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CHAPTER 60 – Abdomen and pelvis: overview and surface anatomy


Although often considered separately, the abdomen and pelvis form the largest effectively continuous visceral cavity of the body. They act together to provide multiple vital functions including: support and protection of the digestive and urinary tracts and internal reproductive organs and their associated neurovascular supplies; transmission of the neurovascular supply to and from the thorax and the lower limb; provision of support and attachment to the external genitalia and access to and from the internal reproductive and urinary organs; provision of accessory muscles of physiological actions such as respiration, defecation, and micturition; support for the spinal column in weight bearing and movement.


The walls of the abdominopelvic cavity consist of five lumbar vertebrae and their intervening intervertebral discs (lying in the posterior midline); three layers of skeletal muscles (transversus abdominis, internal oblique and external oblique) with associated fasciae and skin (lying lateral and anterolateral); a single muscular layer (rectus abdominis) with its associated fascial coverings (lying anterior); the bony ‘bowl’ formed by the walls of the true and false pelvis (ilium, ischium and pubis on each side); the muscles of the pelvic floor and perineum (lying inferiorly); the diaphragm (lying superiorly) (Fig. 60.1).


Fig. 60.1  The bony and muscular structures making up the abdominopelvic ‘cavity’. The anterolateral abdominal muscles have been removed for clarity.

The bony protection of the cavity is restricted to the pelvis (true and false) and the upper abdomen, which is partly enclosed by the anterolateral portions of the lower six ribs and their cartilages even though these structures are technically part of the thoracic wall. Between these two zones, the anterolateral abdominal wall is entirely musculofascial but of sufficient thickness and strength that it provides adequate protection for the viscera such that even direct blows can be resisted.

The abdominal wall and retroperitoneal structures play an important role in the function of the spinal column in both movement of the thorax in relation to the pelvis and in aiding support of the spine in weight bearing. The anterolateral muscles provide assistance with flexion and rotation of the thorax in relation to the pelvis (or vice versa if the thorax is fixed).

In the upright position, the pelvis lies at an angle such that the pelvic canal slopes posteriorly at an angle of 45° to the main abdominal visceral cavity. The main abdominal cavity is shaped by the spinal column and the posterior abdominal wall muscles. Although less pronounced than in the thorax, due to the presence of quadratus lumborum and psoas major, its prominence within the abdominal cavity produces two distinct paravertebral gutters on either side of the vertebral column. The lordosis of the lumbar spine in combination with the angle between the fifth lumbar vertebra and the sacrum produces the parabola shape of the sagittal section of each paravertebral gutter.

Thoracoabdominal interface

The thoracic and abdominal cavities interface with each other across the diaphragm. Six principle communications exist between the two cavities: the inferior vena cava, as it crosses between its short supra-hepatic portion and the intrathoracic portion below the right atrium, through the caval opening of the diaphragm (Ch. 62); the oesophagus passing inferiorly through the oesophageal opening of the diaphragm (Ch. 65); the aorta between the descending thoracic and abdominal portions, posterior to the median arcuate ligament of the diaphragm (Ch. 62); the lymphatics of the abdomen draining upwards to the thorax, mainly posterior to the median arcuate ligament via the thoracic duct lying posterolateral to the aorta, but also via peri-caval lymphatics and small vessels draining directly through and at the peripheral insertions of the diaphragm; the azygos and hemiazygos veins ascending behind the median arcuate ligament of the diaphragm into the thoracic azygos system (Ch. 62); the autonomic nervous system, both sympathetic and parasympathetic (see below) which cross between the two cavities behind the medial arcuate ligaments of the diaphragm, via the various diaphragmatic openings, and directly through the substance of the diaphragm itself (Ch. 54). Cutaneous neurovascular structures also cross between the thorax into the abdominal wall structures.

Pelvis–lower limb interface

The pelvis forms an integral part of the bony structure of both the abdominopelvic cavity and the lower limb. It transmits the weight of the upright body from the femoral heads to the lumbar spine as well as providing a stable platform about which movement of the hip joint can occur. Its bony surfaces give rise to extensive muscular attachments for the muscles of the buttock and thigh (Ch. 67) as well as for the muscles of the pelvic floor and perineal diaphragm (Ch. 63). The pelvis also transmits or gives origin to the neuro-lympho-vascular structures which supply the lower limb. The principle structures are as follows. The venous drainage includes the common femoral vein passing under the inguinal ligament to become the external iliac vein; the obturator veins passing through the obturator foramen; the superior and inferior gluteal veins draining from the buttock into the internal iliac vein via the greater and lesser sciatic foramina; multiple smaller venous channels. The arterial supply includes the external iliac artery passing under the inguinal ligament to become the common femoral artery; the obturator artery passing into the thigh via the obturator foramen; the superior and inferior gluteal arteries from the posterior division of the internal iliac artery passing out of the pelvis via the greater and lesser sciatic foramina. The lymphatic drainage principally passes under the inguinal ligament, via the femoral and obturator canals and via the sciatic foramina, to drain into the pelvic lymphatic chains (Ch. 63). The somatic neural structures include the femoral, obturator and sciatic nerves and other minor branches of the lumbosacral plexus (Ch. 62). The autonomic neural structures include those running with the arterial supply and with the branches of the lumbosacral plexus. Cutaneous neurovascular structures also cross between the lower abdomen and pelvis into the skin and superficial tissues of the lower limb.

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