Muscle mass of the anterior abdominal wall consists of rectus, oblique and transverse abdominal muscles (Fig. 1.3,1.4).

In the anterior section are the rectus abdominis muscles, in the anterolateral section - the external and internal oblique, transverse muscles.

rectus abdominis, m. rectus abdominis, starts from the outer surface of the cartilages of the V-VII ribs and the xiphoid process, is attached by a powerful tendon to the pubic bone.

Muscle fibers m. rectus abdominis are interrupted by transverse connective tissue bridges. Two of them are above the navel, one is at the level and one is below the navel.

Tendon bridges make it difficult to isolate the anterior surface of the rectus muscle during surgery.

Blood supply and innervation is carried out by the branches of the six lower

Rice. 1.5. General form pyramidal (1) and rectus abdominis muscles (2). The neurovascular bundle is visible, approaching the middle third of the pyramidal muscle (3)

intercostal arteries and nerves, as well as the superior and inferior epigastric arteries, the iliac-inguinal and iliac-hypogastric nerves, suitable mainly from the lateral-posterior surface.

That is why paramedian incisions, which are carried out along the medial edge of the rectus muscle with the opening of the walls of its vagina, do not entail significant damage to blood vessels and nerves.

Pararectal incisions along the outer edge of the muscle are therefore recommended to be made no more than 8-10 cm (Kolesov V.I. 1972; Rusanov A.A. 1979).

pyramidal muscle, t. rura-midalis, located anterior to m. gestus abdominis (Fig. 1.5). It, according to our data, has a triangular shape, 3-8 mm thick, starts from the pubic bone and ends at different levels of the lower parts of the white line of the abdomen.

In 82% of observations m. pyramidalis lies in a thin fascial case surrounded by a layer of loose fiber easily separated from the rectus abdominis muscle and moved outward to cover the high inguinal gap

In 18% of cases, the muscle can be mobilized for plastic purposes only in an acute way, since it is defined as a muscle elevation on the m.rectus abdominis. Fiber m. pura-midalis are separated by layers of its unity tissue and several thicknesses of fibers of the rectus muscle.

The length of the pyramidal muscle is 6.4-8.5 cm.

The width at the base is 1.2-3.2 cm. The average area is 7 square centimeters.

With an average area of ​​the inguinal gap of 10 square centimeters, the mobilized pyramidal muscle can sufficiently cover it, eliminating weakness.

At the same time, the blood supply and innervation are not disturbed, since the lower two-thirds of the pyramidal muscle moved to the inguinal region are well provided with preserved neurovascular bundles suitable for its upper third.

Anterior wall of the sheath of the rectus abdominis formed in the upper two thirds by the aponeurosis of the external and superficial leaf of the internal oblique muscles, in the lower third by the aponeuroses of all three muscles (external oblique, internal oblique and transverse).

The back wall of the vagina m. rectus abdominis in the upper two-thirds is formed by sheets of aponeurosis of the internal oblique (deep sheet) and transverse muscles.

In the lower third, the rectus muscle is adjacent to the transverse fascia and peritoneum.

The line of the break of the posterior wall of the vagina m. rectus abdominis, passing about 4-5 cm below the navel, is called the semicircular (Douglasi) line, linea arcuata.

It is a good guide and the most common site for hernia formation at the outer edges of the rectus abdominis muscles.

White line of the abdomen defined as a narrow tendon strip from the xiphoid process to the symphysis with a maximum width (2.5-3 cm) at the navel. It is formed by bundles of aponeuroses of the oblique and transverse muscles that intersect along the midline.

In the white line there are slit-like openings through which the vessels and nerves pass.

Preperitoneal fatty tissue can also come out here, forming preperitoneal lipomas. The holes in such cases increase and may be the site of the formation of hernias of the white line of the abdomen.

The incisions here must be made taking into account the anatomical layers.

After dissection of the skin, subcutaneous tissue, superficial and proper fascia, the tendon layer of the white line is easily exposed, under which the transverse fascia is located.

The layer of loose preperitoneal tissue above the navel is weakly expressed, therefore, when suturing in this area, the white line is usually captured along with the peritoneum.

Below the umbilicus there is a sufficient layer of preperitoneal tissue, which makes it possible to suture the peritoneum and the linea alba separately without much tension.

