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Assessment of Anterior Abdominal Wall Layers Thickness under the influence of Age and Sex, Using Computed Tomography Imaging in Ibn-Sina Hospital, Khartoum, Sudan 2021

Article Information

Ayman E Abbas1, Mohammad Hatem Alrawi2, Esra Ali Mahjoub Saeed3*, Mohammed Abdelmtalab4 

1Faculty of medicine and health sciences, Omdurman Islamic university, Omdurman, Sudan

2Faculty of medicine and health sciences, International University of Africa, Sudan

3Faculty of medicine, University of Khartoum, Khartoum, Sudan

4Assistant Professor, Anatomy Department, Faculty of Medicine, International University of Africa, Sudan

*Corresponding author: Esra Ali Mahjoub Saeed, Faculty of medicine, University of Khartoum, Khartoum, Sudan.

Received: 03 November 2022; Accepted: 15 November 2022; Published: 08 December 2022

Citation: Ayman E Abbas, Mohammad Hatem Alrawi, Esra Ali Mahjoub Saeed. Assessment of Anterior Abdominal Wall Layers Thickness under the influence of Age and Sex, using Computed Tomography Imaging in Ibn-Sina Hospital, Khartoum, Sudan 2021. Archives of Clinical and Biomedical Research 6 (2022): 982-992.

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Abstract

Background: The anterior abdominal wall is made up of skin, superficial fascia, deep fascia, muscles, extraperitoneal fascia, and parietal peritoneum. The radiological assessment of muscle and fat properties is fundamental in muscle diseases and obesity. A few studies in particular measured the thickness of anterior abdominal wall muscles and fatty layer.

Purpose: To study the measurements of anterior abdominal wall layers thickness using CT KUB scan.

Material and Methods: This is a retrospective descriptive radiology centerbased- study of patients come for CT-KUB in Ibn Sina Specialized Hospital during the period July 2021 to December 2021. It includes 232 male and female patients of different age groups. Thickness measurements were taken from a single slice of CT-KUB scan at the level of L3 –L4. The influence of age and gender was investigated, as well as muscular asymmetry.

Results: The thickness of abdominal subcutaneous fatty layer in male is 17.5 mm and 24.8 in females. The mean thickness of subcutaneous fatty layer in mm is 13.28, 23.56, 25.95 and 22.57 in all four groups respectively. The mean thickness of abdominal wall muscles in all patients in RA = 8.08 with a p value = .003, TA = 4.88 with a p value = .011, IO = 6.7 with a p value = .000 and EO = 5.39 with a p value = .000. The RT side show more thickness that is more obvious in RA (10.1 mm for right and 6 mm for left) and IO (8.7 mm for right and 4.7 mm for left). Pearson correlation test was used to test the correlation between the thickness of subcutaneous fatty layer and the muscles. The results show r=-.157 for TM, -.233 for IO, and -.210 for EO. The results were insignificant for RT & LT RA and LT TA muscles.

Conclusion: The infl

Keywords

Anterior Abdominal Wall; Abdominal Surgery; Anatomy; CTKUB; Radiology

Anterior Abdominal Wall articles; Abdominal Surgery articles; Anatomy articles; CT-KUB articles; Radiology articles

Article Details

Abbreviations:

CT KUB- Computed Tomography of Kidneys, Ureters and Bladder; RA- Rectus Abdominus muscle; EO- External Oblique muscle; IO- Internal Oblique muscle; TA- Transversus Abdominus muscle; RT & LT- Right and Left; L- Lumbar vertebrae; BMI- Body Mass Index

Introduction

The anterior abdominal wall develops from both somatic and lateral plate mesoderm. It is made up of skin, superficial fascia, deep fascia, muscles, extraperitoneal fascia, and parietal peritoneum.The superficial fascia is divided into a superficial fatty layer (fascia of Camper) and a deep membranous layer (Scarpa’s fascia). The fatty layer is continuous with the superficial fat over the rest of the body and may be extremely thick (3 in. [8 cm] or more in obese patients) [1]. The superficial fascia of Camper contains a varying quantity of adipose tissue. Subcutaneous adipose tissue is composed of two different subcompartments: a "superficial" Subcutaneous adipose tissue and "deep" Subcutaneous adipose tissue, separated by a connective plane namedfascia superficialis,orScarpa's fascia [2]. The deep fascia in the anterior abdominal wall is merely a thin layer of connective tissue covering the muscles; it lies immediately deep to the membranous layer of superficial fascia [1]. The muscles of the anterior abdominal wall consist of three broad thin sheets that are aponeurotic in front; from exterior to interior they are the external oblique, internal oblique, and transversus. On either side of the midline anteriorly is, in addition, a wide vertical muscle, the rectus abdominis. As the aponeuroses of the three sheets pass forward, they enclose the rectus abdominis to form the rectus sheath. The lower part of the rectus sheath might contain a small muscle called the pyramidalis [1].

