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rectus sheath

{{Short description|Laminas around abdominal muscles}}

{{Infobox anatomy

| Name = Rectus sheath

| Latin = vagina musculi recti abdominis

| Image = Rectus abdominis.png

| Caption =

| Image2 =

| Caption2 =

| System =

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The rectus sheath (also called the rectus fascia{{citation |last=Te Linde |first=Richard W. |title=Te Linde's Operative Gynecology |url=http://dl.minitoons.ir/iums/TeLinde's_Operative_Gynecology_10%20E.pdf |page=107 |publication-date=2003 |year=1977 |editor1=Rock, John A. |access-date=2018-10-01 |edition=10th |location=Philadelphia, PA |publisher=Lippincott |editor2=Jones Howard W.}}.) is a tough fibrous compartment formed by the aponeuroses of the transverse abdominal muscle, and the internal and external oblique muscles. It contains the rectus abdominis and pyramidalis muscles, as well as vessels and nerves.{{Citation |last=Sevensma |first=Karlin E. |title=Anatomy, Abdomen and Pelvis, Rectus Sheath |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK537153/ |work=StatPearls |access-date=2023-05-16 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30725838 |last2=Leavitt |first2=Logan |last3=Pihl |first3=Kerent D.}}

Structure

The rectus sheath extends between the inferior costal margin and costal cartilages of ribs 5-7 superiorly, and the pubic crest inferiorly.

Studies indicate that all three aponeuroses constituting the rectus sheath are in fact bilaminar.{{Cite book |last=Sinnatamby |first=Chummy |title=Last's Anatomy |publisher= |year=2011 |isbn=978-0-7295-3752-0 |edition=12th |pages=224}}

= Below the costal margin =

class="wikitable"

! Region

IllustrationDescription
Above the arcuate line300pxAt the lateral border of the rectus abdominis muscle, the aponeurosis of the internal oblique muscle splits into an anterior layer and a posterior layer (this splitting forms a shallow groove - the semilunar line).

  • An anterior rectus sheath composed of the aponeurosis of the external oblique muscle and anterior portion of the aponeurosis of the internal oblique muscle passes in front of the rectus abdominis muscle.
  • A posterior rectus sheath composed of the posterior portion of the aponeurosis of the internal oblique muscle and the aponeurosis of the transversus abdominis passes behind the rectus abdominis muscle.

All aponeuroses of the rectus sheath unite at (and decussate across) the midline, forming the linea alba.

Below the arcuate line300pxBelow this level, the aponeuroses of all three muscles (including the transversus) pass in front of the rectus. The posterior layer of the rectus sheath is thus absent and the rectus abdominis muscle is separated from the peritoneum only by the transversalis fascia. Due to this reason, this region is more susceptible to herniation.{{Citation needed|date=May 2023}}

Superficial/anterior to the anterior layer of the rectus sheath are the following two layers:{{Citation |last=Flynn |first=William |title=Anatomy, Abdomen and Pelvis: Abdominal Wall |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK551649/ |work=StatPearls |access-date=2023-05-16 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=31869113 |last2=Vickerton |first2=Paula}}

  1. Camper's fascia (anterior part of superficial fascia)
  2. Scarpa's fascia (posterior part of the superficial fascia)

Deep/posterior posterior layer of the rectus sheath (where present) are the following three layers:{{Citation needed|date=May 2023}}

  1. transversalis fascia
  2. extraperitoneal fat{{Cite web |title=extraperitoneal fascia |url=https://medical-dictionary.thefreedictionary.com/extraperitoneal+fascia |access-date=2023-05-16 |website=TheFreeDictionary.com}}
  3. parietal peritoneum

= Above the costal margin =

Since the tendons of the internal oblique and transversus abdominis only reach as high as the costal margin, it follows that above this level the sheath of the rectus is deficient behind, the muscle resting directly on the cartilages of the ribs, and being covered only by the tendons of the external obliques.{{Citation needed|date=May 2023}}

Clinical significance

The rectus sheath is a useful attachment for surgical meshes during abdominal surgery.{{Citation|last=Hollinsky|first=C.|title=6.638 - Biomaterials for Hernia Repair|date=2011-01-01|url=http://www.sciencedirect.com/science/article/pii/B9780080552941002476|work=Comprehensive Biomaterials|pages=593–604|editor-last=Ducheyne|editor-first=Paul|place=Oxford|publisher=Elsevier|language=en|isbn=978-0-08-055294-1|access-date=2021-01-21}} This has a higher risk of infection than many other attachment sites.

Additional images

File:Gray396.png|The Cremaster

File:Gray398.png|The interfoveolar ligament, seen from in front.

References

{{Gray's}}

{{Reflist}}

External links

  • {{SUNYAnatomyFigs|35|04|02}} - "Incisions and the contents of the rectus sheath."
  • {{SUNYAnatomyLabs|35|10|01|03}} - "Anterior Abdominal Wall: The Rectus Abdominis Muscle"
  • {{SUNYAnatomyImage|7|1|80}} - anterior layer
  • {{SUNYAnatomyImage|7|1|33}} - posterior layer above arcuate line
  • {{SUNYAnatomyImage|7|5|74}} - posterior layer above arcuate line
  • {{NormanAnatomy|rectussheath}}
  • {{UMichAtlas|abdo_wall60}} - "The Rectus Sheath, Anterior View & Transverse Section"

{{Muscles of trunk}}

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Category:Abdomen

Category:Muscles of the torso