The ligatures on the linea alba above the umbilicus experience significant tension, as the edges of the incision diverge to the sides under the influence of the traction of the oblique and transverse muscles.

In the region of the umbilical ring there are the following layers: skin, scar connective tissue, transverse fascia and peritoneum. Subcutaneous adipose tissue is absent here.

In the anterolateral abdomen, the muscle layer consists of the external oblique, internal oblique and transverse muscles (see Fig. 1.3, 1.4).

Fibers of the external oblique muscle of the abdomen directed from top to bottom, back to front and below the line connecting the anterior superior iliac spine with the navel, and also at a distance of 1 - 6.5 cm from the outer edge of the ch. rectus abdominis pass into a wide aponeurosis.

However, the line of transition of muscle fibers into aponeurotic ones above the navel usually corresponds to the lateral edge of the rectus abdominis muscle, intersecting with it at a distance of 3-17 cm (8 cm on average) below the costal arch (Orohovsky V.I., Dudnichenko A.S. 1992 ).

There are three types of aponeurosis of the external oblique muscle of the abdomen: strong

(occurs in 10.8-30% of cases), moderate (observed in 19-57.5% of patients) and weak (occurs in 15-61.6% of cases) (Pokidko I.A. 1970; Namashko M. V. 1998).

The lower edge of the aponeurosis m. obli-quus abdominis externus folds over and forms the inguinal (pupart) ligament. The fascia transversalis and fascia lata hips.

The inguinal ligament varies in its density, length and width. Its length varies from 10 to 16 cm depending on the shape and height of the pelvis.

A.A. Lugovoi (1978) distinguishes between two types of pupartte ligaments. The first type is characterized by thick, and the second - by thin elastic fibers with clear signs of defibration.

The deep part of the ligament forms the infra-iliac-pubic cord.

At the pubic tubercle, the fibers of the aponeurosis of the external oblique muscle split and form two legs, crus mediale et laterale, of the superficial inguinal ring. It is limited from below and inwards by the sometimes observed third, posterior, leg - it is made up of a twisted ligament, ligamentum reflexum (Collesi).

The first two legs are superficial, the third is deeper.

In the region of the apex of the gap formed by the splitting of the aponeurosis, the legs are crossed in front by transverse and arcuate fibers - fibrae intercrurales - rounding the gap into a ring.

The ilioinguinal nerve also passes here (see Fig. 1.3).

Internal oblique abdominal muscle separated from the outer - fascial intermuscular plate.

Bottom part m. obliquus abdominis internus usually starts from the lateral half or the outer two-thirds of the inguinal ligament.

The muscle fibers are directed downward and inwards, passing into the aponeurosis at a distance of 1-5 cm from the outer edge of the rectus muscle (see Fig. 1.4). Here the aponeurosis is divided into two sheets

The superficial sheet goes as part of the anterior wall of the vagina directly to the muscle, the deep one - as part of the posterior wall.

Below the semicircular line (linea arcuata), the deep leaf joins the superficial one and participates in the formation of the anterior wall of the vagina m. rectus abdominis.

From the internal oblique and the transverse muscles lying under it, bundles form the muscle that lifts the testicle (m. cremaster), passing to the spermatic cord in the form of fascia crema sterica.

transverse abdominis muscle with its lower bundles running transversely, it starts from the outer third of the inguinal ligament. At a distance of 0.5-5 cm from the outer edge of the rectus muscle, it passes into its aponeurosis, forming a semi-lunar line, linea semilunaris (spi-helium line).

When the non-muscular sections of the oblique and transverse abdominal muscles are combined here, a weak spot is created, an anatomical prerequisite for hernia formation.

Blood supply and innervation of the muscles of the anterolateral region of the abdominal wall is carried out lying on m. transversus abdominis with six lower intercostal and four lumbar arteries, accompanied by the nerves of the same name, n. iliohypogastricus and n. ilio-inguinalis (see Fig. 1.4).

transverse fascia(fascia trans-versalis), which is a thin, strong, connective tissue plate, thickened at the inguinal ligament (iliac-pubic cord) and at the outer edge of m. rectus abdominis, adjacent

em to back surface transverse muscle.

