Clinical Anatomy of the
Anterior Abdominal Wall
in its Relation to Hernia
Handout download:
http://www.oucom.ohiou.edu/dbms-witmer/gs-rpac.htm
Lawrence M. Witmer, PhD
Professor of Anatomy
Department of Biomedical Sciences
26 April 2011 College of Osteopathic Medicine
Ohio University, Athens
[email protected] Anatomical Overview
External Internal Transversus Rectus
oblique oblique abdominis abdominis
fleshy
rectus
portion
sheath
aponeurotic inguinal tendinous
portion ligament intersections
Three flat abdominals: attach to trunk skeleton, inguinal lig., linea alba, etc.;
fleshy laterally and aponeurotic medially, forming rectus sheath medially
Two vertical abdominals: rectus abdominis and pyramidalis (not shown)
Moore et al. 2010
Anatomical Overview
intramuscular exchange of intermuscular exchange of
contralateral external oblique fibers contralateral external & internal oblique
right
external
oblique
left
internal
oblique
continuity of external oblique continuity of fibers across midline
fibers across midline digastric muscle with central
blending of superficial & deep tendon
fibers on opposite side torsion of trunk
Moore et al. 2010
Anatomical Overview
linea alba rectus sheath transv. abd.
rectus abdominis int. obl.
ext. obl.
semilunar line
peritoneum
transversalis fascia
aponeuroses of
abdominal mm.
tendinous fasciae: Scarpas, Campers
intersections
Moore et al. 2010
Anatomical Overview
anterior lamina
of rectus sheath semilunar
line (of Spiegel)
inferior epigastric
vessels
posterior lamina
internal of rectus sheath
oblique (aponeurotic)
iliohypogastric n. arcuate line
(semicircular)
ilioinguinal n. line of Douglas)
posterior lamina
of rectus sheath
(transversalis fascia)
Moore et al. 2010
Anatomical Overview
Anterior Abdominal Hernias
rectus sheath
linea alba
umbilicus
semilunar line
superficial
inguinal ring
femoral
canal
hernia.tripod.com/types.html Moore et al. 2010
Epigastric (Ventral) Hernia linea alba
thachers.org/images/epigastric_hernia.jpg
thachers.org/images/hernia_repair.jpg
scar
repaired hernia
hernial sac health.enotes.com/images/
medicine/gem_03_img0340.jpg
anterior rectus
rectus sheath
abdominis
posterior rectus
sheath
Skandalakis Surgical Anatomy 2004 hernial sac peritoneum
Umbilical (Para-umbilical) Hernia
Congenital Acquired Umbilical Hernia
Umbilical occur after closure of umbilical ring
Hernia 2 to obesity, pregnancy, cirrhosis,
ascites, masses
medicine.ucsd.edu/clinicalimg/
abdomen-umbo-hernia4.jpg
incomplete closure of umbilical ring
Omphalocele
2 to ascites
1988 Moore Developing
Human 4th edition Skandalakis Surgical Anatomy 2004
Spigelian (Lateral Ventral) Hernia
CT rectus sheath:
semilunar posterior & anterior lamina
line
arcuate
line
frequent
hernial
www.e-radiography.net/ibase5/Abdomen/ site
slides/Abdomen_spigelian_hernia_ct.jpg
transversalis
fascia
rectus
Skandalakis Surgical
Anatomy 2004 abdominis
Moore et al. 2010
Case Presentation
A 3-year-old boy presents with a walnut-sized bulge in his left
groin, particularly when he stands, strains, or cries. With the
patient horizontal, the lump disappears. When the skin of the
scrotum is invaginated by a little finger, a definite impact is felt on
coughing. The diagnosis of hernia is made. How would this hernia
be best characterized?
at rest upon straining
reducible, congenital, indirect inguinal hernia
pediatriconcall.com/forpatients/commonchild/images/inguinal_hernia.jpg
Embryological Basis of Indirect Inguinal hernia
Week 7
testis in
abdomen
Moore et al. 2010
Embryological Basis of Indirect Inguinal hernia
Week 28
testis
descends
patent processus vaginalis
Moore et al. 2010
Embryological Basis of Indirect Inguinal hernia
Week 36
testis in
scrotum
processus vaginalis closed
Moore et al. 2010
Embryological Basis of Indirect Inguinal hernia
transversalis fascia
& peritoneum hernial sac
within
abdominal spermatic
muscles cord
partially vas deferens
obliterated
processus pampiniform
vaginalis plexus
epididymis
testis
tunica
vaginalis
Cahill 1997
Inguinal Anatomy
ASIS external
oblique
aponeurosis
& Gallaudets
superficial fascia
circumflex
iliac intercrurual
vessels fibers
superficial medial
epigastric crus
vessels
lateral
crus &
great
inguinal lig.
saphenous
v. ilioinguinal
external n. (L1)
superficial (external)
pudendal spermatic cord
inguinal ring
vessels
Moore et al. 2010
Inguinal Anatomy
inguinal lig.
(of Poupart) myopectineal orifice
internal
inguinal ring of Fruchaud
reflected
inguinal lig.
femoral n.
external iliac
vessels
femoral canal
pectineus pectineal lig. lacunar lig.
(of Cooper) (of Gimbernat)
Moore et al. 2010
Inguinal Anatomy
testicular vessels vas deferens
TF P internal
TA
IO ring
EO Space of
Bogros
ilioinguinal n. external
Moore et al. 2010 conjoint tendon ring
Inguinal Anatomy
shelving edge
of ing. lig.
Moore et al. 2010
Inguinal Anatomy
iliopubic tract
shelving edge
of inguinal parasagittal section
ligament through right side
Skandalakis Surgical Anatomy 2004
lateral umbilical fold arcuate line inferior epigastric vessels
iliopubic iliopubic
tract tract
iliopsoas
testicular
external vessels
iliac vessels deep
Hesselbachs ing. ring
Triangle femoral canal
posterior view of
anterior abdominal wall vas deferens Moore et al. 2010
Hesselbachs (Inguinal) Triangle
posterior view
of anterior
abdominal wall
internal
inguinal
ring
indirect
inguinal hernia
direct inguinal hernia
Moore et al. 2010
Femoral Hernia
femoral canal
lacunar lig.
(of Gimbernat)
Skandalakis Surgical Anatomy 2004
References
Cahill, D. R. 1997. Lachmans Case Studies in Anatomy, 4th Ed.
Oxford University Press, New York.
Moore, K. L., A. F. Dalley, and A M. R. Agur. 2010. Clinically
Oriented Anatomy, 6th Ed. Lippincott, Williams & Wilkins,
Baltimore.
Moore, K. L. and T. V. N. Persaud. 2003. The Developing Human.
Clinically Oriented Embryology, 7th Ed. Lippincott, Williams &
Wilkins, Baltimore.
Skandalakis, J. E., G. L. Colborn, T. A. Weidman, R. S. Foster, A.
N. Kingsnorth, L. J. Skandalakis, N. P. Skandalakis, P. Mirilas
(Editors). 2004. Surgical Anatomy: The Embryologic And Anatomic
Basis Of Modern Surgery. McGraw-Hill, New York.