The radiological assessment of muscle and fat properties is fundamental in muscle diseases and obesity. Measurements of muscles and fat thickness were assessed in different populations and for different purposes. Detailed Knowledge of the layered anatomy of the abdomen in patient is essential for the successful performance of surgery and pleasing outcome, and better understanding of medical conditions that affect the anterior abdominal wall e.g. obesity, hernia.

A morphometric analysis of the abdominal wall can be performed precisely using computed tomography (CT) scans. As they allow for an accurate separation of the various tissue types based on their attenuation characteristics [3] and provide good assessment of muscle properties (size, mass, density, composition, andadipose tissueinfiltration) [4]. Computed tomography (CT) generates very delicate cross sections which is very helpful in the research studies. CT abdomen images are permitting the measurement of the abdominal fatty layer and differentiate it from the intra-abdominal fat [5]. On the other hand, many articles used ultra-sonographic anthropometric analysis to study the effect of age, sex and obesity on male anterior abdominal wall muscles.

Literature review presents a complete morphometric analysis of the healthy abdominal wall, confirms the great variability in abdominal wall anatomy, and the influence of several factors like age, sex and BMI. For example, Jourdan et al. conducted retrospective study in 2019 that included 120 patients over 18 years old and CT scans indicated for renal colic on an outpatient basis (1). Engelke et al. suggest that recent systematic reviews and met-analyses has demonstrated that muscle imaging by quantitative CT plays an important role in a large variety of diseases (2). For example, in 2018, Han, J.Y. and his team established clinical correlation of respiratory muscle with severity of emphysema visualized on CT scan.

Numerous studies that was concerned about quantification of subcutaneous fat and muscle tissue at abdominal computed tomography suggests a precise anatomical landmark in the L3–L4 disc region to predict more accurate measurements (5,7,8). According to the literature review this type of studies were not conducted in Sudanese population. This study is focusing on normal population measurements; therefore, further studies that study diseases that affect muscles and fat can make use of it.

Objectives

Broad Objectives: To assess the measurements of anterior abdominal wall layers thickness under the influence of age and sex, using CT KUB scan.

Specific Objectives:

  1. To define reference values for the thickness of anterior abdominal wall layers, in age-matched individuals.
  2. To compare the difference values for the thickness of anterior abdominal wall layers in different sex.
  3. To determine the asymmetry between right and left anterior abdominal wall muscles ( EO,IO,TA,RA)
  4. To determine the relationship between subcutaneous fatty layer and abdominal wall muscles.
  5. To compare the anterior abdominal wall layers measurements in Sudanese population to other population.

Materials and Methods:

Methods:

Study Design:

This is a retrospective descriptive hospital-based-study to assess the anterior abdominal wall of patients come for computed topography of kidney, ureter and bladder (CT-KUB).

Study Area:

The study was conducted in Ibn-Sina Specialized Hospital radiology center which is a tertiary public hospital located in the center of Khartoum. It has a dedicated imaging center and receives imaging requests from all over Sudan.

Study Duration:

The study was conducted during the period from July to December 2021.

Study Population:

This study was carried on Sudanese patients who presented to Ibn-Sina Specialized Hospital Radiology Center for CT-KUB imaging and aged between 19 – 71 years.

Sample Size:

The study sample size was calculated according to this formula:

Sample Size = z2 * p(1-P)/e2 / 1 + [ z2 * p(1-P)/e2 * N]

  • z-score = 1.96
  • e = margin of error = 5%
  • p = population percentage = 50%
  • N = population size = 500

The sample size =232

Materials:

Ethical Consideration:

The study commenced after approval from the ethical committee of Omdurman Islamic University and the need for an informed consent was waived. Confidentiality has been preserved.