Here it connects with aponeurotic stretching of the internal oblique and transverse muscles, forming the inguinal sickle, falx inguinalis, which is also called the ligament of Henle (Fig. 1.7).

Fascia transversalis is part of the intra-abdominal fascia and is firmly fused below with the horizontal branch of the pubic bone, covering the pectineal (superior pubic) Cooper's ligament in front.

The iliac-pubic band formed here by the transverse fascia in the form of a strip 0.8-1 cm wide, lying parallel and behind the inguinal ligament, is found, according to Yu.A. Yartsev (1964), in 82% of cases.

A.M. Gilroy et al. (1992) notes this fact only in 42% of observations. This anatomical formation is described in his monographs by N.I. Ku-kudzhanov (1969), R. Bittner (1995), R. Condon (1995).

However, a number of anatomists and surgeons (Anson B.J., McVay S.V. 1938; Hollin-shead W.N. 1956; BellisJ. 1971; Dunn D.C., Menzies D. 1996) deny the existence of the iliac-pubic cord.

Deeper than the transverse fascia is the preperitoneal tissue. Here pass a. epigastrica inferior and a. cir-cumflexa ilium profunda, accompanied by the veins of the same name, 4 connective tissue cords are sent to the umbilical ring. The peritoneum, covering them, forms a ligament and folds: ligamentum teres hepa-tis, plicae umbilicales mediana, media et lateralis.

The round ligament of the liver goes from the navel to the lower edge of the ligamentum falciformis hepatis and contains the umbilical vein, obliterated only in the thickness of the anterior abdominal wall. After awakening, the umbilical vein is used for blood transfusions, drug administration

solutions and angiographic studies of the liver.

Down from the navel in the midline is the plica umbilicalis mediana, which contains the overgrown urinary duct, urachus.

Outside of it is the plica umbilicalis media, in which lies the overgrown umbilical artery.

Laterally, the external umbilical fold passes, which contains the inferior epigastric artery (Fig. 1.6).

The folds limit practical pits above the inguinal ligament: fossae inguinales medialis, lateralis et supravesicalis. The pits are places where the viscera protrude during the formation of hernias.

The external inguinal fossa is located outward from the plica umbilicalis lateralis and corresponds to the internal opening of the inguinal canal.

The internal inguinal fossa is located between the plica umbilicalis lateralis and the plica umbilicalis media. This pit corresponds to the projection of the outer opening of the inguinal canal.

Inward from the plica umbilicalis media is the supravesical fossa, fossa supravesicalis.

Inguinal triangle at the top it is limited by a horizontal line drawn from the border between the outer and middle thirds of the inguinal ligament to the rectus abdominis muscle, medially - by the outer edge of m. rectus abdominis and below - ligamentum inguinalis. The inguinal triangle contains the inguinal canal and the inguinal gap.

inguinal canal called the gap between the broad muscles of the abdomen, through which the spermatic cord passes in men, in women - the round uterine ligament. The canal is located above the inner half of the inguinal ligament, has an oblique direction: from top to bottom, from outside to inside and back to front.

Rice. 1.6. Posterior surface of the lower part of the anterior abdominal wall

1 - median umbilical fold; 2 - middle umbilical fold; 3 - lateral umbilical fold with lower epigastric vessels; 4 - suprapubic inguinal fossa; 5 - internal inguinal fossa; 6 - lateral inguinal fossa (internal opening of the inguinal canal)

Four walls and two openings are distinguished in the inguinal canal (see Fig. 1.3).

The anterior wall of the canal is considered to be the aponeurosis of the external oblique abdominal muscle, the upper wall is the lower edges of the internal oblique and transverse abdominal muscles. The lower wall is formed by the inguinal ligament, the posterior - by the transverse fascia.

inguinal gap located between the upper and lower walls of the inguinal canal and is limited on the medial side by the outer edge of the sheath of the rectus abdominis muscle.

The shape and size of the inguinal gap varies greatly.

Its height is from 2.5 to 5 cm, length - from 4 to 9.5 cm. The shape of the inguinal gap is oval-slit-shaped (60%) or triangular (40%)

(Kukudzhanov N.I. 1969; Orokhovsky V.I. et al. 1989). High triangular inguinal spaces (non-muscular area) have a significant area and are an anatomical prerequisite for herniation.

