Abdominal wall

Dr. Alaidaroos

Presentations

• Rectus sheath haematoma

• Desmoid tumour

• Diseases of Umbilicus

ILOs

Anatomy: anterior abdominal wall, inguinal & femoral canal Rectus sheath hematoma & Desmoid tumor: aetiology, clinical presentation & management Groin & Abdominal wall hernias: aetiology, risk factors, presentation, complications & management

Hesselbach Triangle

Weak spot in anterior abdominal wall through which direct hernia appears.

• Medial: Outer border of rectus abdominis
• Lateral: Inferior epigastric vessels
• Below: Medial part of inguinal ligament
• Floor: Fascia transversalis
  • Traversed by medial umbilical fold; (Obliterated Umbilical Artery)

Inguinal Canal (House of Bassini)

• 3.75 cm length
• Extends from deep ring to superficial ring
• Deep ring is a semioval opening in the fascia transversalis
• Superficial ring is a triangular opening in the external oblique aponeurosis

Landmarks

• Deep ring: Half inch above mid point of inguinal ligament (Between anterior superior iliac spine and pubic tubercle) (Remember here: Femoral artery is palpated at Mid inguinal point between ASIS and symphysis pubis)
• Superficial ring: Just above pubic tubercle
• Saphenous opening: 4 cm below and lateral to pubic tubercle

Contents of Inguinal Canal

• Ilioinguinal nerve
• Spermatic cord in male, round ligament in female

round ligaments v spermatic cord

Contents of spermatic cord

• Arteries:
  • Testicular Artery
  • Artery of Vas
  • Artery to Cremaster
• Veins:
  • Pampiniform plexus of veins
  • Veins corresponding to Arteries
• Lymphatics of testis
• Testicular plexus of sympathetic nerves
• Genital branch of genitofemoral N
• Vas deferens

Femoral canal: 2 x 2 cm size

• Medial compartment of femoral sheath
• Base: Femoral ring
• Bounded:
  • Anteriorly: inguinal ligament
  • Posteriorly: cooper’s ligament
  • Medially: lacunar ligament
  • Laterally: femoral vein
• Contents:
  • Cloquet’s node
  • Lymphatics
  • Areolar tissue
• Other names:
  • Inguinal ligament: Poupart’s
  • Lacunar ligament: Gimbernat’s
  • Iliopectineal ligament: Cooper’s
  • Saphenous opening: Fossa ovalis