Selection Criteria:

Inclusion Criteria:

Male or female patient aged more than 18 years old, who marked for CT-KUB scan and has no abnormalities in the anterior abdominal wall.

Exclusion Criteria:

The study excluded patients who did not meet the inclusion criteria e.g. Pediatrics and any patient with abdominal pathology that affect the anterior abdominal wall e.g. ascites or abdominal tumor.

Data Categorization and Management:

The patient’s abdominal CT scan was visualized and data regarding anterior abdominal wall thickness was collected with radiology technician assistance.

Data Collection Tools:

The study data was collected through computerized search of the radiology database, each 4 CT images were copied to a DVD.

Data Collection Technique:

The study data was collected from radiology data base according and saved to external DVD. Each DVD contained 4 images of CT scans. The CT scan images were a single slice of cross sectional view of abdomen at the level of L3 and L4 (where all muscles are observed clearly). DICOM viewer program was used to view the CT scan and take the required measurements.

Statistical Analysis:

The study data were analyzed by statistic expert using SPSS to calculate important values for muscles and subcutaneous tissue e.g. mean and SD. ANOVA test and Pearson correlation test were used where appropriate. P<0.05 was considered statistically significant.

Results

Demographic data

The study results showed that the average age was 43.08 ± 14.408 years old. The total number of patients is 232 male and female aged between 19 to 71. Four age groups were identified (19 – 32) (32 - 45) (45 – 58) (58 – 71) and presented in the table (1).

Table (1) Frequency distribution of age

Age group

Frequency

Percentage

19-32years

62

26.7%

32-45years

72

31.0%

45-58years

55

23.7%

58-71years

43

18.5%

Total

232

100 %

The total number of patients contains equal number of male and female = 116 as shown in table (2)

Table (2): Frequency distribution of gender

Gender

Frequency

Percentage

Male

116

50%

Female

116

50%

Total

232

100%

Measurements and variability:

Table (3) shows the minimum and maximum age of patients involved in the study, the minimum and maximum measurements of all anterior abdominal wall muscles including the right and the left side and the mean and standard deviation of each.

Descriptive Statistics

N

Minimum

Maximum

Mean

Std. Deviation

Age

232

19

70

43.08

14.408

RT RA

232

1.02

31.10

10.1049

3.18711

LT RA

232

1.26

16.20

6.0610

3.64083

RA

232

2.71

17.25

8.0829

2.70406

RT TM

232

1.52

11.40

5.1377

2.36142

LT TM

232

1.57

12.30

4.6247

2.13074

TM

232

1.55

11.20

4.8812

2.10147

RT IM

232

1.00

20.90

8.7459

3.15873

LT IM

232

1.55

11.40

4.7450

2.09721

IM

232

2.75

12.25

6.7455

1.93382

RT EO

232

1.89

10.90

5.5919

2.11594

LT EO

232

1.58

11.50

5.1924

2.02724

EO

232

1.74

10.55

5.3922

1.94195

Subcutaneous fatty layer

232

2.66

47.30

21.2023

10.64099

Valid N (list wise)

232

Influence of age:

Table (3): show the mean of the measured thickness of subcutaneous fatty layer and muscles for each age group. The mean thickness of subcutaneous fatty layer in mm is 13.28, 23.56, 25.95 and 22.57 in all four groups respectively. The mean thickness of all age groups is 21.2.

Table (3): ANOVA Test to compare the mean of the measured thickness in (mm) of (Subcutaneous fatty layer) between age groups.

Report

Subcutaneous fatty layer

Age group

Mean

N

Std. Deviation

19-32years

13.2887

62

8.82723

32-45years

23.5647

72

10.17956

45-58years

25.9571

55

8.57830

58-71years

22.5751

43

10.30850

Total

21.2023

232

10.64099

p-Value .000

As demonstrated in table (4) the mean thickness of each muscle that was measured in right and left side in all four age groups. The total mean thickness of RA in the four age groups is 9, 8.1, 7.5 and 7.33 respectively and the mean thickness in all patients is 8.08 with a p value .003. The RT RA show a mean of 11.46, 10.16, 9.5 and 8.77 respectively with a p value .000. The LT RA show a mean of 6.66, 6, 5.5 and 5.89 respectively with a p value of .406. The mean thickness for RT and LT RA in all patients is 10.1 and 6 respectively.