External opening of the inguinal canal as described above, it is located above the pupart ligament in the aponeurosis of the external oblique muscle of the abdomen.

Internal or deep hole, anulus inguinalis profundus, is a depression in the transverse fascia corresponding to the external inguinal fossa. Fascia transversalis here forms a funnel-shaped protrusion like a finger of a glove, which in men includes elements of the spermatic cord: ductus deferens, blood and lymphatic vessels, non-

Rice. 1.7. Strengthening the inguinal region with tendon fibers of the transverse muscle and Hesselbach's interfoveal ligament

1 - Hesselbach's ligament; 2 - spermatic cord; 3 - tendon and muscle parts of the transverse muscle; four - inguinal sickle(ligament of Henle); 5 - inguinal ligament; 6 - gimbernate ligament; 7 - comb ligament of Cooper; 8 - wide attachment of the rectus abdominis muscle; 9 - femoral vessels; 10 - lower epigastric vessels

ditches of the duct and testis, the remnant of the vaginal process of the peritoneum. Thus, from the transverse fascia, the inner seed coat of the cord and testicle, fascia spermatica interna, is obtained. Outside, along the spermatic cord, within the inguinal canal, nerves pass: from above - p. ilioinguinalis, from below - ramus genitalis n. genitofemoralis. The same formations are present in women, only instead of the spermatic cord, a round ligament of the uterus is found.

The inner inguinal ring lies 1-1.5 cm above the middle of the pupart ligament, has a rounded or elliptical shape with an area of ​​13-15 sq. mm in women and - 15-50 square meters. mm in men (M. M. Gorelik 1963; Yu. A. Yartsev 1964). Quite often, from the inner and lower sides, it is bordered by tendon fibers along

pepper muscle, merging with the transverse fascia (interfoveal ligament of Hesselbach) (Fig. 1.7).

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The anterior abdominal wall is bounded by the costal arch from above, the lower edge of the symphysis, the inguinal folds and the iliac crest from below.

The structure of the anterior abdominal wall:
1 - umbilical ring; 2 - external oblique muscle; 3 - internal oblique muscle; 4 - transverse muscle; 5 - white line of the abdomen; 6 - rectus abdominis; 7 - pyramidal muscle; 8 - superficial epigastric artery; 9 - Spigelian line

The lateral borders of the anterior abdominal wall run along the mid-axillary lines.

There are the following layers of the anterior abdominal wall:
1. Surface layer: skin, subcutaneous fat and superficial fascia.
2. Middle layer: abdominal muscles with corresponding fascia.
3. Deep layer: transverse fascia, preperitoneal tissue and peritoneum.

The skin of the abdomen is a thin, mobile and elastic tissue. Subcutaneous adipose tissue can be expressed to a greater or lesser extent in all departments, with the exception of the navel, where there is practically no adipose tissue.

Next is the thin superficial fascia of the abdomen. In the thickness of the superficial and deep layers of the superficial fascia, there are superficial blood vessels of the anterior abdominal wall (aa. epigastricae superfaciales, extending from aa.femoralis towards the navel).

The abdominal muscles are formed in front by paired rectus abdominis muscles, and laterally by three layers of muscles: external oblique, internal oblique and transverse. The rectus abdominis attaches from above to the costal arch, and from below to the pubic bones between the pubic tubercle and the pubic plexus. Paired pyramidal muscles, located anterior to the rectus, start from the pubic bones and go up, weaving into the white line of the abdomen.

Both muscles are located in the fascial sheath, formed by the aponeuroses of the oblique and transverse abdominal muscles. At the same time, in the upper third of the abdominal wall, the fibers of the aponeurosis of the external oblique muscle of the abdomen and part of the fibers of the internal oblique muscle form the anterior wall of the sheath of the rectus abdominis muscles. The posterior wall is formed by part of the fibers of the aponeurosis of the internal oblique muscle and the fibers of the aponeurosis of the transverse muscle.

In the lower third of the abdomen (approximately 5 cm below the navel), the fibers of the aponeuroses of the superficial and deep oblique muscles and the transverse muscle pass in front of the rectus abdominis muscles. The back wall of their vagina is formed by the transverse fascia and peritoneum.

