2. • Introduction
Abdominal Cavity is the largest Cavity. It encloses the
peritoneal cavity between it’s parietal and visceral
layers.Parietal layer clings to the wall of parieties while
visceral layer is intimately adherent to viscera concerned. So
their vascular supply and nerve supply are same as the
parieties and viscera, respectively.
There are very lengthy organs in the abdominal cavity.
These had to be disciplined with limited movements for
proper functioning of the gut in particular and the body in
3. l
general. Infections involving the parietal Peritoneum impart
protective board like rigidity to the abdominal wall. Refered pain
from the viscera to a distinct area is due to somatic and
sympathetic nerves reaching the same spinal segment.
• Nine Regions of Abdomen
• For the purpose of describing the location of vicera, the
abdomen is divided into nine Regions by four imaginary
planes
• These are the two horizontal and two vertical
• The horizontal planes are the transpyloric and
4. Transtubercular planes.
• The vertical planes are right and left lateral planes.
• The pelvic cavity lies below and posterior to the
abdominal cavity.
5. • Trans pyloric plane of Addison passes midway between the
suprasternal notch and public symphysis.
• Anteriorly it passes through the tips of the ninth costal
cartilage and posterity through the body of vertebra L1 near
it’s lower border.
• Organs present on this plane are pylorus of stomach,
beginning of duodenum, neck of pancreas and hila of the
kidney.
• Trance tubercular plane passes through the tubercal of the
iliacrest and the body of vertebra L5 near its upper border.
6. • The right and left lateral planes correspond to mid clavicular
or memory lines
• Each of these vertical planes passes through the mid inguinal
point and crosses the tip of the nine Costal cartilage.
8. • Large intestine lies at the
periphery of the
abdominal cavity
• The pelvic cavity lies
posterioroinferiorly
between pubic symphysis
anteriorly and concavity of
sacrum including coccyx
posteriorly.
10. • The peritoneum( Means stretched over) is a large serous
membrane lining the abdominal cavity.
• It covers the many of abdominal organ inside (visceral
layer)
• IT acts as a conduit for the passage of blood vessels,
lymphatic and nerves.
• It supports the organs of the abdomen.
• It also called the abdominal membrane.
• It is composed of an outer layer of fibrous tissue which
gives strength to the membrane and inner layer of
mesothelial cells which secret a serous fluid which
lubricates the surface does allowing free moments of
11. Of Visra.
• Peritoneum is in the form of closed sec which is in
veginated by a number of Visra.
• The peritonium is divided into:-
1. And outer or parietal layer.
2. An inner or visceral layer.
3. Folds of peritoneum by which
the Viscera are suspended.
12. 1. Parietal peritoneum
• It lies the inner surface of the abdominal and pelvic
walls.
• And the lower surface of the diaphragm.
• It is loosely attached to the walls by extraperitoneal
connective tissue.
• Embryology it is derived from the Somato-Pleuric layer
of the lateral plate mesoderm.
• It’s blood supply and nerve supply are the same as those
of the overlying body wall.
• Because of the somatic innervation, parietal peritonium
is pain sensitive.
13. 2. Visceral Peritoneum
• It lines the outer surface of the Viscera, which it is firmly
adherent and cannot stripped.
• In fact, it forms a part and parcel of the Viscera.
• Embryologically it is derived from the splanchno pleuric layer
of the lateral plate mesoderm.
• It’s blood supply and now supply are the same as those of
the underline Viscera.
14. • Folds of peritonium
1. Many organs within the abdomen are suspended by
folds of peritonium.
• such organs are mobile.
• Other organs are fixed and immobile.
• They rest directly on the posterior abdominal wall and
may be covered by peritonium on one side.
• Such organs are said to be retroperitoneal.
15. • Retro peritoneal means posterior to the peritonial cavity.
• Some organs are
suspended by
peritonium folds in
early embryonic life,
but later become
retroperitoneal.
• Apart from allowing
mobility the peritoneal
folds provide pathways
for passage of vessels,
16.
17. • Peritoneal fold are given various names:-
• In general name of the fold is made up of the prefix mes or
meso followed by the name of the organ.
• For example the fold suspending the small intestine is called
the mesentery and a fold suspending part of the colon is
called mesocolon.
• Large peritonial folds attached to the stomach are called
omenta singular of which is omentum which means cover.
18.
19. In many situations double layered folds of peritonium connect
organs to the abdominal wall or to each other.
• Such folds are called ligaments.
• These may be named after the structures they connect.
• For example gastrosplenic ligament connects the stomach to
the spleen.
• Other folds are named according to their shape example the
triangular ligament of the liver.
