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Anatomy of Anterior Abdomin al Wall Mohammed El-Matary Lecturer of General Surgery Ain Shams University.

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Presentation on theme: "Anatomy of Anterior Abdomin al Wall Mohammed El-Matary Lecturer of General Surgery Ain Shams University."— Presentation transcript:

1 Anatomy of Anterior Abdomin al Wall Mohammed El-Matary Lecturer of General Surgery Ain Shams University

2 Anterior Abdominal Wall Layer of anterior abdominal wall: A- Lateral: 1- Skin. 2- Subcutaneous tissue. 3- External oblique muscle. 4- Internal oblique muscle. 5- Transversus abdominis muscle. 6- Fascia transversalis. 7- Peritoneum.

3 Anterior Abdominal Wall B- Medial: 1- Skin. 2- Superficial fascia. 3- Anterior wall of rectus sheath. 4- Rectus muscle. 5- Posterior wall of rectus sheath. 6- Peritoneum.

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5 1- Skin A- Lateral

6 2- Subcutaneous tissue A- Lateral

7 3- External Oblique m. A- Lateral

8 4- Internal Oblique m. A- Lateral

9 5- Transversus abdominis m. A- Lateral

10 6- Fascia Transversalis m A- Lateral

11 7- Peritoneum A- Lateral

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13 Anterior Abdominal Wall Layer of anterior abdominal wall: B- Medial: 1- Skin. 2- Superficial fascia. 3- Anterior wall of rectus sheath. 4- Rectus muscle. 5- Posterior wall of rectus sheath. 6- Peritoneum.

14 1- Skin B- Medial

15 2- Subcutaneous tissue B- Medial

16 3- Ant. Wall of Rectus sheath B- Medial

17 4- Rectus Muscle B- Medial

18 B- Medial 5- Post. Wall of Rectus sheath

19 B- Medial 6- Peritoneum

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21 External Oblique Muscle Origin Fleshy digitations from the lower 8 ribs

22 External Oblique Muscle The muscle is inserted by fleshy fibers as well as aponeurosis, as follows: A- Fleshy fibers: Outer lip of the iliac crest B- Aponeurosis: 1.Medial part → linea alba from xiphoid process to symphysis pubis 2.Lateral part → folded upwards & backwards upon itself to form the inguinal ligament (ASIS → pubic tubercle) Insertion Xiphoid Process Symphysis Pubis

23 External Oblique Muscle Direction of fibers Downward Forwards Medially

24 External Oblique Muscle Nerve Supply I II Intercostal nerves (T7 -T11) & Subcostal nerve (T12)

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26 Internal Oblique Muscle Origin Insertion 1.Anterior 2/3 of the intermediate line of the iliac crest 2.The lateral 2/3 of the inguinal ligament 3.Lumbar fascia 1.Lower 6 costal cartilages 2.Xiphoid process 3.Linea Alba 4.Pubic crest

27 Internal Oblique Muscle Direction of fibers Upwards Forwards Medially Nerve Supply T7-T12 Iliohypogastric n. Ilioinguinal n.

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29 Transversus Abdominis Muscle Origin 1- Lower 6 intercostal cartilages 2- Lumbar Fascia 3- Ant. 2/3 of inner lip of iliac crest 4- Lat. 1/3 of inguinal ligament

30 Insertion 1- Xiphoid Process 2- Pubic Crest 3- Linea Alba

31 Direction of fibers Horizontally

32 Nerve Supply T7-T12 Iliohypogastric n. Ilioinguinal n.

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34 Rectus Abdominis Muscle Origin From the pubic crest Insertion 7th, 6th, 5th costal cartilages Xiphoid process

35 Rectus Abdominis Muscle The muscle is divided into segments by tendinous intersections, Which indicate that the muscle arises from a number of myotomes, fused together 1- Segmental nerve supply. 2- Hematoma of rectus m. is localized 2- In paramedian incision  displace m. laterally (n. supply comes from lateral) Surgical Importance

36 Pyramidalis Muscle It is a landmark of linea alba intraoperative

37 Actions of Anterior Abdominal Wall Muscles They assist in raising the intra-bdominal pressure (so, they help in vomiting, cough, delivery, etc….) Keep the abdominal viscera in position. Rectus abdominis flexes the trunk, while the 2 oblique muscles bend the trunk laterally. Act as accessory expiratory muscles. Lower midline & paramedian incisions.

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39 Medially Laterally Rectus Sheath Linea Alba Linea Semilunaris Arcuate Line

40 Falciform Ligament External Oblique Internal Oblique Transversus Abdominis Ant. Layer of Rectus Sheath Post. Layer of Rectus Sheath Rectus Abdominis Above Arcuate Line SKIN Peritoneum Transverslais Fascia

41 External Oblique Internal Oblique Transversus Abdominis Ant. Layer of Rectus Sheath Rectus Abdominis Below Arcuate Line Urachus in Median Umbilical Fold Medial Umbilical Ligament Transverslais Fascia SKIN Peritoneum

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43 Superior epigastric a. Subcostal a. Inferior epigastric a. Deep circumflex iliac a. - I - Internal Mammary a. - III - External Iliac a. - II - Descending Aorta 10th, 11th intercostal a.

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