Table (4): ANOVA Test to compare the mean of the measured thickness in (mm) of (Rt.RA &LT.RA& RA) between age groups

Report

Age group

RT RA

LT RA

TOTAL RA

19-32years

Mean

11.4611

6.6621

9.0616

N

62

62

62

Std. Deviation

3.16855

4.05128

2.71541

32-45years

Mean

10.1674

6.0432

8.1053

N

72

72

72

Std. Deviation

2.64043

3.49295

2.43498

45-58years

Mean

9.5355

5.5369

7.5362

N

55

55

55

Std. Deviation

3.87439

3.33436

2.77347

58-71years

Mean

8.7730

5.8944

7.3337

N

43

43

43

Std. Deviation

2.28853

3.63685

2.68567

Total

Mean

10.1049

6.0610

8.0829

N

232

232

232

Std. Deviation

3.18711

3.64083

2.70406

P value

.000

.406

.003

Table (5) shows the total mean thickness of TA in the four age groups is 5.56, 4.88, 4.5 and 4.35 respectively and the mean thickness in all patients is 4.88 with a p value .011. The mean thickness of TA muscle was measured in the right and left side in all four age groups. The RT TA show a mean of 5.89, 5.16, 4.8 and 4.4 respectively with a p value .009. The LT TA show a mean of 5.2, 4.6, 4.2 and 4.3 respectively with a p value of .041. The mean thickness for RT and LT TA in all patients is 5.1 and 4.6 respectively.

Table (5): ANOVA Test to compare the mean of the measured thickness in (mm) of (Rt.TA &LT.TA& Total TA) between age groups

Report

Age group

RT TA

LT TA

TOTAL TA

19-32 years

Mean

5.8905

5.2356

5.5631

N

62

62

62

Std. Deviation

2.59040

2.23215

2.20999

32-45years

Mean

5.1693

4.6090

4.8892

N

72

72

72

Std. Deviation

2.37698

2.23395

2.15451

45-58years

Mean

4.8189

4.2051

4.5120

N

55

55

55

Std. Deviation

2.29289

1.89180

2.02223

58-71years

Mean

4.4072

4.3070

4.3571

N

43

43

43

Std. Deviation

1.75943

1.95207

1.71595

Total

Mean

5.1377

4.6247

4.8812

N

232

232

232

Std. Deviation

2.36142

2.13074

2.10147

P value

.009

.041

.011

As demonstrated in table (6) the total mean thickness of IO in the four age groups 7.8, 6.8, 6.2 and 5.68 respectively and the mean thickness in all patients is 6.7 with a p value .000. The mean thickness of IO muscle was measured in the right and left side in all four age groups. The RT IO show a mean of 10.27, 8.89, 8.1 and 7.05 respectively with a p value .000. The LT IO show a mean of 5.35, 4.78, 4.33 and 4.32 respectively with a p value of .028. The mean thickness for RT and LT IO in all patients is 8.7 and 4.7 respectively.

Table (6): ANOVA Test to compare the mean of the measured thickness in (mm) of (Rt.IO &LT.IO & Total IO) between age groups

Report

Age group

RT IO

LT IO

TOTAL IO

19-32 years

Mean

10.2718

5.3508

7.8113

N

62

62

62

Std. Deviation

3.34706

2.40568

1.90328

32-45 years

Mean

8.8975

4.7860

6.8417

N

72

72

72

Std. Deviation

3.23516

2.15600

2.01891

45-58 years

Mean

8.1498

4.3395

6.2446

N

55

55

55

Std. Deviation

2.73779

1.82035

1.60337

58-71 years

Mean

7.0547

4.3214

5.6880

N

43

43

43

Std. Deviation

2.09896

1.65019

1.39468

Total

Mean

8.7459

4.7450

6.7455

N

232

232

232

Std. Deviation

3.15873

2.09721

1.93382

P value

.000

.028

.000

Table (7) shows the total mean thickness of EO in the four age groups is 6.17, 5.48, 4.8 and 4.79 respectively and the mean thickness in all patients is 5.39 with a p value .000. The mean thickness of EO muscle was measured in the right and left side in all four age groups. The RT EO show a mean of 6.3, 5.7, 5.09 and 4.87 respectively with a p value .001. The LT EO show a mean of 6.02, 5.2, 4.59 and 4.7 respectively with a p value of .000. The mean thickness for RT and LT EO in all patients is 5.59 and 5.19 respectively.

