Anterior Abdominal Wall,

Inguinal Canal, Abdominal

viscera in situ, External Genitalia
Dissection Approach Lecture
9 Abdominal Regions
 4 Abdominal Quadrants
Median sagittal
plane
Transumbilical
plane
Osteology
1. Xiphisternal junction
➢ Where the xiphoid
process meets the body of
the sternum
2. Xiphoid process
➢ Most inferior part of the
sternum
3. Costal Margin
➢ 7th- 10th Costal cartilages
 Osteology
1. Pubic crest
➢ Broad upper boarder of the
body of the pubis
2. Pubic tubercle
➢ Forward projecting tubercle
on medial aspect of superior
ramus of pubis
3. Pubic Symphysis
➢ Cartilaginous joint between
the bodies of the right and
left pubis
4. Iliac crest
5. Iliac tubercle
6. Anterior Superior Iliac Spine
Osteology
1. Pubic crest
2. Pubic tubercle
3. Pubic Symphysis
4. Iliac tubercle
➢ Attachment for the origin of the
iliotibial tract
5. Iliac crest
➢ Superior border of the ilium
6. Anterior Superior Iliac Spine
➢ Spine like projection at the
anterior end of the iliac crest
Palpable Structures
1. Xiphoid process
2. Costal Margin
3. Umbilicus
4. Anterior Superior Iliac
Spine
5. Pubic tubercles
6. Inguinal ligament
Reflect the skin
 Right image: Both Camper’s and
Scarpa’s fascia have been reflected-

Subcutaneous tissue scarpa’s fascia on the posterior surface

of the reflected ‘flap’ of fascia.

➢ Highly variable amount of fat

(adipose)
➢ 2 layers of fascia
1. Camper’s fascia- the most
supericifical layer of fascia, a
fatty layer.
2. Scarpa’s fascia- deep layer,
just superficial to the rectus
sheath, a membranous layer.

Camper’s fascia Scarpa’s fascia

 Green areas are continuous: Scarpa’s,
Colle’s, and dartos fasca.
• Scarpa’s fascia (the deep,
membranous one) is
continuous with Colle’s
fascia
• Scarpa’s fascia is NOT
continuous with fascia lata
(fascia of the thigh)
• Relevance?
• Ruptured urethra in the
region of the bulb of the
penis
 Ruptured urethra
• Straddle injury (gymnast
tripping on the beam and
landing with left and right legs
on each side of the bar)
• Blunt or sharp trauma
• At the site of penile fracture

• Urine will flood to the

abdomen, the scrotum, the
penis because these area’s are
covered by fascial layers that
are continuous with each
other.
 Linea alba translates to ‘white line’ in
Latin.

1. Linea alba
➢ Aponeurotic raphe
running from xiphoid
process to public
symphysis
2. Semilunar lines
3. External oblique muscle
4. Anterior lamina of the rectus
sheath
1. Linea alba
2. Semilunar lines
➢ One on each side of rectus
abdominis
➢ Mark the point where the
aponeurosis of internal
oblique splits to encase the
rectus sheath
3. External oblique muscle
4. Anterior lamina of the rectus
sheath
1. Linea alba
2. Semilunar lines
3. External oblique muscle
➢ Fibres travel inferiorly as
they pass anteromedially
➢ Immediately deep to
subcuteanous tissue
4. Anterior lamina of the rectus
sheath
1. Linea alba
2. Semilunar lines
3. External oblique muscle
4. Anterior lamina of the rectus
sheath
➢ Formed by the aponeuroses
of external and internal
oblique superior to arcuate
line
➢ Below arcuate line- formed
by the aponeuroses of
external and internal oblique
and transversus abdominis
Rectus sheath

Above

Arcuate line

Below
 Arcuate Line
➢Seen in the Posterior Internal oblique
lamina of the rectus Transversus abdominis
Transversalis fascia
sheath

➢Below the arcuate line,

rectus abdominis backs
directly onto the
transversalis fascia

Transversalis fascia
 External surface of ribs 5-12
External Oblique  linea alba, pubic
tubercle, anterior iliac crest

FREE EDGE
 Thoracolumbar
Internal Oblique fascia, anterior
2/3 iliac crest
 linea alba,
inferior borders
of ribs 10-12,
pectin pubis
(pectineal line)

*Torsion of the
trunk
 Internal surfaces of
Transversus abdominis the 7th -12th costal
cartilages,
thoracolumbar
fascia, iliac crest 
Linea alba, pubic
crest, pectin pubis
Rectus abdominis Tendinous
intersection

