Anatomy of the Inguinal Region: Structures and Divisions of the Abdominal Wall, Exams of General Surgery

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Anterolateral Abdominal Wall

And

By

Prof. Saeed Abuel Makarem

Inguinal Region

• The groin or the inguinal region, extending between the

ASIS and pubic tubercle.

• Surgically and anatomically, it is a very important area

where structures enter and exit the abdominal cavity.

• It is a potential site for Herniation.
• In fact , the majority of all abdominal hernias, occur in

this region in particular the inguinal hernia , which

account for about 80 to 90 % of all abdominal hernias.

The transpyloric plane

&The intertubercular plane

The Rt. & Lt. lateral vertical planes

divisions of the abdomen

The anterior abdominal wall

9 regions by

is divided into

2 transverse lines

and 2 vertical line

Epigastrium

Umbilical

3 on the right side & 3 on the left side

Divisions of the abdomen

Rt. & Lt. Lumbar region

The 9 regions are

Rt. & Lt. Hypochondrium

3 in the middle

Hypogastrium

Rt. & Lt. Iliac region

From above downward

From above downward

Origin:

Outer surface of lower 8 ribs.

Direction of its fibers : Downward, Forward, and Medially.

Insertion: Xiphoid process, Linea alba, Symphysis pubis Pubic crest, Pubic tubercle, ASIS. Anterior ½ of outer lip of iliac crest.

External Oblique

Femoral ring

Layers of the Anterior

Abdominal Wall

1- Skin.

2- Superficial fascia:

a- Superficial fatty layer, (Camper’s fascia) b- Deep membranous layer, (Scarpa’s fascia) No Deep Fascia in the anterior abdominal wall

3- External oblique muscle. 4- Internal oblique muscle. 5- Transversus abdominis muscle. 6- Fascia Transversalis. 7- Extraperitoneal fatty Tissue. 8- Peritoneum.

Superficial Inguinal Ring: It’s an oval slit in the lower aponerotic fibers of the External oblique just above & lateral to the pubic tubercle. The lateral crus attaches to pubic tubercle & the medial crus attaches to pubic crest. Its base is formed by the lateral part of pubic crest

Transversus

Abdominis

Origin:

• Lateral 1/3 of inguinal ligament,
• Anterior 2/3 of inner lip of iliac crest,
• Lumber fascia and
• Lower 6 costal cartilages.

Direction of its fibers :

• Horizontally.

Insertion:

• Xiphoid Process,
• Linea alba,
• Pubic crest, and
• Pectineal line.

• It is an oblique intramuscular passage in the lower medial part of the Anterior Abdominal Wall.
• It runs just above and parallel to the medial half of the inguinal ligament.
• Its length is about 2 inches (5 cm), long in adult.
• Its gives a passage for the spermatic cord in male, or round ligament of the uterus in female.
• Also it gives a passage for the Ilioinguinal nerve in both sexes.
• It connects between the superficial and deep inguinal rings.

INGIUNAL CANAL

Deep Inguinal Ring

It is an opening in

the fascia

transversalis 1 cm

above the middle

of the inguinal

ligament (midpoint

of inguinal ligament point)

It lies lateral to

the inferior

epigastric vessels

INGUINAL CANAL Anterior. Wall: External oblique along whole length Internal oblique along lateral half. Posterior. Wall: Fascia Transversalis along whole length. Conjoint tendon along the medial part. Reflected ligament along the medial part.

Deep ring Superficial inguinal ring

Anterior wall: Internal oblique along lateral half.

Deep Inguinal Ring: Its an opening in the fascia transversalis 1cm above the middle of the inguinal ligament and lateral to the inferior epigastric vessels.

Posterior wall