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Internal Relief of the Anterior Abdominal Wall

Q: The medial fossa serves as the hernia gate for which specific type of hernia?

The medial inguinal fossa (fossa inguinalis medialis) serves as the hernia gate for direct inguinal hernias. It is located on the internal surface of the anterior abdominal wall between the medial and lateral umbilical folds, projecting onto the superficial inguinal ring. In direct inguinal hernias, the hernia sac pushes directly through the superficial ring without traversing the entire inguinal canal. An intraoperative landmark is that the hernia gate lies medial to the inferior epigastric vessels.

Q: 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 hernias. This fossa is located lateral to the lateral umbilical fold and projects onto the deep inguinal ring. In indirect inguinal hernias, the hernia sac enters through the deep inguinal ring and traverses the entire inguinal canal. An important surgical landmark is that the hernia gate in an indirect hernia lies lateral to the inferior epigastric vessels.

Q: Which peritoneal ligament runs from the umbilicus to the inferior surface of the liver?

The round ligament of the liver (lig. teres hepatis) extends from the umbilicus to the liver. It forms postnatally as a result of the obliteration of the umbilical vein. The round ligament contains paraumbilical veins (vv. paraumbilicales), which in portal hypertension participate in retrograde blood flow toward the umbilicus, producing the 'caput medusae' sign. Gastric cancer may also metastasize to the umbilicus along the path of the round ligament.

For medical students2 min readUpdated 2026-10-10

The internal surface of the anterior abdominal wall features a complex relief formed by the parietal peritoneum and the underlying transversalis fascia. The folds and fossae created here serve as essential topographical landmarks for surgeons, as they precisely indicate the location of potential hernia gates.

LayersThe relief is formed by the peritoneum and transversalis fascia

FoldsThere are exactly 5 umbilical folds on the anterior wall

SurgeryUmbilical fossae serve as landmarks for hernia gates

LandmarksVessels and embryonic remnants course beneath the folds

Umbilical Folds of the Anterior Abdominal Wall

The relief of the internal surface is defined by five longitudinal elevations. These structures are formed as the transversalis fascia (fascia transversalis) and the overlying peritoneum are raised by underlying anatomical structures—specifically vessels or fibrous cords.

In anatomy, the following folds are distinguished:

Median umbilical fold (plica umbilicalis mediana) — an unpaired structure. It lies strictly in the midline and covers the obliterated urachus (lig. umbilicale medianum).
Medial umbilical folds (plicae umbilicales mediales) — two paired folds. They run lateral to the median fold and are formed over the obliterated umbilical arteries (a. umbilicales).
Lateral umbilical folds (plicae umbilicales laterales) — also paired structures located most laterally. They overlie the functional inferior epigastric vessels (a. et v. epigastricae inferiores).

Umbilical Fossae as Landmarks for Hernia Gates

Natural depressions form between the folds described above, known in anatomy as fossae. These are of critical significance in surgical practice because these weak points of the abdominal wall act as hernia gates (rings) during the formation of inguinal herniae.

Topographically, three types of fossae are distinguished:

Supravesical fossa — a depression located between the median and medial umbilical folds.
Medial inguinal fossa — located between the medial and lateral umbilical folds.
Lateral inguinal fossa — located lateral to the lateral umbilical fold.

Topographically Related Neck Muscles: Sternohyoid Muscle

When studying adjacent topographical regions and muscular landmarks, the sternohyoid muscle (m. sternohyoideus) is examined.

Its anatomical characteristics:

Origin (Origo): arises from the posterior surface of the manubrium sterni and the sternal end of the clavicle.
Insertion (Insertio): fibers ascend to insert onto the lower margin of the hyoid bone.
Function: depresses the hyoid bone upon contraction.
Innervation: supplied by branches of the ansa cervicalis (C1–C3).
Blood supply: supplied 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): arises from the transverse processes of cervical vertebrae C3 to C6.
Insertion (Insertio): 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).

Frequently asked 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 spots and serve as landmarks for hernia gates.

Supravesical fossa (fossa supravesicalis) — site of rare supravesical (internal oblique) hernias.
Medial inguinal fossa (fossa inguinalis medialis) — projects onto the superficial inguinal ring; direct inguinal hernias emerge here.
Lateral inguinal fossa (fossa inguinalis lateralis) — projects onto the deep inguinal ring; indirect inguinal hernias emerge here.

The medial fossa serves as the hernia gate for which specific type of hernia?

The medial inguinal fossa (fossa inguinalis medialis) serves as the hernia gate for direct inguinal hernias.

It is located on the internal surface of the anterior abdominal wall between the medial and lateral umbilical folds, projecting onto the superficial inguinal ring. In direct inguinal hernias, the hernia sac pushes directly through the superficial ring without traversing the entire inguinal canal. An intraoperative landmark is that the hernia gate lies 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 hernias.

This fossa is located lateral to the lateral umbilical fold and projects onto the deep inguinal ring. In indirect inguinal hernias, the hernia sac enters through the deep inguinal ring and traverses the entire inguinal canal. An important surgical landmark is that the hernia gate in an indirect hernia lies lateral to the inferior epigastric vessels.

Which peritoneal ligament runs from the umbilicus to the inferior surface of the liver?

The round ligament of the liver (lig. teres hepatis) extends from the umbilicus to the liver.

It forms postnatally as a result of the obliteration of the umbilical vein. The round ligament contains paraumbilical veins (vv. paraumbilicales), which in portal hypertension participate in retrograde blood flow toward the umbilicus, producing the 'caput medusae' sign. Gastric cancer may also metastasize to the umbilicus along the path of the round ligament.

Which structures form the umbilical folds?

The folds on the internal surface of the anterior abdominal wall are formed by the peritoneum and transversalis fascia, which are elevated over underlying vessels and fibrous cords.

What lies 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 represent weak spots in 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.

Go deeper

Obliteration of umbilical arteries and formation of fibrous cords
Topography of inferior epigastric vessels
Formation and branches of the cervical loop (ansa cervicalis)
Blood supply of the anterior neck muscles