Table (7): ANOVA Test to compare the mean of the measured thickness in (mm) of (Rt. EO &LT.EO ) between age groups

Report

Age group

RT EO

LT EO

TOTAL EO

19-32years

Mean

6.3356

6.0223

6.1790

N

62

62

62

Std. Deviation

2.17086

1.97912

1.93558

32-45years

Mean

5.7589

5.2108

5.4849

N

72

72

72

Std. Deviation

2.24903

2.14758

2.07375

45-58years

Mean

5.0976

4.5998

4.8487

N

55

55

55

Std. Deviation

2.02199

1.71551

1.76252

58-71years

Mean

4.8723

4.7228

4.7976

N

43

43

43

Std. Deviation

1.50282

1.90557

1.53590

Total

Mean

5.5919

5.1924

5.3922

N

232

232

232

Std. Deviation

2.11594

2.02724

1.94195

P value

.001

.000

.000

Influence of sex:

As shown in table (8) the total mean thickness of RA in males and females is 9.1 and 7.03 respectively, with a p value .000. The mean thickness of RA muscle was measured in the right and left side in both sex. The RT RA show a mean of 11.3 in males and 8.89 in females, with a p value .000. The LT RA show a mean of 6.95 in males and 5.1 in females with a p value of .000.

Table (8): T- Test to compare the mean of the measured thickness in (mm) of (Rt.RA &LT.RA& RA) between male and female

Group Statistics

P value

Gender

N

Mean

Std. Deviation

Std. Error Mean

RT RA

Male

116

11.3173

3.47962

.32307

.000

Female

116

8.8924

2.30873

.21436

LT RA

Male

116

6.9544

3.93153

.36503

.000

Female

116

5.1676

3.09182

.28707

RA

Male

116

9.1359

2.78555

.25863

.000

Female

116

7.0300

2.16601

.20111

Table (9) demonstrate the total mean thickness of TA in males and females is 5.55 and 4.21 respectively, with a p value .000. The mean thickness of TA muscle was measured in the right and left side in both sex. The RT TA show a mean of 5.8 in males and 4.44 in females, with a p value .000. The LT TA show a mean of 5.27 in males and 3.97 in females with a p value of .000.

Table (9): T- Test to compare the mean of the measured thickness in (mm) of (RT TA &LT TA & TA) between male and female

Group Statistics

P value

Gender

N

Mean

Std. Deviation

Std. Error Mean

RT TA

Male

116

5.8314

2.63215

.24439

.000

Female

116

4.4441

1.81718

.16872

LT TA

Mae

116

5.2731

2.38148

.22111

.000

Female

116

3.9764

1.61247

.14971

TA

Mae

116

5.5522

2.36076

.21919

.000

Female

116

4.2102

1.54571

.14352

Table (10): show the total mean thickness of IO in males and females is 7.4 and 6.07 respectively, with a p value .000. The mean thickness of IO muscle was measured in the right and left side in both sex. The RT IO show a mean of 9.47 in males and 8.01 in females, with a p value .000. The LT IO show a mean of 5.3 in males and 4.1 in females with a p value of .000.

Table (10): T- Test to compare the mean of the measured thickness in (mm) of (RT IO &LT IO & IO) between male and female

Group Statistics

P value

Gender

N

Mean

Std. Deviation

Std. Error Mean

RT IO

Mae

116

9.4738

3.46729

.32193

.000

Female

116

8.0181

2.63648

.24479

LT IO

Male

116

5.3609

2.23235

.20727

.000

Female

116

4.1290

1.75669

.16310

IO

Male

116

7.4174

2.01516

.18710

.000

Female

116

6.0735

1.59378

.14798

Table (11): demonstrate the total mean thickness of EO in males and females is 6.16 and 4.61 respectively, with a p value .000. The mean thickness of EO muscle was measured in the right and left side in both sex. The RT EO show a mean of 6.37 in males and 4.8 in females, with a p value .000. The LT EO show a mean of 5.95 in males and 4.42 in females with a p value of .000.