20. • Peritoneal cavity
• Generally peritoneal cavity is called the potential space
between the parietal Layer and visceral layer.
• The Viscera which invaginate the peritonial cavity
completely feel it so that the cavity is reduced to a potential
space separating adjacent layers of peritoneum.
• Between these layers there is a film of fluid secreted by the
mesothelial cells.
• This fluid performs a lubricating function and allows free
movement of one peritoneal surface over another.
21. • The peritoneal cavity is divided broadly into two parts.
• The main larger part is known as the greater sac and the
smaller part situated behind the stomach is the laser
omentum and the liver is known as the Omental bursa or
lesser sec.
• The two sacs communicate with each other through the
epiploic Foramen or foramen of Winslow or opening into
the laser set.
22.
23. • Small pockets or recesses of the peritoneal cavity by small
folds of peritoneum.
• These peritoneal recesses or fossa are of clinical
importance.
• Internal hernia may take place into these recesses.
• Under abnormal circumstances there maybe collection of
fluid called ascites or blood called hemoperitoneum, or of
air called pneumoparitonium within the peritonial cavity.
24. Sex Differences
In the male, the peritoneum is a closed sac lined by
mesothelium or flattened epithelium. The female peritoneum
has the following distinguishing features.
1 The peritoneal cavity communicates with the exterior through
the uterine tubes.
2 The peritoneum covering the ovaries is lined by cubical
epithelium.
3 The peritoneum covering the fimbria is lined by columnar
ciliated epithelium.
25. Functions of Peritoneum
1 Movements of viscera: The chief function of the peritoneum
is to provide a slippery surface for free movements of
abdominal viscera. This permits peristaltic movements of the
stomach and intestine, abdominal movements during
respiration andperiodic changes in the capacity of hollow
viscera associated with their filling and evacuation. The
efficiency of the intestines is greatly increased as a result of the
wide range of mobility that is possible because the intestines
are suspended by large folds of peritoneum.
2 Protection of viscera: The peritoneum contains various
phagocytic cells which guard against infection. Lymphocytes
26. Present in normal peritoneal fluid provide both cellular and humoral
immunological defence mechanisms. The greater omentum has the
power to move towards sites of infection and to seal them thus
preventing spread of infection. For this reason, the greater omentum is
often designated as the ‘policeman of the abdomen’.
3 Absorption and dialysis: The mesothelium acts as a semipermeable
membrane across which fluids and small molecules of various solutes
can pass. Thus, the peritoneum can absorb fluid effusions from the
peritoneal cavity. Water and crystalloids are absorbed directly into the
blood capillaries, whereas colloids pass into lymphatics with the aid of
phagocytes. The greater absorptive power of the upper abdomen or
subphrenic area is due to its larger surface area and because
respiratory movements aid absorption.
27. Therapeutically, considerable volumes of fluid can be
administered through the peritoneal route. Conversely,
metabolites, like urea can be removed from the blood by
artificially circulating fluid through the peritoneal cavity. This
procedure is called peritoneal dialysis
4 Healing power and adhesions: The mesothelial cells of
The peritoneum can transform into fibroblasts which promote
healing of wounds.
5 Storage of fat: Peritoneal folds are capable of storing large
amounts of fat, particularly in obese persons.
6 Provides passage for nerves, vessels and lymphatics to and
from the suspended viscera.
28. CLINICAL ANATOMY
• Collection of free fluid in the peritoneal cavity is known as
ascites. Common causes of ascites are cirrhosis of the liver,
tubercular peritonitis, congestive heart failure, and malignant
infiltration of the peritoneum. Veins also get prominent in
cirrhosis of liver.
• Fluid from the (peritoneal cavity) may be removed by
puncturing the abdominal wall either in the median plane
midway between the umbilicus and pubic symphysis, or at a
point just above the anterior superior iliac spine. The
procedure is called paracentesis. Urinary bladder must be
emptied before the procedure .
29.
30.
31. • Inflammation of the peritoneum is called peritonitis. It may
be localized when a subjacent organ is infected; or may be
generalized. The latter is a very serious condition.
• The presence of air in the peritoneal
cavity is called
pneumoperitoneum. It may occur after
perforation
of the stomach or intestines.
32. • Laparoscopy is the examination of the peritonealcavity
under direct vision using an instrumentcalled laparoscope.
• Opening up the abdominal cavity by a surgeon iscalled
laparotomy.
• • Greater omentum limits the spread of infection by sealing
off the site of ruptured vermiform appendix or gastric ulcer
and tries to delay the onset of peritonitis. It is called
‘abdominal policeman’.
