The Abdominal Wall

Inguinal and Posterior Abdominal Wall

Lectured by Bien Eli Nillos, MD
 Inguinal Canal
► An oblique passage through the lower
part of the anterior abdominal wall
► Present in both sexes
► Males: spermatic cord and ilioinguinal
nerve
► Females: round ligament of the uterus
and ilioinguinal nerve
► About 1 and ¼ inches long in the adult
► Extends from the deep inguinal ring
which is a hole in the transversalis
fascia, downward and medially to the
superficial inguinal ring which is a hole
in the aponeurosis of the external
oblique muscle.
► Lies parallel to and immediately above
the inguinal ligament
► In the newborn, the deep ring lies
almost directly posterior to the
superficial ring, thus the canal is
considerably short at this age.
► As one grows up, the deep ring moves
laterally
 Deep Inguinal Ring
► Oval opening
► ½ inch above the inguinal ligament
midway betwee the anterior superior
iliac spine and the symphysis pubis
► Medially are the inferior epigastric
vessels
 Superficial Inguinal Ring
► Triangular shaped defect
► Base is formed by the pubic crest
► The crura – margins of the ring, give
origin to the external spermatic fascia
► Anterior wall of the canal – formed by
the aponeurosis of the external
oblique muscle, reinforced in its lateral
third by the fibers of origin of the
internal oblique.
► This wall is therefore strongest where
it lies opposite the weakest part of
the posterior wall --- the deep inguinal
ring
► Posterior Wall of the Canal – formed by
the transversalis fascia, reinforced in
its medial third by the conjoint
tendon (the common tendon of
insertion of the internal oblique and
transversus muscles)
► The wall is therefore strongest where it
lies opposite the weakest part of the
anterior wall --- superficial inguinal
ring.
► Inferior
wall or floor of the canal –
formed by the rolled-under inferior
edge of the aponeurosis of the
external oblique muscle (the inguinal
ligament) and at its medial end the
lacunar ligament
► Superiorwall or roof of the canal –
formed by the arching lowest fibers of
the internal oblique and transversus
abdominis muscle.
► On coughing or straining, the arching
lowest fibers of the internal oblique
and transversus abdominis muscles
contract  flattening out the arched
roof so that it is lowered toward the
floor  making the canal virtually
closed.
 The Spermatic Cord
► Vas Deferens
► Testicular artery
► Cremasteric Artery
► Genital branch of the Genitofemoral
nerve
► Pampiniform plexus
► Lymphatic vessels
► Processus vaginalis
► The spermatic cord is sensitive to
torsion, in which the testicle rotates
within its sac and kinks off its own
blood supply. Testicular torsion may
result in irreversible damage to the
testicle within hours.
 Coverings of the Spermatic
Cord
► Internal spermatic fascia – derived
from the transversalis fascia
► Cremasteric Fascia – derived from the
internal oblique muscle
► External spermatic fascia – derived
from the external oblique aponeurosis
 Scrotum
► Outpouching of the lower part of the
anterior abdominal wall
► Contains the testes, epididymes and
the lower ends of the spermatic cord
► The skin is wrinkled and pigmented
and forms a single pouch
► The slightly raised ridge in the midline
indicates the line of fusion of the two
lateral labioscrotal swellings.
► The superficial fascia is continuous
with the fatty and membranous layers
of the anterior abdominal wall: the fat
is replaced by a smooth muscle 
Dartos muscle
► The Cremaster muscle can be made to
contract by stroking the skin on the
medial aspect of the thigh 
cremasteric reflex
► Tunica vaginalis  lies within the
spermatic fasciae and covers the
anterior, medial and lateral surfaces of
each testis.
► It is a closed sac, invaginated from
behind by the testis.
 Posterior Abdominal Wall
► Formed in the midline by the five
lumbar vertebrae and their
intervetebral discs; laterally by the
12th ribs, the upper part of the bony
pelvis, psoas muscles, the quadratos
lumborum, aponeurosis of origin of the
transversus abdominis muscles.
► The iliacus muscles lie in the upper
part of the bony pelvis
 Psoas Muscle
► Origin: transverse process, bodies and
intervertebral discs of 12th thoracic
and five lumbar vertebrae
► Insertion: with iliacus into lesser
trochanter of the femur
► Nerve supply: lumbar plexus
► Action: flexes thigh on trunk
 Quadratus Lumborum
► Origin: iliolumbar ligament, iliac crest,
tips of the transverse processes of the
lower lumbar vertebrae
► Insertion: 12th rib
► Nerve supply: Lumbar plexus
► Action: Fixes 12th rib during inspiration;
laterally flexes vertebral column same
side
 Iliacus
► Origin: iliac fossa
► Insertion: with psoas into lesser
trochanter of femur
► Nerve supply: femoral nerve
► Action: Flexes thigh on trunk