THE POSTERIOR ABDOMINAL WALL

 The posterior abdominal wall offers protection to the

abdominal contents, houses components of the abdominal
cavity and serves as a passageway for structures travelling to
other regions of the body
 It is composed of:
- Bony structures: the bodies of the five lumbar vertebrae
(and their intervertebral discs), which project forwards into
the abdominal cavity, the medial region of the ilia, and ribs
XI and XII.
- Muscular structures: the psoas major, iliacus and
quadratus lumborum muscles (Fig. 5.22). The iliolumbar
ligament is a ligament passing from the transverse process
of L5 vertebra to the posterior part of the iliac crest.

The Fascia of Posterior Abdominal Wall:

Psoas Fascia
 The psoas fascia covers the psoas major muscle.
 It is attached to the lumbar vertebrae medially, continuous
with the thoracolumbar fascia laterally and continuous
with the iliac fascia inferiorly
Thoracolumbar Fascia
 Actually an extension of the aponeuroses of the
transversus abdominis and external abdominal oblique
muscles.
  It divides into an anterior plane and posterior plane. It thus
serves to compartmentalize the muscles, which lies in
between the two planes.
 Anterior plane attaches to the transverse process of the
lumbar vertebrae.
 Posterior plane attaches to joins with the other muscles in
the back.
Abdominal Aorta:
 The abdominal aorta is a continuation of the descending
thoracic aorta
 It supplies all of the abdominal organs, and its terminal
branches go on to supply the pelvis and lower limbs. It also
supplies the undersurface of the diaphragm and parts of the
abdominal wall.
 Enters the Aortic Hiatus between the right crus and left crus
of the diaphragm at the level of T12.
 Extends retroperitoneally along the anterior surface of the
vertebrae (slightly to the left), until the level of L4.
 It is accompanied through the aortic opening by the azygos
vein and the thoracic duct.
 Bifurcation of the Abdominal Aorta: It bifurcates at L4, into
the Left Common Iliac and Right Common Iliac Arteries.
 RELATIONS:
o Goes posterior to the Uncinate Process and Body of the
pancreas.
o Goes posterior to the horizontal (third portion of)
duodenum.
o Goes posterior to the Left Renal Vein. The left renal
vein passes over (anterior to) the Aorta.
o The Inferior Vena Cava is to the right and slightly more
anterior than the abdominal aorta.
Branches: There are three sets of branches:
Firstly: Unpaired ventral branches which are the celiac trunk, the superior
& inferior mesenteric arteries and the median sacral artery.
Secondly: Paired lateral branches to the structures derived from the
intermediate mesoderm of the embryo (suprarenal gland, kidneys &
ovaries or testes).

1- Inferior phrenic arteries

■ Arise from the aorta immediately below the aortic hiatus, supply
the diaphragm, and give rise to the superior suprarenal arteries.

■ Diverge across the crura of the diaphragm, with the left artery
passing posterior to the esophagus and the right artery passing
posterior to the IVC.

2- Middle suprarenal arteries:

■ Small paired visceral arteries that arise either side posteriorly at

the level of L1 to supply the adrenal glands.

3- Renal arteries:

■ Arise from the aorta inferior to the origin of the superior

mesenteric artery. The right artery is longer and a little lower than
the left and passes posterior to the IVC; the left artery passes
posterior to the left renal vein.

■ Give rise to the inferior suprarenal and ureteric arteries.

■ Divide into the superior, anterosuperior, anteroinferior, inferior,

and posterior segmental branches.

4- Testicular or Ovarian Arteries

■ Descend retroperitoneally and run laterally on the psoas major

muscle and across the ureter.

a. The testicular artery accompanies the ductus deferens into the

scrotum, where it supplies the spermatic cord, epididymis, and
testis.

b. The ovarian artery enters the suspensory ligament of the ovary,

supplies the ovary, and anastomoses with the ovarian branch of the
uterine artery.
Thirdly: Paired posterolateral lumbar arteries: These are four pairs of
arteries which arise from the posterior surface of the abdominal aorta in
series with the posterior intercostal arteries. They pass backward &
laterally deep to psoas muscle to reach the abdominal wall.

Inferior Vena Cava

■ Is formed on the right side of L5 by the union of the two common iliac
veins, below the bifurcation of the aorta.
■ Is longer than the abdominal aorta and ascends along the right side of
the aorta.
■ Passes through the opening for the IVC in the central tendon of the
diaphragm at the level of T8 and enters the right atrium of the heart.
■ Inferior vena cava crossed anteriorly by:
- SMA in root of mesentery,
- Ileocolic & right colic arteries,
- 3rd part of duodenum
- Gonadal vessels
- Head of pancreas & CBD
- Portal vein in lesser omentum
- Liver
■ Tributaries of IVC:
1. Common iliac veins,
2. 3rd &4th lumbar veins
3. Renal veins
4. Right gonadal vein
5. Right suprarenal veins
6. Inferior phrenic veins
7. Hepatic veins
Lymph Nodes of posterior abdominal wall:
Preaortic nodes: lie in front of the aorta near the vessels of the name
Coeliac- drain gastric, hepatic and pancreaticosplenic node
Superior mesenteric- drain nodes in the mesentery
Inferior mesenteric- drain nodes in the mesentery
Efferent vessels from pre-aortic nodes form intestinal trunks and help in
the formation of the thoracic duct
Paraaortic nodes (left and right) – drains kidneys, adrenal glands, ureter,
posterior abdominal wall, testis, ovary, uterus and uterine tubes.
External iliac lymph nodes receive lymphatics from inguinal nodes,
external genitalia, vagina, and cervix; they drain into the common iliac
nodes.