• Inflammation of parietal peritoneum causeslocalized severe
pain and rebound tenderness on removing the fingers.
• Peritoneal dialysis is done in case of renal failure. The
procedure removes the urea, etc. as it diffuses through blood
35. • Devloping gut is divisible into 3
parts:-
1. foregut
2. midgut
3. hindgut
• Each part has its own artery:-
foregut – coeliac artery
midgut – superier mesentric
artery
hindgut – inferior mesentric
artery
36. • Foregut forms: 1. oesophagus
2. stomach
3. upper part of
dueodnem upto opening of bile
duct
• Midgut forms: 1. rest of dueodnem
2. jejunum
3. ileum
4. appendix
5. ceacum
6. ascending colon
7. two- third of
transverse colon
37. • Hind gut forms: 1. one – third of
transverse colon.
2. decending colon
3. sigmoid colon
4. proximal part of
rectum.
• The abdominal part of foregut is
suspended by mesentries both
ventrally and dorsally.
• Ventral mesentry of foregut is
venral mesogastrium.
• Dorsal mesentry of foregut is
dorsal mesogastrium.
38. • Vansntral mesogastrium divides
by developing liver into ventral
and dorsal parts
• Ventral part form ligaments of
liver
• Dorsal part form lesser omentum
• Midgut and hindgut have only a
dorsal mesentry and forms the
mesentry of jejunum and ileum,
transverse mesocolon and
sigmoid mesocolon.
• Mesentries of dueodnem,
ascending and descending colon,
and rectum are lost during
development.
40. • Greater omentum is a large fold of peritonium hangs down
from the greater curvature of stomach and covers the loop of
intestine
• It is made up of 4 layers of peritonium which are fused
together.
Attachments
• Anterior two layers decends from the greater curvature of
stomach to variable extent
• And fold upon themselves to form the posterior two layers
which ascends to the anterior surface of head.
• Folding of the omentum is such that first layer become forth
layer and second layer become third.
41.
42. Contents:
• The right and left gastroepiploic
vesseles anastomoses with each
other in the internal between the
two layers of the greater omentum
a little below the greater curvature
of stomach.
• Often laden with fat
43. Functions
• Store house of fat
• Protects the peritonial cavity agaist infection because of
presence of macrophage in it.
• It also limits the spread of infection by moving to the site of
infection and sealing it off from the surronding areas.
• Greater omentum know as police man of the abdomen.
44. • Greater omentum forms a partition
between supracolic and infracolic
compartments of the greater sac.
46. • Fold of peritoneum
• It’s extends from the lesser
curvature of the stomach
and 1st 2cm of the
duodenum to the liver.
47. • Ligaments
• The portion of lesser
omentum between the
stomach and the liver is
called the hepatogastric
ligament.
• The portion between the
duodenum and the liver is
called the hepatoduodenal
ligament.
48. • Epiploic foramen
• The lesser omentum has a free
right margin behind which
there is the epiploic foramen.
• The greater and lesser sacs
communicate through this
foramen.
49. • Attachment
• Inferiorly :
• The lesser omentum is attached to the lesser curvature of the
stomach and to the upper border of the 1st 2cm of the
duodenum.
• Superiorly :
• it is attached to the liver the line of attachment being in the
form of inverted ‘L’.
• Vertical limb of the L is attached to bottom of the ligamentum
venosum.
• Horizontal limb to the margin of Porta hepatis..
50.
51. • Contents :
• Right free margin of lesser omentum.
• Proper hepatic artery.
• Portal vein
• Bile duct
• Lymph nodes and lymphatics
• Lesser curvature of the stomach and along the upper border of the
duodenum.
• Right gastric vessels
• Left gastric vessels
• Gastric nerve
• Lymph node and lymphatics
53. • The mesentery of the small
intestine or mesentery proper is
a broad fan shaped fold of
peritoneum.
• Suspends the coils of jejunum
and ileum from the posterior
abdominal wall.
54. • Border
• The attached border/root of
the mesentery:
• It is 15 cm long and directed
Obliquely downwards and to
the right.
• It Extends from
duodenojejunal flexure on the
left side of vertebra L2 to the
part of the right sacroiliac
joint.
55. • It crosses the following structure.
• 3rd part of the duodenum where the superior mesenteric vessels enter
into it.
• Abdominal aorta
• Inferior vena cava
• Right ureter
• Right psoas major
56. • Free or intestinal border:
• It is 6 metres long and is thrown into pleats.
• The attached to the gut forming it’s visceral peritoneum or
serious coat.
• Breadth of the mesentery is maximum and is about 20 cm in
the central part.
57. • Distribution of fat
• The lower part of the mesentery. Fat is most abundant in the
lower part.
• Extending from the root to the intestinal border.
• The upper part of the mesentery. Less fat
• Extend to accumulate near the root.
• Near The intestinal border, Leaves oval or circular fat free
,Translucent areas or windows.
58. • Contents:
• Jejunal and ileal branches of the superior mesenteric artery.
• Accompanying veins
• Autonomics nerve plexuses
• Lymphatics or lacteals
• 100-200 lymph nodes
• Connective tissue with fat
60. • It is a small , triangular fold of
peritoneum.
• Suspends the vermiform
appendix from the posterior
surface of the lower end of
the mesentery close to the
ileocecal junction.
• Usually the fold extends up to
the tip of the appendix.
• Sometimes it fails to reach
the distal 1/3rd or so.
63. • Features:
• This is a broad fold of
peritoneum.
• Suspends the
transverse colon from
the upper part of the
posterior abdominal
wall.
64. • Attachment:
• Root of the transverse
mesocolon is attached
to the anterior surface
of the head and the
anterior border of the
body of the pancreas.
65. • Contents:
• Middle colic vessels
• Nerves
• Lymphnodes and
lymphatics of the
transverse colon.
67. • Features:
• This is a triangular fold of
peritoneum.
• Suspends the sigmoid
colon from the pelvic
wall.
68. • Attachment:
• The root is shaped like an inverted ‘V’.
• It’s Apex lies over the left ureter at the termination of the
left common iliac artery.
• Left limb of ‘V’ is attached the upper half of the left external
iliac artery.
• Right limb to the posterior pelvic wall extending downwards
and medially from the apex to the median plane at the level
of vertebra S3.
69. • Contents:
• Sigmoid vessels in the
left limb
• Superior rectal vessels
• Nerve
• Lymphnodes and
lymphatics in the righ
limb of the sigmoid
colon.
71. Reflection of peritoneum
• It can be seen that on reaching the liver, the
peritoneum forming the 2 layers of lesser omentum
passes on to the surface of liver, covering the liver it
gets reflected onto the diaphragm and anterior
abdominal wall in the form of number of ligaments.
74. • These are the falciform ligament, the left triangular
ligament, the coronary ligament and the right
triangular ligament.
• The falciform ligamemt is a sickle shaped fold of
peritoneum which connects the anterosuperior surface
of the liver to the anterior abdominal wall and to the
undersurface of the diaphragm. This fold is raised by
the ligamentum teres.
• The ligamentum teres extends from the umbilicus to
the inferior border and inferior surface of the liver.
76. Vertical tracing or Sagittal tracing
• Peritonium lining anterior abdominal wall and
diaphragm layer 1st.
• Peritonium lining upper part of posterior abdominal
wall and diaphragm layer 3rd. Itreflected on liver as
layer 2nd.
• Layer 1st and layer 2nd enclose most of the liver.
• The two layer gets reflected at porta hepatis to form
lesser omentum.
77. • Lesser omentum encloses stomach and two layer pass
downward as greater omentum, where these fold upon
themselves.
• 1st layer becomes 4th layer and 2nd layer becomes 3rd
layer.
• 3rd and 4th layers include transverse colon to continue as
transverse mesocolon.
• 3rd layer lines structure on the upper part of posterior
abdominal wall.
78. • 4th layer passes
around the small
intestine to form the
mesentry of small
intestine.
• Peritoneum lines the
posterior abdominal
wall and descends
into the true pelvis
in front of rectum.
Sagittal section of male abdomen
79. Difference in male and female
• In male,
peritoneum
passes from the
front of rectum
to urinary
bladder forming
rectovesical
pouch. Sagittal section of male abdomen
80. • In female, it passes from front of rectum to uterus
forming rectouterine pouch and from uterus to bladder
forming vesicouterine pouch.
Sagittal section of female pelvis
81. • Both in male and female, peritoneum passes from
urinary bladder to the anterior abdominal wall, thus
completing the sagittal tracing of the peritoneum.
82. Boundries of lesser Sac
• The lesser sac is bounded in front by:
1. The posterior layer of lesser omentum.
2. Peritoneum lining the posterior surface of the
stomach.
3. 1st and 2nd layers of greater omentum.
83. • Lesser sac is bounded
behind by:
1. 3rd and 4th layers of
greater omentum.
2. Peritoneum lining the
upper part of the
posterior abdominal
wall.
Sagittal section of male abdomen
84. Horizontal tracing above transverse colon
• Falciform ligament from anterior abdominal wall
encloses the liver.
• At porta hepatis, it forms lesser omentum which
encloses the stomach.