The lateral border of the rectus abdominis muscle (the so-called semilunar line) is formed by the fasciae of the lateral muscles. By middle line In the abdomen, the fibers of the fascial sheaths intersect, forming a white line of the abdomen, passing from the symphysis to the xiphoid process and separating the rectus abdominis muscles from each other.

Approximately in the middle between the xiphoid process and the pubis (which corresponds to the cartilage between the III and IV lumbar vertebrae) there is an opening - the umbilical ring. Its edges are formed by the fibers of the aponeurosis, and the bottom (umbilical plate) is a low-elastic connective tissue covered from the side abdominal cavity transverse fascia, with which the peritoneum of the anterior abdominal wall is closely fused around the umbilical ring at a distance of 2-2.5 cm from its edges. It should also be noted that the white line is wider in the umbilical region than in other departments.

The blood supply to the rectus abdominis muscles is carried out mainly from a. epigastrica inferior, extending from a. iliaca externa at the level of the entrance to the inguinal canal. A. epigastrica inferior goes medially and upwards, forming an arc located with a bulge downwards, passes along the back wall of the sheath of the rectus abdominis muscle in the region of its middle and anastomoses with a at the level of the navel. epigastrica superior from the system a. mammalia interna.

Blood supply to the rectus abdominis muscles:
1 - external iliac artery; 2 - lower epigastric artery; 3 - round ligament of the uterus; 4 - internal thoracic artery; 5 - navel; 6 - median umbilical fold; 7 - middle umbilical fold

Immediately after moving away from a. iliaca externa a. epigastrica inferior crosses with the round ligament entering the inguinal canal. Inner landmark a. epigastrica inferior - pl. umbilicalis lat., in which this artery passes, accompanied by the veins of the same name.

From the inside, the muscular layer of the anterior abdominal wall is lined with transverse fascia, passing from above to the diaphragm, then to m. iliopsoas, anterior side lumbar spinal column and descends further into the small pelvis. The transverse fascia is considered as part of the connective tissue layer that serves as the basis for the peritoneum. Between the transverse fascia and the peritoneum is the preperitoneal tissue, the layer of which grows downward and passes into the parietal tissue of the pelvis.

Thus, the parietal peritoneum, which covers the anterior abdominal wall from the inside, is weakly connected with the underlying layers, with the exception of the umbilical ring, where it is closely fused with the transverse fascia and the fascia of the white line of the abdomen over an area of ​​3-4 cm in diameter.

The rectus abdominis muscle (m. rectus abdominis) (Fig. 90, 109, 110) tilts the body forward. It is part of the abdominal press and provides intra-abdominal pressure, due to which the internal organs are held in a certain position. In addition, she takes part in the acts of urination, defecation and childbirth. This flat long muscle is located in the anterior abdominal wall on the sides of the white line (linea alba), which runs from the xiphoid process of the sternum to the pubic fusion. The point of origin of the rectus abdominis muscle is located on the xiphoid process of the sternum and cartilages of the V-VII ribs, and the attachment point is on the pubic bone between the pubic tubercle and the pubic symphysis (symphysis). The muscle bundles of the rectus abdominis are interrupted by three to four transverse tendon bridges, two of which are located above the navel, the third at the level of the navel, and the fourth (poorly developed) below.

Rice. 109. Muscles of the anterior wall of the abdomen and pelvis: 1 - rectus abdominis;2 - iliac fascia;3 - iliopsoas muscle;4 - interfoveal ligament;5 - external iliac artery;6 - external iliac vein;7 - internal locking muscle;8 - muscle that raises the anus;9 - external locking muscle

The pyramidal muscle of the abdomen (m. pyramidalis) (Fig. 90, 110) stretches the white line of the abdomen. The muscle has a triangular shape, starts on the pubic bone, anterior to the insertion of the rectus abdominis muscle, and is attached at various levels of the lower white line.

Muscles of the lateral wall of the abdomen

The muscles of the lateral wall of the abdomen are broad abdominal muscles and are arranged in three layers.