Table (11): T-Test to compare the mean of the measured thickness in (mm) of (RT EO &LT EO & EO) between male and female

Group Statistics

P value

Gender

N

Mean

Std. Deviation

Std. Error Mean

RT EO

Mae

116

6.3736

2.28404

.21207

.000

Female

116

4.8103

1.59494

.14809

LT EO

Male

116

5.9590

2.09291

.19432

.000

Female

116

4.4258

1.63991

.15226

EO

Male

116

6.1663

2.03786

.18921

.000

Female

116

4.6180

1.48769

.13813

Table (12): show the mean thickness of subcutaneous fatty layer in males and females is 17.59 and 24.8 respectively, with a p value .000.

Table (12): T-Test to compare the mean of the measured thickness in (mm) of Subcutaneous fatty layer between male and female

Group Statistics

P value

Gender

N

Mean

Std. Deviation

Std. Error Mean

Subcutaneous fatty layer

Male

116

17.5959

10.37666

.96345

.000

Female

116

24.8087

9.67119

.89795

Correlation:

Table (13): show the Pearson correlation test result that was used to test the correlation between the thickness of subcutaneous fatty layer and the muscles. The results show r=-.157 for TM, -.233 for IO , and -.210 for EO.

Table (13): Correlation between Subcutaneous fatty layer with abdominal muscle wall thickness in mm

Table icon

Table (14): demonstrate the Pearson correlation test result that was used to test the correlation between the thickness of fatty layer with abdominal muscle wall (RA&TM& &IO & EO) thickness in mm. The results were insignificant for RT & LT RA and LT TA muscles.

Table (14): Correlation between Subcutaneous fatty layer with abdominal muscle wall (RA&TM& &IO & EO) thickness in mm

Correlations

Subcutaneous fatty layer

RA

TM

IO

EO

Subcutaneous fatty layer

Pearson Correlation

1

-.080

-.157*

-.233**

-.210**

Sig. (2-tailed)

.225

.017

.000

.001

N

232

232

232

232

232

*. Correlation is significant at the 0.05 level (2-tailed).

**. Correlation is significant at the 0.01 level (2-tailed).

fortune-biomass-feedstock

Figure (1): Asymmetry rate of (RT&LT RA thickness)

Muscle Asymmetry:

The Figure shows the difference between the mean thickness of right and left RA muscles and the rate of asymmetry.

fortune-biomass-feedstock

Figure (1): Asymmetry rate of (RT&LT RA thickness)

fortune-biomass-feedstock

Figure (2): Asymmetry rate of (RT&LT TA thickness)

Figure (2): demonstrate the difference between the mean thickness of right and left TA muscles and the rate of asymmetry

fortune-biomass-feedstock

Figure (3): Asymmetry rate of (RT&LT IO thickness)

Figure (3): show the difference between the mean thickness of right and left IO muscles and the rate of asymmetry

fortune-biomass-feedstock

Figure (4): Asymmetry rate of (RT&LT EO thickness)

Figure (4): show the difference between the mean thickness of right and left EO muscles and the rate of asymmetry

fortune-biomass-feedstock

Figure (5): Asymmetry rate of (RA & TA & IO& EO thickness)

Figure (5): show the difference between the mean thickness of the four muscles (RA, TA, IO, EO) and the rate of asymmetry.

