Umbilical folds of the anterior abdominal wall
The relief of the inner surface is determined by the presence of five longitudinal elevations. These structures are formed due to the fact that the transversalis fascia (fascia transversalis) and the peritoneum covering it from the inside are elevated above various anatomical structures—vessels or fibrous cords.
In anatomy, the following folds are distinguished:
- Median umbilical fold (plica umbilicalis mediana) is an unpaired structure. It lies strictly in the midline and rises over the urachus (lig. umbilicale medianum).
- Medial umbilical folds (plicae umbilicales mediales) are two paired folds. They run to the right and left of the median fold and are formed over the obliterated umbilical arteries (a. umbilicales).
- Lateral umbilical folds (plicae umbilicales laterales) are also paired structures located most laterally. They conceal functioning vessels—the inferior epigastric arteries and veins (a. et v. epigastricae inferiores).
Umbilical fossae as landmarks for hernia gates
Natural depressions, anatomically termed fossae, form between the folds described above. They are of critical importance in surgical practice because these weak points of the abdominal wall act as hernia gates during the formation of inguinal hernias.
Topographically, three types of fossae are distinguished:
- Supravesical fossa — a depression located between the median and medial umbilical folds.
- Medial fossa — located between the medial and lateral umbilical folds.
- Lateral fossa — located lateral to the lateral umbilical fold.
Topographically related muscles of the neck: Sternohyoid muscle
As part of studying adjacent topographic regions and muscular landmarks, the sternohyoid muscle (m. sternohyoideus) is examined.
Its anatomical characteristics:
- Origin (Origo): the muscle originates from the posterior surface of the manubrium sterni and the sternal end of the clavicle.
- Insertion (Insertio): the fibers ascend and attach to the lower margin of the hyoid bone.
- Function: upon contraction, the muscle depresses the hyoid bone.
- Innervation: supplied by branches of the ansa cervicalis — ansa cervicalis (C1–C3).
- Blood supply: vascularized by the superior thyroid artery (a. thyroidea superior) and superficial cervical artery (a. cervicalis superficialis).
Longus capitis muscle
Another important muscle topographically related to the axial skeleton is the longus capitis muscle (m. longus capitis).
Key anatomical data:
- Origin (Origo): originates from the transverse processes of the cervical vertebrae from the third to the sixth (C3–C6).
- Insertion (Insertio): the fibers run superiorly and attach to the basilar part of the occipital bone (pars basilaris ossis occipitalis).
- Function: bilateral or unilateral contraction flexes the head forward.
- Innervation: supplied by branches of the cervical nerves (nn. cervicales C1–C4).
- Blood supply: blood is supplied by the vertebral arteries (aa. vertebrales) and ascending cervical arteries (aa. cervicales ascendentes).
Briefly: answers to topical questions
What is the clinical significance of the umbilical fossae of the anterior abdominal wall?
The umbilical fossae of the anterior abdominal wall are weak points and serve as landmarks for hernia gates.
- Supravesical fossa (fossa supravesicalis) — rare supravesical (internal oblique) hernias emerge through it.
- Medial inguinal fossa (fossa inguinalis medialis) — projects onto the superficial inguinal ring; direct inguinal hernias emerge through it.
- Lateral inguinal fossa (fossa inguinalis lateralis) — projects onto the deep inguinal ring; indirect inguinal hernias emerge through it.
For which specific hernias does the medial fossa serve as the hernia gates?
The medial inguinal fossa (fossa inguinalis medialis) serves as the hernia gates for direct inguinal hernia.
It is located on the inner surface of the anterior abdominal wall between the medial and lateral umbilical folds. This fossa projects onto the superficial inguinal ring. During the formation of a direct inguinal hernia, the hernia sac emerges directly through the superficial inguinal ring without traversing the entire inguinal canal. An intraoperative landmark is that the hernia gates are located medial to the inferior epigastric vessels.
For which type of hernia does the lateral fossa serve as the internal opening of the hernia canal?
The lateral inguinal fossa (fossa inguinalis lateralis) serves as the internal opening of the hernia canal for indirect inguinal hernia.
This fossa is located lateral to the lateral umbilical fold and projects onto the deep inguinal ring. When an indirect inguinal hernia occurs, the hernia sac enters through the deep inguinal ring and traverses the entire inguinal canal. An important surgical landmark is that the hernia gates in an indirect hernia are located lateral to the inferior epigastric vessels.
Which peritoneal ligament runs from the umbilical ring to the inferior surface of the liver?
The round ligament of the liver (lig. teres hepatis) runs from the umbilicus to the liver.
It is formed after birth as a result of the obliteration of the umbilical vein. The round ligament of the liver contains paraumbilical veins (vv. paraumbilicales) which, in portal hypertension, participate in retrograde blood flow to the umbilicus and the formation of caput medusae. Metastasis of gastric cancer to the umbilicus can occur along the course of the round ligament of the liver.
Class and exam questions
Which structures form the umbilical folds?
Folds on the inner surface of the anterior abdominal wall are formed by the peritoneum and transversalis fascia, which are elevated over vessels and cords.
What is located beneath the lateral umbilical folds?
The inferior epigastric arteries and veins (a. et v. epigastricae inferiores) run beneath these paired folds.
What is the clinical significance of the umbilical fossae?
The supravesical, medial, and lateral fossae are weak points of the abdominal wall and serve as landmarks for hernia gates.
Where does the sternohyoid muscle originate?
It originates from the posterior surface of the manubrium sterni and the sternal end of the clavicle.
What else to study on this topic
- Obliteration of umbilical arteries and formation of fibrous cords
- Topography of the inferior epigastric vessels
- Formation and branches of the ansa cervicalis
- Blood supply to the muscles of the anterior neck region
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