Anterior abdominal wall &

Inguinal canal
Dr. Kavitha Ganesh
PNU
 OBJECTIVES
• By the end of the lecture, the students should
be able to;
• Enumerate the layers of anterior abdominal wall
• Describe the muscles in regard to origin
insertion, action and nervesupply
• Describe the extent,boundaries and contents of
inguinal canal
• Enumerate the types of inguinal hernia and the
features
 Functions of the Abdominal Wall

• The main roles of the abdominal wall:

• Forms a firm, flexible wall which keeps the abdominal
viscera in the abdominal cavity
• Protects the abdominal viscera from injury
• Maintains the anatomical position of abdominal viscera
against gravity
• Assists in forceful expiration by pushing the abdominal
viscera upwards
• Involved in any action (coughing, vomiting) that increases
intra-abdominal pressure
 Layers of the Abdominal Wall

• The layers of the abdominal wall consist of (external to

internal):
• Skin.
• Superficial fascia (or subcutaneous tissue).
• Muscles and associated fascia.
• Parietal peritoneum.
 The Superficial Fascia

• The superficial fascia consists of

fatty connective tissue. The
composition of this layer depends
on its location:
• Above the umbilicus: A single sheet
of connective tissue. This
continuous with the superficial
fascia in other regions of the body.
• Below the umbilicus: It is divided
into two layers; the fatty superficial
layer (Camper’s fascia) and the
membranous deep layer (Scarpa’s
fascia). Superficial vessels and
nerves run between these two
layers of fascia.
 Muscles
• Consists of Three broad thin
sheets that are aponeurotic in
front

• From exterior to interior they are:

• External oblique, internal oblique,

and transverse

• A wide vertical muscle, the rectus

abdominis

• They lie on either side of the

midline anteriorly
 External Oblique Muscle
• Is a broad, thin, muscular sheet

• Origin: Lower 8 ribs

• Insertion: Xiphoid process, linea

alba, pubic tubercle, iliac crest

• Nerve Supply: Lower 6 thoracic

nerves, iliohypogastric &
ilioinguinal nerves

• Action: Supports abdominal

contents, assist in forced
expiration, micturition,
defecation, parturition, vomiting
 Internal Oblique Muscle
• Origin: Lumbar fascia, iliac crest,
lateral two-thirds of inguinal
ligament

• Insertion: Lower three ribs and

costal cartilages, xiphoid
process, linea alba, symphysis
pubis

• Nerve Supply: Lower six thoracic

nerves, iliohypogastric &
ilioinguinal nerves

• Action: Supports abdominal

contents, assist in forced
expiration, micturition,
defecation, parturition, vomiting
 Transversus Abdominis
• Origin: Lower six costal cartilages,
lumbar fascia, iliac crest, lateral
third of inguinal ligament

• Insertion: Xiphoid process, linea

alba, symphysis pubis

• Nerve Supply: Lower six thoracic

nerves, iliohypogastric &
ilioinguinal nerves

• Action: Compresses abdominal

contents
 Rectus Abdominis
• Origin: Symphysis pubis and
pubic crest

• Insertion: 5th, 6th and 7th costal

cartilages and xiphoid process

• Nerve Supply: Lower six

thoracic nerves

• Action: Compresses
abdominal contents, flexes
vertebral column, accessory
muscle of expiration
 The Rectus Sheath

• The rectus sheath is formed by the aponeuroses of the three flat

muscles, and encloses the rectus abdominus 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 abdominus.
 The Rectus Sheath
• Approximately midway between
the umbilicus and the pubic
symphysis, all of the aponeuroses
move to the anterior wall of
the rectus sheath.
• At this point, there is no posterior
wall to the sheath; the rectus
abdominus is in direct contact
with the transversalis fascia.
• The area of transition between
having a posterior wall, and no
posterior wall is known as the
arcuate line.
 Clinical Relevance: Surgical Incisions

• There are various incisions used to gain access

to abdominal cavity. In assessing which
incision is best, the surgeon must consider:
• Direction of muscle fibres (split the muscle
fibres rather than cut them)
• Location of nerves
• Ease of access to the desired viscera
 Inguinal Canal
• It is an oblique passage through
the lower part of the anterior
abdominal wall
• Present in both sexes
• It is about 1 ½ inches or 4cm long
in the adults
• Extends from the deep inguinal
ring downward and medially to
the superficial inguinal ring
• Lies parallel to and immediately
above the inguinal ligament
• In the newborn child, the deep
ring lies almost directly posterior
to the superficial ring
 Boundaries

• The inguinal canal is

made up of:
• Anterior and posterior
walls
• Superficial and deep
rings (openings)
• Roof and floor (or
superior and inferior
walls)
Boundaries
 Walls of inguinal canal

• The anterior wall is formed by the aponeurosis of the external

oblique, and reinforced by the internal oblique muscle laterally.
• The posterior wall is formed by the transversalis fascia.
• The roof is formed by the transversalis fascia, internal oblique and
transversus abdominis.
• The floor is formed by the inguinal ligament (a ‘rolled up’ portion
of the external oblique aponeurosis) and thickened medially by
the lacunar ligament.
 Contents

• In men, the spermatic cord passes through the inguinal canal,

to supply and drain the testes.
• In females it permits the passage of the round ligament of the
uterus from the uterus to the labium majus
• Transmits ilioinguinal nerve in both sexes
• The walls of the inguinal canal are usually collapsed around
their contents, preventing other structures from potentially
entering the canal and becoming stuck.
 Superficial Inguinal Ring
• Is triangular in shape

• Lies in the aponeurosis of

the external oblique muscle

• Lies immediately above and

medial to the pubic
tubercle

• Its margins give attachment

to the external spermatic
fascia
 Deep Inguinal Ring
• Is an oval opening in the
fascia transversalis

• Lies about ½ inch (1.3cm)

above the inguinal ligament
midway between the antero
superior iliac spine and the
symphysis pubis

• Margins of the ring give

attachment to the internal
spermatic fascia
 Inguinal triangle
•
 Mechanics of inguinal canal

• The presence of inguinal canal in

the lower part of the anterior
abdominal wall in both sexes
constitutes a potential weakness.
• During periods of increased intra-
abdominal pressure, the
abdominal viscera are pushed into
the inguinal canal.
• To prevent herniation, the
muscles of the anterior and
posterior wall contract, and
‘clamp down’ on the canal.
 clinical Relevance: Inguinal Hernias

• A hernia is defined as the protrusion

of an organ of fascia through the
wall of cavity that normally contain
it.
• Hernias involving the inguinal canal
can be divided into two main
categories:
• Indirect – where the peritoneal sac
enters the inguinal canal through the
deep inguinal ring.
• Direct – where the peritoneal sac
enters the inguinal canal though the
posterior wall of the inguinal canal.
• Both the hernias can present as
lumps in the scrotum or labia
majora.
 Indirect Inguinal Hernias
• This classification of
hernia is the more
common. It has a
congenital origin –
• The peritoneal sac
enters the inguinal
canal via the deep
inguinal ring.
• As the sac moves
through the inguinal
canal, it acquires the
same three coverings
as the contents of the
canal.
 Direct Inguinal Hernia
• It composes about 15% of all
inguinal hernias

• Common in old men with weak

abdominal muscles and rare in
women

• Hernial sac bulges forward

through the posterior wall of the
inguinal canal medial to the
inferior epigastric artery

• The neck of the hernial sac is wide