Illustrated Clinical Anatomy Hodder Arnold
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The abdominal wall and peritoneum
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The anterior abdominal wall

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Figure 5.1 Surface anatomy of the abdominal wall, showing abdominal planes and regions: 1, epigastrum; 2, umbilical; 3, suprapubic; 4, hypochondrium or L and R hypochondrial; 5, lumbar; 6, iliac; 7, transtubercular plane; 8, subcostal plane; 9, transpyloric plane; 10, midclavicular line
Figure 5.2 Abdominal viscera: 1, liver; 2, oesophagus; 3, stomach; 4, spleen; 5, gallbladder; 6, first part of duodenum; 7, head of pancreas; 8, duodenojejunal flexure; 9, transverse colon; 10, ascending colon; 11, descending colon; 12, sigmoid colon; 13, terminal ileum; 14, appendix
 
Figure 5.3 (a) Surface anatomy of anterior abdominal wall: 1, linea alba; 2, tendinous intersections; 3, linea semilunaris; 4, anterior superior iliac spine; 5, inguinal ligament;
 
Figure 5.3 (b) Surface anatomy of anterior abdominal wall: outer musculofascial layer;
 
Figure 5.3 (c) Surface anatomy of anterior abdominal wall: deep layer (external and internal oblique muscles removed);
   
Figure 5.3 (d) Surface anatomy of anterior abdominal wall: inguinal region viewed from within the abdomen
   
Figure 5.3 (e) Surface anatomy of anterior abdominal wall: transverse section at the supraumbilical level;
 
Figure 5.3 (f) Surface anatomy of anterior abdominal wall: transverse section below the level of the arcuate line;
 
 
Figure 5.3 (g) Surface anatomy of anterior abdominal wall: contraction of rectus abdominis emphasizes the ‘6-pack’ produced by the tendinous intersections
 
Figure 5.4 Abdominal incisions: 1, upper midline; 2, right paramedian; 3, transverse; 4, nephrectomy; 5, cholecystectomy; 6, appendectomy; 7, right iliac; 8, lower midline; 9, suprapubic; 10, laparosopic ports
 
Figure 5.5 (a) Inguinal canal: surface anatomy: 1 anterior superior iliac spine; 2 inguinal ligament; 3 iliopsoas muscle; 4 femoral nerve; 5 femoral artery passing beneath mid-inguinal point; 6 femoral vein; 7 origin of pectineus muscle; 8 reflected part of the inguinal ligament (pectineal [lacunar] ligament); 9 symphysis pubis; 10 superficial inguinal ring; 11 position of deep inguinal ring above midpoint of the inguinal ligament
 
Figure 5.5 (b) Inguinal canal: anatomy of the inguinal region, external oblique being divided to demonstrate the course of the inguinal canal
 
Figure 5.5 (c) Inguinal canal: deeper dissection
 
Figure 5.5 (d) Inguinal canal: diagram of horizontal section through the inguinal canal
 
    
Figure 5.5 (e) Inguinal canal: posterior aspect of inguinal region showing inguinal (Hesselbach’s) triangle (thick red lines)
 
Figure 5.6 Inguinal hernia
 
 
Figure 5.7 Right indirect inguinal hernia extending into the scrotum
 
 
Figure 5.8 Umbilical hernia protruding from a grossly distended abdomen, due to ascites
 
 
Figure 5.9 Epigastric hernia accompanying bilateral direct inguinal hernias (because not descending into scrotum)
 
 
 
© Edward Arnold (Publishers) Ltd 2005