GOSS ANATOMY OF THE
ANTERIOR ABDOMINAL WALL
& RECTUS SHEATH
D. S. Amaza (Ph.D.): Professor of Anatomy
Department of Anatomy
Kaduna State University
Structure of Abdominal Cavity
Superiorly it is formed by diaphragm which
separates the abdominal cavity from the
thoracic cavity
Inferiorly the abdominal cavity is
continuous with the pelvic cavity through
the pelvic inlet
Structure of Abdominal Wall
Anteriorly:
The abdominal wall is formed above by
lower part of the thoracic cage
Below by the rectus abdominis, external
oblique, internal oblique, and transversus
abdominis muscles and fasciae
Structure of Ant. Abdominal Wall
It is made up of skin, superficial fascia,
deep fascia, muscles, extraperitoneal
fascia and parietal peritoneum
The abdominal walls are lined by a fascial
envelope and the parietal peritoneum
Skin
Natural lines of cleavage in the skin are
constant and run almost horizontally
around the trunk
An incision along a cleavage line will heal
as a narrow scar, while one that crosses
the lines will heal as a wide scar
Cutaneous Nerve Supply
Is derived from the anterior rami of the lower
six thoracic and first lumbar nerves
Thoracic nerves are the lower five intercostal
and the subcostal nerves
First lumbar nerve is represented by the
iliohypogastric and ilioinguinal nerves
Blood Supply
Skin near the midline is supplied by branches
of the:
Superior Epigastric artery (br. of Internal Thoracic
Artery)
Inferior Epigastric Artery (br. of External Iliac
Artery)
Skin laterally are supplied by branches from
the intercostal, lumbar, and deep circumflex
arteries
Superficial Fascia
Fatty layer or fascia of camper is continuous
with the superficial fat over the rest of the
body and may be extremely thick in obese
patients
The membranous layer or scarpa’s fascia is
thin and fades out laterally and above
Becomes continuous with the superficial
fascia of the back and the thorax
Superficial Fascia
Inferiorly the membranous layer passes onto the
front of the thigh, where it fuses with the deep
fascia
In the midline inferiorly forms a tubular sheath for
the penis or clitoris
Below in the perineum, enters wall of the scrotum
or labia majora
From there it passes to be attached on each side
to the margins of pubic arch, here it is called
Colle’s fascia
Superficial Fascia
Posteriorly it fuses with the perineal body
and the margin of the perineal membrane
The fatty layer is represented as a smooth
muscle in the scrotum, the dartos muscle
The membranous layer persists as a
separate layer
Deep Fascia
Deep fascia in the anterior abdominal wall is
merely a thin layer of connective tissue
covering the muscles
It lies immediately deep to the membranous
layer of the superficial fascia
Muscles
Consists of Three (3) 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
Muscles
As the aponeurosis of the three sheets pass
forward, they enclose the rectus abdominis
to form the rectus sheath
The cremaster muscle which is derived from
the lower fibers of internal oblique, passes
inferiorly as a covering of the spermatic cord
and enters scrotum
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 and vomiting
External Oblique Muscle
A triangular shaped defect in the external
oblique aponeurosis lies immediately above
and medial to the pubic tubercle, known as
superficial inguinal ring
Between the antero-superior iliac spine and
the pubic tubercle, the lower border of the
aponeurosis is folded backward on itself,
forming the inguinal ligament
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
and 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
Nerve Supply to the Muscles
The four muscles = EO, IO, TA and RA are all
supplied by T7 – T12 nerves
In addition IO and TA are supplied by
branches of L1 nerves while
Pyramidilis muscles is supplied by T12 only.
Note: external = 8 letters; EO takes origin from
external surfaces of lower 8 ribs and
interdigitates with Serratus (8 letters) anterior
in middle 4 ribs = 5 - 8 ribs
Remember
• 1. IO takes origin from iliac crest + L – Lumbar
fascia + L – Inguinal Ligament
• 2. TA takes origin from iliac crest + L – Lumbar
fascia + L – Inguinal Ligament and inner surfaces of
Lower 6 ribs interdigitating with the origin of the
diaphragm.
