Rectus Sheath

The rectus sheath is a long fibrous sheath Formed mainly by the aponeuroses of the three lateral abdominal muscles. Encloses the rectus abdominis muscle and pyramidalis muscle (if present) and contains the anterior rami of the lower six thoracic nerves and the superior and inferior epigastric vessels and lymph vessels.

 Description the rectus sheath is considered at three levels. Above the costal margin, Anterior wall # Aponeurosis of the external oblique. Posterior wall # Thoracic wall that is, the fifth, sixth, and seventh costal cartilages and the intercostal spaces.

 Between the costal margin and the level of the anterior superior iliac spine, the aponeurosis of the internal oblique splits to enclose the rectus muscle; the external oblique aponeurosis is directed in front of the muscle, and the transversus aponeurosis is directed behind the muscle.

 Between the level of the anterosuperior iliac spine and the pubis, the aponeuroses of all three muscles form the anterior wall. The posterior wall is absent, and the rectus muscle lies in contact with the fascia transversalis.

Linea alba
Is a tendinous median raphe between the two rectus abdominis muscles, extending from the xiphoid process to the pubic symphysis. Is formed by the fusion of the aponeuroses of the external oblique, internal oblique, and transverse muscles of the abdomen. The posterior wall of the rectus sheath is not attached to the rectus abdominis muscle. The anterior wall is firmly attached to it by the muscle's tendinous intersections

Linea semilunaris Is a curved line along the lateral border of the rectus abdominis. Linea semicircularis (arcuate line) Is a crescent-shaped line marking the inferior limit of the posterior layer of the rectus sheath just below the level of the iliac crest.

Lacunar ligament (Gimbernat's ligament) Represents the medial triangular expansion of the inguinal ligament to the pectineal line of the pubis. Forms the medial border of the femoral ring and the floor of the inguinal canal. Pectineal (Cooper's) ligament Is a strong fibrous band that extends laterally from the lacunar ligament along the pectineal line of the pubis

Hematoma of the Rectus Sheath

uncommon but important, since it is often overlooked. It occurs most often on the right side below the level of the umbilicus. The source of the bleeding is the inferior epigastric vein or, more rarely, the inferior epigastric artery.

These vessels may be stretched during a severe bout of coughing or in the later months of pregnancy, which may predispose to the condition. The cause is usually blunt trauma to the abdominal wall, such as a fall or a kick. The symptoms that follow the trauma include midline abdominal pain. An acutely tender mass confined to one rectus sheath is diagnostic.