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Abdominal Incisions

Approach to the Critically Ill Surgical Patient



A- air way


C- circulation
I - IV: two large bore IV’s with normal saline, wide open
M - Monitors: O2sat, ECG, BP
F - Foley catheter to measure urine output
I - Investigations: see above
N – +/- NG tube
E - Ex rays


Abdominal Incisions


  1. Kocher's (subcostal) : access to RUQ or LUO contents i.e. gallbladder, spleen
  2. upper midline  :access to stomach, duodenum, gallbladder, liver, transverse colon
  3. paramedian : can make similar incision in each quadrant (or access to each quadrant's contents
  4. lateral paramedian   :
  5. incision made at outer 1/3 - medial 2/3 border of rectus ,
  6. modification of paramedian but with lower risk of dehiscence or ventral hernia
  7. Rutherford Morrison :  access to lower ureter, colon, and iliac arteries
  8. lower midline : access to pelvic organs
  9. Pfannenstiel   : suprapubic incision for access to pelvic cavity
  10. Grid-Iron        :
  11. incision at McBurney's point
  12. access to appendix


Layers of the Abdominal Wall

Layers of the Abdominal Wall

  1. skin
  2. superficial fascia
    • Camper's fascia ---> dartos muscle
    • Scarpa's fascia ---> Colles' fascia
  3. muscle
    • external oblique ---> inguinal ligament, external spermatic fascia, fascia lata
    • internal oblique ---> cremasteric muscle
    • transversalis abdominus ---> posterior inguinal wall
  4. transversalis fascia ---> internal spermatic fascia
  5. peritoneum ---> tunica vaginalis


At midline

  1. rectus abdominus muscle: in rectus sheath, divided by linea alba

Above semicircular line of Douglas (midway between symphysis pubis and umbilicus):


above semicircular line of Douglas (midway between symphysis pubis and umbilicus):
anterior rectus sheath = external oblique aponeurosis and anterior leaf of internal oblique aponeurosis
posterior rectus sheath = posterior leaf of internal oblique aponeurosis and transversus


Below semicircular line of Douglas:

below semicircular line of Douglas
anterior rectus sheath = aponeurosis of external, internal oblique, transversus



  • superior epigastric (branch of internal thoracic), inferior epigastric (branch of external iliac), both arteries anastomose and lie behind the rectus muscle
ACUTE ABDOMEN Part 03 ACUTE ABDOMEN Part 03 Reviewed by Radiology Madeeasy on September 03, 2010 Rating: 5
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