Anterior Abdominal Wall

and Inguinal Canal

Richard D. Lane, Ph.D.

Professor and Acting Chairman
Department of Neurosciences
Room 103, Block HSB
Rlane@meduohio.edu
 Anterior
Posterior
Abdominal
Abdominal
Wall
Wall
Anterior Abdominal Wall
A. Definitions:
Abdomen:
The portion of the trunk between the
thorax and pelvis

Abdominal cavity:
The space enclosed by the abdominal wall,
Continuous with the pelvic cavity
(abdominopelvic cavity)
Contains the abdominal viscera and peritoneal
cavity

Anterior (anteriolateral) abdominal wall:

Musculocutaneous sheet anchored to the
skeleton (ribs, lumbar vertebrae, pelvis)
Linea
Alba

Linea
Semilunaris

Umbilicus

Anterior
Superior
Iliac Spine
 Umbilicus

ASIS
• Physiology of the Anterior Abdominal Wall:

1. Bend and rotate trunk

2. Support trunk

3. Raise abdominal pressure (Valsalva Maneuver)

Loud speech, vomiting, defecation, child birth
II. Clinical Relevancy
A. Diagnostic
1. Palpate abdominal organs
2. Rigidity and/or rebound tenderness indicate
irritation of the deep surface
3. Enlarged - 5 Fs & 1 T: Fetus, fluid (ascites), fat
(superficial or deep), flatus, feces, and
tumor

B. Surgical
1. Common site of entry into abdominal cavity
2. Repair of inguinal hernia
4 Quadrants
Median plane

RUQ LUQ
Transumbilical plane (TUP)
IV disc between L3 & L4
RLQ LLQ
9 Regions
Midclavicular line (MCL)

E
RH LH
Subcostal plane (L2)
RL U LL

Transtubercular plane (L5)

RI H LI
I. Muscles of the Anterior Abdominal Wall

Innervation: Anterior rami of T7-T12 spinal nerves (Thoracoabdominal

nerves) +/- L1

Combined action: Compress abdominal contents

 Inferior ribs

Rectus Sheath

Anterior ½ iliac crest

Anterior superior Inguinal ligament

Iliac spine
Superficial Inguinal
ring
Pubic tubercle
Lower
ribs

Rectus sheath

Anterior 2/3
Iliac crest
Lateral “1/2” Conjoined tendon =
Inguinal lig. Falx Inguinalis
Attached to pectineal
Line of superior pubic
Ramus
Innervated by the genital branch of the
Genitofemoral nerve (Cremaster reflex, L1) Thin and weak
Ribs and
Costal margin

Thoracolumbar fascia

Iliac crest
Lateral “1/3”
Inguinal ligament
(Does not contribute
a layer to the
spermatic cord)
 Ribs 5-7 &
Xyphoid process

Pubic crest
Pubic symphysis
 Linea alba

Linea
Semilunaris
Arcuate line: The crescent shaped inferior border of the posterior layer of the rectus sheath
Locate approximately 1/3 of the distance from the umbilicus to the pubic crest.
Anterior rami of spinal nerves
Dermatome
Motor - abdominal muscles
Sympathetics – sweat glands, blood v.
T7
Sensory - skin, muscles, and parietal
peritoneum

Travel between the internal oblique and

transverse abdominus muscles, pierce
the rectus sheath to supply the rectus
abdominus and provide ant. cutaneous
branches. T10

T7-T11 Thoracoabdominal nerves

T12 Subcostal nerve
L1 Iliohypogastric nerve
L1 Ilioinguinal nerve

L1
 Internal thoracic

Musculophrenic

(small vessel)

Posterior
intercostal

Subcostal

External Iliac

Femoral
Superficial epigastric
Superficial circumflex iliac
 subcostal

Paramedian

Median

X
McBurney’s
ASIS point

Suprapubic
• Inguinal Canal
• An oblique intermuscular passage through the inferior portion of the anterior
abdominal wall.

• During development, it serves as a route of passage for the testes from the
posterior abdominal wall to the scrotum.

• It contains the spermatic cord in males and the round ligament in females.

• It runs parallel and superior to the inguinal ligament along the medial one-
half of the ligament.

• It is 4-5 cm in length.

• It runs deep (lateral) to superficial (medial).

• It extends from the deep inguinal ring (lateral) to the superficial inguinal ring
(medial).
•
 Medial
Crus
Lateral
Crus
Intercrural
fibers
Spermatic cord
Contents
Ductus deferens
Testicular A., Vas A.
Pampiniform plexus
lymph vessels
Nerves

Layers
External spermatic f.
Cremasteric fascia
Internal spermatic f.
-Transversalis f.

Hydrocele
excess fluid in a
persistent process
vaginalis
Cord or testis
Blood supply
Nerve supply
Lymphatic drainage
XII Clinical Correlation: Inguinal Hernias

Hernia: the abnormal protrusion of a

structure from the cavity in which it
belongs.

Inguinal hernia: abdominal hernia through

the anterior abdominal wall in the inguinal
region
Direct: Leaves the abdominal cavity medial to the inferior epigastric artery
(within the inguinal triangle).
Travels anteriorly through the posterior wall of the inguinal canal that is formed by
transversalis fascia and exits via the superficial inguinal ring, hence only the medial
portion of the inguinal canal is traveled.
Covered by one or two layers of the spermatic cord.
Transversalis fascia forms the hernial sac.
Less common than indirect hernias, usually occurs in men older than 40 years.
Indirect: Leaves the abdominal cavity lateral to the inferior epigastric
artery
Travels through the deep inguinal ring, the entire inguinal canal, and the
superficial inguinal ring.
Originates lateral to the inferior epigastric vessels.
Covered by all three layers of the spermatic cord.
The remains of the process vaginalis forms the hernial sac.

20 times more common in males than females .

Boundaries of the Inguinal Triangle