The external oblique muscle of the abdomen (m. obliquus externus abdominis) forms the surface layer of the lateral wall of the abdomen. With a bilateral contraction (with a fixed position of the pelvis), the external oblique muscle pulls the chest and tilts the body forward, bending spinal column, with one-sided turns the body in the opposite direction. The muscle is wide and flat, is part of the abdominal press. The starting point is on outer surface eight lower ribs. Muscle bundles are directed obliquely down and anteriorly (to the anterior section of the abdominal wall), pass into the aponeurosis (Fig. 104, 106). The attachment point is located on the upper part of the aponeurosis. The bundles of the aponeurosis, intertwining with the fibers of the aponeurosis of the muscles of the opposite side, form the white line of the abdomen. In this case, the lower bundles of the external oblique muscle are attached to the iliac crest, and the middle bundles of the aponeurosis form the inguinal ligament (lig. inguinale).

The internal oblique muscle of the abdomen (m. obliquus internus abdominis) (Fig. 101, 105, 110) is located under the external oblique muscle in the anterolateral part of the abdominal wall, that is, it forms the second layer of muscles of the lateral wall of the abdomen. With a unilateral contraction, the internal oblique muscle turns the trunk in its direction. The muscle is wide and flat, is the abdominal muscle. It originates from the iliac crest, inguinal ligament and thoracolumbar fascia. The muscle bundles diverge in a fan-like manner, heading along the oblique from below and from front to top and back. The posterior bundles are directed almost vertically and are attached to the outer surface of three or four lower ribs. The middle bundles, not reaching the lateral edge of the rectus abdominis muscle, pass into the aponeurosis, which forms the sheath of the rectus abdominis muscle. The lower bundles are directed horizontally, descend along the spermatic cord (funiculus spermaticus) and are part of the muscle that raises the testicle (m. cremaster) (Fig. 110).

The transverse abdominal muscle (m. transversus abdominis) (Fig. 103, 110) forms the deepest layer of the muscles of the lateral abdominal wall. The muscle is part of the abdominal press, flattens the abdominal wall and brings together the lower sections of the chest wall. At the top, the muscle starts from inner surface cartilage of the six lower ribs, and below - from the iliac crest, inguinal ligament and thoracolumbar fascia. The muscle bundles are directed horizontally forward, not reaching the outer edge of the transverse muscle, they pass into the aponeurosis, which takes part in the formation of the white line of the abdomen. The bundles of the lower section of the transverse muscle, connecting with the lower bundles of the internal oblique muscle, participate in the formation of the muscle that lifts the testicle.

rectus abdominis, m. rectus abdominis(see Fig. 309-311, 315, 325, 326), steam room, flat, refers to the long muscles of the abdomen; lies in the anterior part of the abdominal wall on the sides of the white line of the abdomen, which stretches along the midline from the xiphoid process to the pubic fusion. The rectus abdominis muscle starts from the cartilages of the V-VII ribs and from the xiphoid process; heading down, narrows and attaches to the pubic bone in the gap between the pubic symphysis and the pubic tubercle. Across the muscle bundles of the rectus abdominis, interrupting them, there are 3-4 tendon bridges, interectiones tendineae. Two of them lie above the umbilical ring, one - at its level, and a poorly developed fourth bridge - sometimes below its level.

2. Pyramidal muscle , m. pyramidalis(see Fig. 309-311, 319, 323), steam room, has the shape of a triangle, its dimensions vary. It starts from the pubic bone, anterior to the place of attachment of the rectus abdominis muscle; its bundles, converging, rise upward and end at various levels of the lower divisions of the white line.
Both muscles, rectus and pyramidal, are enclosed in the vagina of the rectus abdominis muscle, vagina m. recti abdominis (see Fig. 310, 315, 319, 325), which is formed by aponeuroses broad muscles belly.
Function: are part of the abdominals, tilt the body anteriorly; the pyramidal muscles, in addition, stretch the white line of the abdomen.
innervation: nn. intercostales (ThV-ThXII), n. iliohypogastricus (ThXII, LI).
blood supply: rectus abdominis - aa. intercostalis, epigastricae superioret inferior; pyramidal muscle - aa. Cremasterica, epigastrica inferior.

