Anterolateral abdominal wall
Muscles
 Anterolateral abdominal wall
Muscles

Deep fascia:
- Above the arcuate line, aponeurosis of the external oblique muscle and half of the
aponeurosis of the internal oblique muscle form the anterior layer of the rectus sheath:
-The other half of the aponeurosis of the internal oblique muscle and aponeurosis of the
transversus abdominis muscle form the posterior layer of the rectus sheath
- Below the arcuate line, aponeurosis of the external oblique, internal oblique and transversus
abdominis muscles form the anterior layer of the rectus sheath.
Transversalis fascia (fascia transversalis, fascia endoabdominalis):
- It is a continuation of the endothoracic fascia (fascia endothoracica).
- It continues into the pelvic cavity as the endopelvic fascia (fascia endopelvina).
-It is attached to the iliac crest and lateral half of the inguinal ligament and continues as the
iliac fascia (fascia iliaca).
- It is attached to the pubic tubercle, pubic crest and Cooper’s pectineal line medially.
 Weak places:
They are places where the tendons are not
closely fused together and the foramina or
fissures are thus formed.
- Hernias lend to occur in these places.
-The common hernias of the anterolateral
abdominal wall are as follows:
- White line (linea alba, Hunter’s line).
- Umbilical region (regio umbilicalis).
- Inguinal region (regio inguinalis).
-Semilunar line (linea semilunaris, Spigelli’s
line).
-Arcuate line (linea arcuata, linea
semicircularis.
Arterial supply Arterial supply: Nerve supply:
Anterior and collateral branches of the posterior intercostals vessels of the 10th and
11th intercostals spaces, and from the anterior branches of the subcostal arteries and
the same veins.
Nerve supply.
Thoracoabdominal (formerly known as the inferior intercostals) nerves
-anterior abdominal (cutaneous) branches of the anterior primary rami of the inferior

6 thoracic nerves (Th7 toTh11).

- Subcostal nerves (Th12).
- Iliohypogastric and ilioinguinal nerves (Th1).
- Th7 to Th9 supply the skin superior to the umbilicus.
- Th10 innervates the skin around the umbilicus.
- Cutaneous branches of the subcostal nerves (Th12), iliohypogastric and
ilioinguinal
(L1) supply the skin inferior to the umbilicus.
Arterial supply: Nerve supply:
Arterial supply: Nerve supply:
 Topography of the inguinal region
Inguinal triangle (trigonum inguinale, Hesselbach’s triangle):)
(regio inguinalis
Borders:
- Superior: Horizontal line drawn between the lateral and middle 1/3 of the inguinal ligament.
- Medial: Lateral margin of the rectus abdominis muscle.
- Inferior: Inguinal ligament.
Inguinal canal (canalis inguinalis):
Walls:
- Anterior: Aponeurosis of the external oblique muscle
- Posterior: Transversalis fascia
Superior / Roof: Inferior border of the internal oblique and transversus abdominis muscles.
- Inferior / Floor: Inguinal (Poupart’s) ligament.
Topography of the inguinal region
(regio inguinalis)
 Topography of the inguinal region (regio inguinalis)
Inguinal triangle (trigonum inguinale, Hesselbach’s triangle)
 Inguinal region (regio inguinalis)
Rings: Rings:

The Superficial Ring of the Inguinal Canal:

- Although it is called a ring, the superficial (external) inguinal ring is a more or less triangular
aperture (deficiency) in the aponeurosis of the external oblique muscle.
-Emerging from the superficial inguinal ring is the spermatic cord in the male and the
round ligament of the uterus in the female. In addition, the ilioinguinal nerve makes its
exit through the ring to supply skin on the superomedial aspect of the thigh.

The Deep Ring of the Inguinal Canal:

-This opening in the transversalis fascia is located just lateral to the inferior epigastric
artery.
- This deep (internal) ring is immediately superior to the midpoint of the inguinal ligament
and medial to the origin of the transverses abdominis muscle from the inguinal ligament.
Contents:
- In males: Spermatic cord (funiculus spermaticus) and ilioinguinal nerve (nervus ilioinguinalis).
- In females: Round ligament of the uterus (ligamentum teres uteri), ilioinguinal nerve
and genital branch of the genitofemoral nerve.
Inguinal region (regio inguinalis)
Rings:
 Constituents of the Spermatic Cord:

Within the coverings of the cord are:

- The Ductus Deferens. This large duct of the testis, formerly called the vas deferens.
- Arteries. The cremasteric artery is a small vessel that arises from the inferior
epigastric artery.
-Veins. Up to 12 veins leaving the posterior surface of the testis anastomose to form a
pampiniform plexus.
It is located within the internal spermatic fascia and ends in the testicular vein.
- Nerves. There are sympathetic fibers on the arteries and sympathetic and parasympathetic
fibers on the ductus deferens.
The genital branch of the genitofemoral nerve passes into the spermatic cord and supplies the
cremasteric muscle.
- Lymph vessels. The lymph vessels draining the testis and immediately associated structures
pass superiorly in the spermatic cord.
Sometimes remnants of the stalk of the processus vaginalis persist, which may become swollen
with fluid to form a hydrocele of the spermatic cord. The pampiniform plexus of veins
sometimes becomes varicose (dilated and tortuous), producing a condition known as varicocele
that feels like a “bag of worms”.
Constituents of the Spermatic Cord:
Constituents of the Spermatic Cord:
 Coverings of the Spermatic Cord:
The structures passing to and from the testis (ductus deferens and associated nerves and
vessels) and constituting the spermatic cord, are surrounded by three layers of fascia
derived from the anterior abdominal wall. These coverings are not easily separated
from one another.
-The Internal Spermatic Fascia from the transversalis fascia
-The Cremasteric fascia from the fascia covering the internal oblique aponeurosis
-The External spermatic fascia from the external oblique aponeurosis
-The muscle, which is continuous with the internal oblique, reflexly draws the testis to
a more superior position in the scrotum, particularly in cold temperatures.
-The area supplied by the ilioinguinal nerve.
-This results in contraction of the cremaster muscle supplied by the genital branch of
the genitofemoral nerve (Li and L2).
Coverings of the Spermatic Cord: