Tracing peritoneum

2. Cavities of body

4. Peritoneum
• Large serous sac
• Lines inner surface of abdomino-
pelvic wall

5. Why different layers?
• Invaginated by viscera from
different sides
• Invagination throws the peritoneum
into folds &
• Forms
• Parietal & visceral layers
• & potential spaces

6. Peritoneum - parts
• Parietal Peritoneum
• Lines the inner surface of
• Abdominal and pelvic walls and
• Lower surface
• Diaphragm
• Embryologically from somatopleuric
mesoderm
• Derives blood & nerve supply from body
wall
• Visceral Peritoneum
• Lines outer surface of viscera
• Firmly attaches with viscera
• Develops from splanchnopeuric
mesoderm
• Blood supply and nerve supply are the
same as those of underlying viscera

7. Interperitoneal organs
• Most part of viscera surrounded by
peritoneum
• Stomach, Liver, gallbladder
• Tail of pancreas, spleen
• First part of duodenum, jejunum, ileum
• Transverse colon, sigmoid colon
• Upper part of rectum, urinary bladder and
uterus

8. Retroperitoneal organs
• Organs lie on the posterior abdominal
wall are covered by peritoneum on
their anterior surfaces
• Descending and horizontal parts of
duodenum, pancreas (head, neck & body)
• Ascending & descending colon
• Kidney, suprarenal gland, ureters
• Abdominal aorta & IVC
• Middle and lower parts of rectum

9. Secondary retroperitoneal organs
• Duodenum
• 2nd and 3rd part
• Pancreas (except tail)
• Ascending colon
• Descending colon
• Upper rectum

10. Folds of Peritoneum -
types
• Many organs within abdomen are
suspended by folds of peritoneum
• Provide pathways for passage of
vessels, nerves and lymphatics
• Named after their attached organs
• Omentum
• Fold of peritoneum connecting stomach to
other organs
• Mesenteries
• Fold invests small intestine
• Mesocolon
• Fold invests large intestine
• Peritoneal ligaments
• Folds attached with other organs

11. Disposition – Vertical
• Start from
• Anterior abdominal wall
• At umbilical level
• Lines
• Inner aspect of anterior abdominal wall
• Trace
• Upto ant part of diaphragm (under surface)
• Right of median plane
• Falciform ligament
• In free margin it contains
• Ligamentum teres hepatis
• Obliterated left umbilical vein (extends
from umbilicus to inferior surface of
liver)
• Also it contains para umbilical veins
• Tributaries to left branch of Portal vein

12. Disposition – Vertical
• Inferior surface of diaphragm to upper
surface of liver
• Falciform ligament
• 2 layers diverge to right & left
• On right (right layer of falciform)
• From diaphragm to right lobe of liver forms
• Superior layer of coronary ligament
• On left (left layer of falciform lig)
• From diaphragm to left lobe of liver forms
• Left triangular ligament (anterior layer)

13. Disposition – Vertical
• After covering the superior and anterior
surfaces of liver
• Reaches inferior surface of liver
• Right of Gall bladder
• Peritoneum passes down to
• Suprarenal & kidney as inferior layer of
coronary ligament
• Bare area
• Between the 2 layers of coronary ligament
• Right triangular ligament
• 2 layers of coronary ligament unite to form
• Connects right lobe of liver with diaphragm

14. Disposition – Vertical
Ligamentum venosum - remnant of ductus venosus
(oblitrated ductus venosus), which shunted blood from
the umbilical vein to the IVC in fetal life
• On the left of gall bladder
• After covering quadrate lobe & left lobe
• Becomes posterior layer of left triangular ligament
• Then passes to
• Left margin of fissure for ligamentum venosum & anterior lip
of porta hepatis &
• From anterior lip of porta hepatis to right and then posterior lip
of porta hepatis
• Covering caudate lobe & attached to right lip of fissure for
ligamentum venosum
• These two layers form
• Lesser omentum
• Has inverted L shaped attachment

15. Omentum
• Peritoneal folds related to stomach
• Lesser omentum
• Greater omentum

16. Lesser omentum
• Connects liver to stomach
• Attachment
• Above to porta hepatis & fissure for
ligamentum venosum
• Inferiorly to lesser curvature of the
stomach & 1st inch of duodenum
• Parts
• Hepato gastric ligament
• Hepato duodenal ligament
• Forms free margin
• Contains
• Portal vein (posteriorly)
• Hepatic artery (anterior & left)
• Bile duct (anterior & right)

17. Lesser omentum
• Contents
• Hepatic artery, bile duct, portal vein
• In free margin -
• Rt. & lt. gastric vessels
• Along lesser curvature

18. Tracing lesser omentum
• Peritoneum from
• Anterior lip of porta hepatis and left lip of
fissure for ligamentum venosum
• Posterior lip of porta hepatis and right lip
of fissure for ligamentum venosum
• Continues downwards as lesser
omentum towards lesser curvature of
stomach and first one inch of
duodenum
• Forms anterior boundary for upper part
of lesser sac

19. Tracing lesser omentum
• After reaching lesser curvature
• Two layers separates
• And covers the surfaces
• Reaches greater curvature
• Becomes anterior two layers of greater omentum

20. Tracing greater
omentum
• From greater curvature
• Anterior & posterior layers
comes downwards
• After awhile it returns back
towards anterior border of
pancreas
• So 4 layers are there
• Together they form Greater
omentum
• Space between 2nd & 3rd layer is
lesser sac
• Patent in fetal life
• But obliterated - after birth

21. Fate of 3rd & 4th layers
• Continuation of layers of lesser
omentum
• Forms 1st & 2nd layer of greater omentum
• While returns back to pancreas
• 1st layer becomes 4th layer
• 2nd layer becomes 3rd layer
• Third layer
• Runs upwards towards anterior border of
pancreas (infront of transverse colon)
• Passes infront of
• Anterior surface of pancreas, kidney and
suprarenal gland
• Reaches the liver
• Forms posterior wall of lesser sac

22. Fate of 3rd & 4th layers
• 4th layer
• Runs towards anterior surface of head &
anterior border of body of Pancreas
• Then comes down to transverse colon as
upper layer of Transverse mesocolon
• Encloses transverse colon
• Then goes towards inferior surface of
pancreas – as inferior layer of
Transverse mesocolon
Fourth layer of Greater omentum and
Superior layer of Transverse mesocolon are
adherent – but separable.

23. Greater omentum
• Largest fold of peritoneum
• Hangs down like an apron
• In front of coils of small intestine
• Made of 4 layers
• Anterior 2 layers from Greater
curvature and 1st part of duodenum
• Extending downwards for a considerable
distance &
• Fold upon themselves to be 3rd & 4th
layer
• To anterosuperior surface of
Tranasverse colon (head & ant border
of pancreas)

24. Greater omentum – parts &
contents
• Parts
• Gastrophrenic ligament
• Gastrosplenic ligament
• Gastrocolic ligament
• Contents
• Rt. &Lt. gastroepiploic vessels
• Lymph nodes
• Fat
• Functions
• Store house of fat
• Limits the spread of infection

25. Transverse mesocolon
• Suspends transverse colon
• Attached to anterior
aspect of head & anterior
border of body of
pancreas
• Contains –Middle colic
art.

26. Root of mesentery
• Peritoneum from transverse mesocolon
• Covers lower part of anterior surface of
head of pancreas
• Passes to front of 3rd & 4th parts of
duodenum
• Then covers posterior abdominal wall
• Becomes folded between
• Duodenojejunal flexure(left of L2) to
ileocecal junction (rt sacroiliac joint)
• Forms root of mesentery

27. Mesentery
• Fan-shaped fold of peritoneum
• Suspends the coils of jejunum and
ileum from posterior abdominal wall
• Has 2 borders
• Attached
• Free

28. Mesentery - borders
• Attached border
• Known as root of mesentery
• Lies obliquely
• Extent
• From
• Duodenojejunal flexure (L2 – left side)
• To
• Ileocecal junction (Rt. Sacroiliac joint)
• Length - 6 inches (15 cm)
• Structures crossed by it
• 3rd part of duodenum, Abdominal aorta, IVC
• Rt. Psoas major,
• Rt. Gonadal vessels, Rt. Genitofemoral nerve &
Rt. ureter (medial to lateral)
• Rt. Sacroiliac jt

29. Mesentery - borders
• Free border
• Encloses jejunum and ileum
• 6 meters in length
• Contents
• Jejunum, ileum
• Lymph nodes
• Jejunal & ileal branches of superior
mesenteric artery & nerve plexus
• Fat

30. Meso-appendix
• Δ-gular fold
• Suspends appendix
• From post surface of lower end
of mesentery
• Appendicular artery

31. Peritoneum in Pelvis
• After covers the structures of
posterior abdominal wall
• Reaches pelvis
• First invests sigmoid colon from pelvic
wall
• Sigmoid mesocolon
• Then covers Rectum
• Upper third on front & sides
• Middle part on front only
Tracing the peritoneum anteriorly differs
in male & female

32. Sigmoid
mesocolon
• Suspends sigmoid colon
• Attached to post abdominal and
pelvic walls like inverted V
• Apex of V lies on ureter at
bifurcation of Lt. com iliac
artery
• Lt limb – along upper ½ of Lt,
Ext iliac
• Contents – Superior rectal
vessels

33. Peritoneum - Pelvis
• In male
• From rectum to seminal vesicle
• Then upper surface of urinary bladder
• Forms rectovesical pouch
• From apex of UB to inner surface of
anterior abdominal wall till umbilicus
• In female
• From rectum to posterior fornix of vagina
• And covers supravaginal cervix, body and
fundus
• Forms rectouterine pouch (pouch of Douglas)
• Then covers anterior surface of body
• From body to UB
• Forms uterovesical pouch

34. Female pelvis
• Communicates with extraperitoneal
pelvis exteriorly
• Through fallopian tubes, uterus and
vagina

35. Folds in anterior abdominal wall
• Median umbilical fold
• Remnant of urachus (median
umbilical ligaments)
• Medial umbilical fold
• Remnants of umbilical arteries
(medial umbilical ligaments)
• Lateral umbilical fold
• Inferior epigastric vessels

36. Fossae of anterior abdominal wall

38. Peritoneal cavity - Divisions
• Transverse mesocolon divides the
peritoneal cavity in to
• Supramesocolic space
• Also known as subphrenic spaces
• Inframesocolic space
• Bilateral paracolic & pelvic spaces
are also peritoneal spaces

39. Supra colic space
• Also known as subphrenic spaces
• Boundaries
• Superiorly
• Diaphragm
• Inferiorly
• Transverse colon
• In front
• Ant abdominal wall
• Behind
• Lesser omentum, stomach, greater
omentum

40. Supracolic compartment
• Supracolic compartment contains
• Stomach, liver, and spleen
• Infracolic compartment contains
• Small intestine and ascending & descending
colons
• Infracolic compartment is divided into
• Right and left infracolic spaces by the
mesentery of small intestine
• Communication occurs between the
supracolic and infracolic compartments
• Through paracolic gutters

41. • Right
• Right anterior subphrenic
(subdiaphragmatic)
• Right posterior subphrenic (hepatorenal
or Morrisons pouch)
• Right extraperitoneal
• Left
• Left anterior intraperitoneal / left
suprahepatic / subphrenic
• Left posterior intraperitoneal / left
subhepatic
• Left extraperitoneal
Supracolic compartment - Spaces

42. Right anterior intraperitoneal / subphrenic / suprahepatic
• Presents
• Right of falciform ligament
• Boundaries
• In front
• Ant abdominal wall & diaphragm
• Behind
• Superior anterior & right lateral surface of right
lobe of liver, superior layer of coronary
ligament
• Below
• Communicates with right posterior
intraperitoneal compartment
• Above
• Diaphragm

43. Morrison’s Pouch / Hepatorenal pouch /
Rt subhepatic pouch
• Right posterior subphrenic space
• Most dependent part of peritoneal cavity in
upper abdomen
• Boundaries
• In Front
• Inferior surface of rt. lobe of liver and Gall bladder
• Behind
• Anterior surface of rt. kidney & rt. supra renal gland
• Rt. Colic flexure & 2nd part of duodenum
• Above
• Inf layer of coronary ligament
• Below
• Communicate with infracolic part of peritoneal cavity
• Left
• Communicate with omental bursa
• Right
• Limited by diaphragm

44. Morrison’s Pouch Hepatorenal pouch Rt subhepatic pouch
• Most dependent part of abdomen
proper
• Commonest site of subphrenic abscess
• From
• Perforated peptic ulcer of stomach &
duodenum

45. Right extraperitoneal space
• Bare area of liver presents
• Liver directly related to diaphragm
• Boundaries
• Left
• IVC
• Right
• Rt. triangular ligament
• Above
• Superior layer of coronary ligament
• Below
• Inferior layer of coronary ligament
• Clinical anatomy
• Common site for
• Amoebic liver abscess

46. Left anterior intraperitoneal
• Lies on left of falciform ligament
• Boundaries
• In front
• Ant abdominal wall
• Behind
• Lt triangular ligament
• Lt. lobe of liver
• Stomach & spleen

47. Left posterior intraperitoneal
• It is lesser sac

48. Lesser Sac
• Position
• Behind the lesser omentum and stomach
walls

49. Lesser sac
• Boundaries
• Superior
• Peritoneum which covers the caudate lobe of liver
and diaphragm
• Anterior
• Lesser omentum
• Peritoneum of posterior wall of stomach
• And anterior two layers of greater omentum
• Posterior
• Posterior two layers of greater omentum
• Transverse colon & transverse mesocolon
• Peritoneum covering pancreas, left kidney and
suprarenalgland
• Inferior
• Continuity of anterior and posterior two layers of
greater omentum

50. Lesser Sac
• Right border
• From above downwards
• Deficient above
• Epiploic foramen
• Peritoneum covering
• Posterior surface of proximal part of
duodenum to the head of pancreas
• Left border
• From above downwards
• Gastrophrenic ligament
• Gastrosplenic and lienorenal
ligament
• Left border of greater omentum

51. Parts of lesser sac
• Body
• Lies behind lesser omentum &
stomach
• Superior recess
• Lies behind caudate lobe of liver
• Splenic recess
• Between gastrosplenic and
lienorenal ligament
• Inferior recess
• Lies between the folds of greater
omentum

52. Epiploic foramen
• Communication between
• Lesser and greater sac
• Location
• T -12 vertebra level
• Boundaries
• Anteriorly
• Free margin of lesser omentum
• Contains
• Front right to left
• Bile duct & hepatic artery
• Behind
• Portal vein
• Posteriorly
• IVC (covered by peritoneum)
• Superiorly
• Caudate process of liver
• Inferiorly
• 1st part of duodenum

53. Epiploic foramen
Boundaries
• Anteriorly
• Free margin of lesser omentum
• Contains
• Front right to left
• Bile duct & hepatic
artery
• Behind
• Portal vein
• Posteriorly
• IVC (covered by peritoneum)
• Superiorly
• Caudate process of liver
• Inferiorly
• 1st part of duodenum

54. Applied anatomy
• Internal abdominal hernia
• Occasionally a loop of intestine may
enter into lesser sac
• Through epiploic foramen
• None of the boundaries can be incised
to reduce the hernia
• Pushing the herniated loop out of lesser
sac by inserting the index finger into it
through ant. 2 layers of greater omentum

55. Infracolic Compartments
• Lies below the transverse colon &
mesocolon and behind the greater
omentum
• Divided into w by root of mesentery
• Right infracolic Compartment
• Left infracolic Compartment

56. Right infracolic compartmet
• Boundaries
• Above
• Transvers colon & mesocolon
• On right
• Ascending colon
• On left
• Root of Mesentery
• Below
• Closed

57. Left infracolic compartmet
• Lies left of root of mesentery
• Boundaries
• In front
• Anterior abdominal wall
• Above
• Transverse mesocolon
• Below
• Open with pelvis
• On right
• Root of mesentery
• On left
• Descending colon

58. Paracolic gutters
• Longitudinal channels
• Lined by peritoneum
• Lies along the sides of ascending &
descending colons
• Right & left paracolic gutters
• Right paracolic gutter
• Lies lateral to ascending colon
• Communication
• Beween Hepato-renal pouch (above)
& pelvis (below)
• Left paracolic gutter
• Lies lateral to descending colon
• Above it is separated from
• Spleen & lienorenal space by
Phrenico-colic ligament
• Below it is communicated with
pelvis
•

59. Rectouterine Pouch (Pouch of
Douglas)
• Boundaries:
• Anteriorly: uterus and posterior fornix of vagina
• Posteriorly: rectum
• Inferiorly (floor): rectovaginal fold of
peritoneum
• Clinical anatomy
• Most dependent part of peritoneal cavity
• Pus collected here
• Can be drained through rectum or posterior fornix of
vagina

60. Applied anatomy
• Ascites
• Excessive accumulation of peritoneal fluid
in peritoneal cavity
• Commonly due to
• Cirrhosis
• TB & Malignancy
• Paracentesis
• Draining fluid
• Peritonitis
• Infection & inflammation of peritoneum
• May result in fatal
• Minimize the damage of peritoneum