Wide and long muscles the abdominal wall relate to the muscles of the body and determine the following movements: lowering the ribs, thus participating in the act of breathing; change the position of the spinal column; contraction of all muscles (except transverse) pulls chest downward - the vertebral column leans anteriorly; with unilateral contraction, lateral flexion of the spinal column occurs. With a unilateral contraction of the external oblique muscle, the spinal column turns in the direction opposite to the contracted muscle, and with a contraction of the internal oblique muscle, in its direction. The muscle tone of the abdominal wall and diaphragm helps maintain intra-abdominal pressure, which is important in keeping the abdominal organs in a certain position. With relaxation of the muscle tone of the abdominal wall (atony), a decrease in intra-abdominal pressure is observed and, as a result, the organs move downwards (ptosis) under the influence of their own gravity, followed by a violation of their function. Due to the contraction of the muscles of the abdominal wall, the capacity of the abdominal cavity decreases, the organs are compressed, which helps to empty them (the act of defecation, urination, childbirth). On this basis, the muscles of the abdominal wall are called the abdominal press.

323. Inguinal canal, canalis inguinalis; front view.(On the right, the lower sections of the external oblique muscle of the abdomen are cut and pulled; on the left, the anterior wall of the sheath of the rectus abdominis muscle is opened and pulled.)

324. Inguinal canal, canalis inguinalis; front view.(Right outer and internal muscle the abdomen is cut and turned away, the walls of the deep inguinal ring, anulus inguinalis profundus, are visible; the spermatic cord is removed on the left, the superficial inguinal ring is visible, anulus inguinalis superftcialis.)

325. Inguinal canal, canalis inguinalis; front view.(On the right, the transverse fascia, fascia transversalis, and deep inguinal ring are visible.)

1. Rectus abdominis, m. rectus abdominis, steam room, flat, refers to the long muscles of the abdomen; lies in the anterior part of the abdominal wall on the sides of the white line of the abdomen, linea alba, which stretches along the midline from the processus xiphoideus to the pubic fusion. The rectus abdominis muscle starts from the cartilage of the V-VII ribs and from the processus xiphoideus; heading downward, it narrows and attaches to the pubic bone in the interval between the symphysis and tuberculum pubicum. The muscle bundles of the rectus abdominis are interrupted by 3-4 transverse tendon bridges, intersecliones tendineae. Two of them lie above the umbilicus, one at the level of the umbilicus, and a poorly developed fourth bridge sometimes below the navel.
2. Pyramidal muscle, m. pyramidalis, steam room, has a triangular shape, its dimensions vary. Starts from the pubic bone, anterior to the insertion of the rectus abdominis; its bundles, converging, rise upward and end at various levels of the lower divisions of the white line.

Both muscles, rectus and pyramidal, are enclosed in the vagina of the rectus abdominis muscle, vagina m. recti abdominis, which is formed by the aponeuroses of the broad abdominal muscles. Action: they are part of the abdominal press, tilt the body forward; the pyramidal muscles, in addition, stretch the white line of the abdomen. Innervation: nn. intereostales, n. lumbalis (Th,-Thc; L,). Blood supply: rectus abdominis - aa. epigastricae superior et inferior, pyramidal muscle - aa. cremasterica, epigastrica inferior.

The wide and long muscles of the abdominal wall are the muscles of the body and determine the following movements: lowering the ribs, thus participating in the act of breathing; change the position of the spinal column; contraction of all muscles (except the transverse one) pulls the chest downward - the spinal column leans forward; with unilateral contraction, lateral flexion of the spinal column occurs. With a unilateral contraction of the external oblique muscle, the spinal column rotates in the direction opposite to the contracted muscle, and with a contraction of the internal oblique muscle, the spinal column rotates in the direction corresponding to it.

The muscles of the abdominal wall and the diaphragm, with their tone, maintain intra-abdominal pressure at a certain height, which is important in keeping the abdominal organs in a certain position. With the relaxation of the muscle tone of the abdominal wall (atony), a decrease in intra-abdominal pressure is observed and, as a result, the organs move downward (ptosis) under the influence of their own gravity, followed by a violation of their function. With the contraction of the muscles of the abdominal wall, the capacity of the abdominal cavity decreases, the organs are compressed, which helps to empty them (the act of defecation, urination, childbirth). On this basis, the muscles of the abdominal wall are called the abdominals. prelum abdominale.