Pubic symphysis, pubic crest 

Xiphoid process, 5th – 7th costal
cartilages

Anterior
lamina of
rectus
sheath
Pyramidalis
Pubic crest  Linea
alba

*Located within the rectus sheath

 Superior and Inferior
epigastric vessels
➢ Found in the rectus sheath
➢ Inferior- branches from external iliac, travels
superiorly and pierces the transversalis fascia to
enter rectus sheath, posterior to rectus abdominis
➢ Superior- terminal branch of internal thoracic
artery, pierces through posterior lamina of rectus
sheath to travel within the sheath, posterior to
rectus abdominis
➢ Veins follow arteries
➢ Deep to rectus abdominis
➢ Anastomose above the umbilicus
➢ Very difficult to distinguish arteries from veins
because they are closely associated to each other
Superior and Inferior
epigastric vessels
• 1 x Median umbilical fold
• Remnant of urachus
• 2 x Medial umbilical fold
• Remnant of obliterated
umbilical arteries
• 2 x Lateral umbilical fold
• Inferior epigastric vessels
• On the internal aspect of
the anterior abdominal
wall
 Iliohypogastric nerve
1. Pierces transversus abdominis
and internal oblique- will
contribute to the innervation of
both
2. Differentiated from ilioinguinal
nerve by location- pierces
through transversus abdominis
and internal oblique more
superior and posterior than
ilioinguinal
 Ilioinguinal nerve
1. Pierces through transversus
abdominis, below
iliohypogastric nerve
2. Passes through superficial
inguinal ring but not deep
inguinal ring (therefore is only
in part of the inguinal canal)
3. You can use this information
to identify this nerve- follow
it’s course- it will travel
towards the genitals
Iliohypogastric
nerve

Ilioinguinal
nerve
Inguinal Canal:
Male
Anterior Wall: External Oblique Aponeurosis
Floor: Inguinal Ligament
Superficial inguinal ring: Defect in the external
oblique aponeurosis

Spermatic
cord
Roof: Arching fibres of transversus abdominis
and conjoint tendon
Deep inguinal ring: structures of the spermatic
cord pass through transversalis fascia
Posterior Wall: Transversalis fascia and
Conjoint tendon
The Inguinal Canal
Hesselbach’s Triangle: Common site for Direct Hernia

Medial border= lateral Superior

border of rectus abdominis

Lateral border= medial

‘border’ of inferior epigastric
vessels Lateral Medial

Inferior border= Inguinal

ligament

Inferior
HINT: Round ligament
medial/inferior and
often larger
Inguinal Canal: Female

Round
ligament

Round
ligament Ilioinguinal
nerve

Ilioinguinal
nerve
HINT: Usually visible
on top of spermatic
cord if it has been left
Ilioinguinal nerve: Male
uncut
 The Scrotum
1. Using the spermatic cord as a guide
to location, cut through the skin
and reflect to reveal dartos fascia

2. Dartos fascia- continuous with

Colle’s fascia which is continuous
with Scarpa’s fascia.

3. Very superficial and usually

reflected away with the skin
Scrotal Septum Scrotal Liagment
External Spermatic Fascia

➢ Can be identified by what else you

can see

➢ Formed from the investing fascia of

External Oblique
Cremasteric Fascia

➢Differentiated in relation
to the other layers OR
by the visible presence
of muscle fibres
Internal Spermatic fascia

➢Differentiated in relation to the other

layers
➢It must be clear in the image which
layers have been dissected away
➢Remember that the Internal spermatic
fascia is the last layer you would open
before you are looking at spermatic
cord contents
Vas Deferens
Testicular artery
➢Very closely
associated with
Pampiniform plexus

➢Extends from superior

pole of the testis

➢Error in textbook*
HINT: Testicular artery
usually very tortuous
Pampiniform plexus

➢Multiple venous structures,

branching between each
other

➢Very close to testicular artery

➢Become one vein at the level

of the deep inguinal ring
Tunica vaginalis Parietal layer

Visceral layer

HINT: Usually
smooth and shiny
compared to
fascia coverings
 Testes
➢ Tunica albuginea
i. Usually demonstrated on a cross-
section of a testis because
visceral layer of tunica vaginalis
cannot be dissected from the
surface
ii. Thick, blue-grey outer covering of
the testis

➢ Seminiferous tubules
i. Production of spermatozoa
ii. Gives the tissue inside the testis
a kind of ‘fluffy’ appearance
Epididymis

Head

Body

Tail
 Greater
omentum

Parietal Visceral
peritoneum peritoneum
 Falciform ligament

Spleen

Liver
Left colic
flexure
Right colic
flexure Stomach
Ascending
Descending colon
colon
Transverse colon

Caecum Ileum
 Falciform ligament
Liver
Stomach

Transverse colon

Jejunum
Ascending colon

Ileum
Sigmoid colon
Caecum
*The gloved finger is
traveling through
the Epiploic foramen
into the lesser sac

Lesser
Omentum
 Liver
Hepato-duodenal
ligament (free
edge of lesser
omentum)

Hepato-gastric Duodenum Stomach

ligament
(membranous)
Mesentery
proper

Sigmoid
mesocolon
 Transverse Greater
colon omentum
(reflected (reflected
superiorly) superiorly)

Transverse
mesocolon

Appendix
Mesoappendix