Insertions of Abdominal Muscles
• 3. EO = Linea alba + pubic crest + pectineal line +
Iliac crest
• 4. IO = Linea alba + pubic crest + Iliac crest +
pectineal line + tips of lower 6 ribs
• 5. TA = Linea alba + pubic crest + pectineal line
Lymph Drainage
Lymph drainage of the skin of anterior abdominal
wall above the umbilicus is upward to the anterior
axillary (pectoral group of nodes)
Below the level of umbilicus drains downward and
laterally to the superficial inguinal nodes
Swelling in the groin may be due to enlarged
superficial inguinal node
Venous Drainage
Venous blood is collected into a network of veins
that radiate from the umbilicus
The network is drained above into the axillary vein
via the lateral thoracic vein
Below into the femoral vein via the superficial
epigastric and the great saphenous veins
Few small veins, the paraumbilical veins form a
clinically important portal-system venous
anastomosis
Caput Medusae
The superficial veins around the umbilicus
and the paraumbilical veins connecting them
to the portal vein may become grossly
distended in case of portal vein obstruction
The distended subcutaneous veins radiate
out from the umbilicus, producing in severe
cases the clinical picture called Caput
Medusae
Nerves
Nerves of the anterior abdominal wall supply the
skin, muscles and the parietal peritoneum
They are derived from the anterior rami of lower
six thoracic and the first lumbar nerves
Inflammation of parietal peritoneum causes pain
in the overlying skin and
also a reflex increase in tone of the abdominal
musculature in the same area
Rectus Sheath
Is a long fibrous sheath
Encloses the rectus abdominis and pyramidalis
muscle (if present)
Contains the anterior rami of lower six thoracic
nerves and the superior and inferior epigastric
vessels and lymph vessels
Formed mainly by aponeurosis of three lateral
abdominal muscles
RECTUS SHEATH
The rectus sheath is a long sheath enclosing
the rectus abdominis & pyramidalis muscles,
on anterior abdominal wall
Components
It is formed by the aponeuroses of the 3
lateral abdominal muscles
1. external oblique
2. internal oblique
3. transversus abdominis
Description It is considered at 3 levels
(A) Anterior to ribs above the costal margin,
(B) Between costal margin and an imaginary
line midway between the umbilicus and
pubis symphysis
(C) below the imaginary line up to pubic
symphysis.
(a)Above the costal margin, the anterior sheath comprises the external
oblique aponeurosis only; posteriorly lie the costal cartilages.
(b)From the costal margin to a point half-way between umbilicus and
pubis, the external oblique and the anterior part of the internal
oblique aponeurosis form the anterior sheath. Posteriorly lie the
posterior part of this split internal oblique aponeurosis and the
aponeurosis of transversus abdominis.
(c)Below a point half-way between umbilicus and pubis, all the
aponeuroses pass in front of the rectus so that the anterior sheath
here comprises the tendinous expansions of all three oblique
muscles blended together. The posterior wall at this level is made
up of the only other Structures available—the transversalis fascia,
(the thickened extraperitoneal fascia of the lower abdominal wall),
and peritoneum.
Rectus Sheath
For description it is considered at three
levels:
Above the costal margin the anterior wall is
formed by the aponeurosis of the external
oblique and posterior wall is formed by the
thoracic wall
Thatis the 5th , 6th and 7th costal cartilages
and the intercostal spaces
Rectus Sheath
Between the costal margin and the level of
the anterosuperior 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
Transversus aponeurosis is directed
behind the muscle
Rectus Sheath
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
The rectus muscle lies in contact with the
fascia transversalis
Rectus Sheath
Theposterior wall of the rectus sheath is
not attached to the rectus abdominis
muscle
Theanterior wall is firmly attached to it by
the muscle’s tendinous intersections
Contents of Rectus Sheath
A. 2 Muscles: Rectus Abdominis & Pyramidilis
B. 2 Arteries: Superior Epigastric artery
(branch of internal thoracic artery) and Inferior
Epigastric artery (branch of external iliac
artery).
C. 2 Veins Superior Epigastric vein (drain into
internal thoracic vein) and Inferior Epigastric
artery (drain into external iliac vein).
D. 6 nerves T7 – T12.
Remember the Rectus Sheath
3 levels A, B, and C
1. Anterior wall:
Level A = 1 muscle EOA
Level B = 2 muscles EOA & IOA
Level C = 3 muscles EOA, IOA & TA
2. Posterior wall:
Level A = 1 bony hard (ribs 5, 6 & 7)
Level B = 2 muscles OA & TA
Level C = 3 soft (fascia transversalis)