Discussion

After careful literature review, this study is the first of its kind to be done in Sudan, emphasizing the value of the use of CT in measurement of anterior abdominal wall thickness, the uniqueness of this study emerges from its representative study sample and the accuracy of the measurements, in contrast to previous studies were ultrasonography was used for the measurement of thickness which is exposed to more subjectivity and the need for exclusion of intra-abdominal pathologies and gynecological conditions [13,14]. Clearly knowing the normal anterior abdominal wall measurements will have a big role in helping in preparation of abdominal surgeries especially in patients with abnormal abdominal wall. According to what is mentioned before, this data represents a reference value for Sudanese population anterior abdominal wall measurements because it includes four age groups between the age 19 and 71, and the gender is represented equally. Because of the wide range of measurements performed in this work, it is now possible to explain this variability through the influence of age and sex, in contrast to Khan et al were subjects were grouped according to age and obesity ,obesity was measured using the help of BMI which later showed little correlation with abdominal muscles thickness [8]. The influence of age on abdominal subcutaneous fatty layer is noted and found to be increased with age, this is consistent with the Jourdan et al, and Khan et al. Jourdan et al show nearly similar results in all four age groups of 21.5, 22.1, 25.1, 21.3 mm respectively. In contrast to muscle, which show a decrease in thickness with age (RA, TA, IO, EO), which is consistent with previous studies [8,10]. This was explained by Khan et al, the slight decrease in abdominal muscle thickness with advancing age is observed by simultaneous increase in intramuscular fat content. Comparing the mean thickness of all muscles of all ages to Jourdan et al, the mean thickness was higher than the mean we found in EO and IO, 8.5 and 8 respectively, and lower than TA and RA, 6.1 and 3.7 respectively. In comparing the right and left abdominal musculatures, we used the thickness in mm unlike Jourdan et al in which the asymmetry was evaluated with the muscle area. In contrast to Mannion et al., which suggests no significant differences between left and right sides, the RT side show more thickness that is more obvious in RA ( 10.1 mm for right and 6 mm for left )and IO ( 8.7 mm for right and 4.7 mm for left ). Although this could be explained by hand dominance, the lack of asymmetry based on hand dominance was not supported in previous studies [14]. The influence of sex on abdominal subcutaneous fatty layer is showing female predilection and this is in accordance with previous work. The thickness of subcutaneous fatty layer in female in our study is 24.8 mm which is consistent with Jourdan et al which show 24.2 mm and Kim et al study which show subcutaneous fat thicknesses of 24.31 mm (right) and 23.39 mm (left). However, a slight difference in male was found, 17.6 mm and 20.8 mm respectively. In contrast, the muscles in males have more thickness compared to females. Using ultrasound image Springer et. al. illustrated the thickness of TA in male and female and found out similar values 5+/-0.9 and 4.2 +/- 0.7 respectively. Tahan et al. also used ultrasound imaging to evaluate EO, IO, TA and RA thickness in healthy adult male and female subjects and found similar values to ours (Rt EO 5.7 mm, Lt EO 5.4 Rt IO 8.9 mm, Lt IO 8.5, Rt TA 4.5 mm, Lt TA 3.8 mm, Rt RA 10.3, Lt RA 10.4 for males and 4.8, 4.8, 6.1, 5.8, 3.5, 3.3, 8.7, 8.3 for females respectively). A Pearson correlation show weak negative correlation between the thickness of subcutaneous fatty layer and the muscles r=-.157 for TM, -.233 for IO, and -.210 for EO. The correlation is insignificant between RM and subcutaneous fatty layer, in contrast to Kim et al study which demonstrate positive correlation, clear association was found between age and wall thickness, and the influence of sex was also significant, in relevance to Mannion et al which showed that the main effect of gender was significant for all the OI parameters, OE change in thickness from rest to hollowing , and the sum of all lateral parameters during hollowing , but in contrast the differences were mainly significant to left side [13]. This study is not devoid of certain limitations. All measurements were taken on single slice which could limit the accuracy of the results. Additionally, human error could happen during measurements.

Conclusion

The study was performed among 232 patients who underwent CT KUB scan in Ibn Sina Specialized Hospital in the second half of 2021 with equal number of male and female. It demonstrates the mean thickness of subcutaneous fatty layer and anterior abdominal wall muscles in both right and left group. The muscle thickness is decreasing with age, in contrast to subcutaneous fatty layer thickness which increases with age. Males have thicker muscles than female however, females have thicker subcutaneous fat. The asymmetry is present between all muscles with right group dominance. The RT RA has the highest mean thickness followed by IO then EO and then TA. The correlation between abdominal wall muscles and fatty layer is weakly negative.

Recommendation

The study gives reference measurements which can be useful to surgeons in different conditions like when they are dealing with ventral hernia, abdominal wall flaps. Because it can improve the outcome, increasing the awareness of this muscles measurements and variations is one of our recommendations. Additionally, we recommend further researches to assess the abdominal wall muscles in relation to BMI. Furthermore, more focus on subcutaneous fatty layer to study its accuracy in diagnosing obesity instead of BMI. Additionally further studies regarding the correlation between hand dominance and muscle wall thickness could be of a value, finally we recommend studying the effects of various conditions on abdominal wall muscle thickness.

Statements and Declarations

Authors declare that they have no competing interests.

Funding

no fund.

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