• The two layers pass to left towards spleen as
gastrosplenic ligament. At the hilum, the two layers of
gastrosplenic ligament diverge.
85. • The anterior layer encloses the spleen, forms one
layer of lienorenal ligament, covers left kidney and
continues to line the structures in the anterior
abdominal wall.
• The posterior layer forms the outer layer of
lienorenal ligament and lines the structures in the
posterior abdominal wall.
• The two layers get reflected as falciform ligament on
the liver.
87. Horizontal tracing below the level of transverse
colon
• On the back of the anterior abdominal wall, we see a
number of peritoneal folds and fossae. Starting from
medial plane they are:
1. Median umbilical fold raised by the median
umbilical ligament (remnant of the urachus).
2. Supravesical fossa.
3. The medial umbilical fold raised by obliterated
umbilical artery.
88. 4. The medial inguinal fossa.
5. The lateral umbilical fold raised by the inferior
epigastric vessels.
6. The lateral inguinal fossa overlying the deep
inguinal ring.
• Further laterally, the peritoneum passes over the
lateral part of the abdominal wall to reach the
posterior abdominal wall.
89. • Near the middle, the peritoneum becomes
continuous with the two layers of the mesentery and
thus reaches the small intestine.
• At this time we also see the greater omentum made
up of 4 layers. It lies between the intestine and
anterior abdominal wall.
91. Horizontal tracing of peritoneum in lesser
pelvis or true pelvis (male)
• Note the following.
1. The rectovesical pouch
2. The sacrogenital folds forming the lateral limit of
the rectovesicle pouch.
3. The pararectal fossae.
4. The paravesicle fossae.
93. Horizontal tracing of peritonium in the lesser
pelvis or true pelvis (female)
• Note the following
1. The uterus and broad ligaments form a
transverse partition across the pelvis.
2. The pararectal and paravesical fossae.
3. The rectouterine pouch.
4. The mesovarium by which the ovary is
suspended from the posterior (superior) layer of
the broad ligament.
95. Some clinical findings of peritoneal cavity
• Ascites – fluid collection in peritoneal cavity
• Pneumoperitoneum – air in the peritoneal cavity
• Paracentesis – removal of fluid, from midway between
umbilicus and pubic symphysis or just above anterior
superior iliac spine
• Peritonitis – inflammation of peritoneum
• Laparoscopy – examination of peritoneal cavity
• Laparotomy – opening of cavity by surgeon
96. Epiploic foramen
• Synonyms - epiploic foramen / foramen of Winslow/
Aditus/ opening of lesser sac.
• This is a vertical slit like opening through which lesser
sac communicates with the greater sac.
• The foramen is situated behind the right free margin
of lesser omentum at the level of 12th thoracic
vertebra.
98. Boundries of epiploic foramen
• Anteriorly :
• right free margin of the lesser omentum containing portal
vein.
• proper hepatic artery .
• the bile duct.
• Posteriorly :
• the inferior vena cava.
• the right suprarenal gland.
• T12 vertebra.
102. Passage of internal
hernia into the lesser
sac occurs through the
epiploic foramen.
This is called winslow
hernia.
Clinical anatomy of epiploic foramen
104. This is a large recess of the
peritoneal cavity behind the
stomach, the lesser omentum and
the caudate lobe of the liver.
It is closed all around, except in
the upper part of its right border
where it communicates with the
greater sac through the epiploic
foramen.
105. Anterior
1.Peritoneum covering caudate lobe and caudate process of liver.
2.Posterior layer of lesser omentum
3.Peritoneum covering posterior surface of stomach.
4.Second layer of greater omentum.
posterior
1.Third layer of greater omentum.
2.Peritoneum covering anterosuperior surface of transverse colon.
3.Upper layer of transverse mesocolon.
4.Peritoneum covering the anterior surface of body of pancreas, left
suprarenal, left kidney, splenic vessels and diaphragm.
106. • Sagittal section through the abdomen to show the reflections of
peritoneum, and 1-4 layers of greater omentum.
107. subdivision of lesser sac
• The downward and forward course of the common hepatic artery
raises a sickle shaped fold of peritoneum from the posterior wall;
this is known as the right gastropancreatic fold.
• similarly, the upwards course of the left gastric artery raises
another similar fold, called the left gastropancreatic fold.
• These folds divide the lesser sac into a superior and an inferior
recess.
• superior recess of the lesser sac lies behind the lesser omentum
and the liver.The portion behind the lesser omentum is also
known as the vestibule of the lesser sac.
108. • Inferior recess of the
lesser sac lies behind the
stomach and within the
greater omentum.
• The splenic recessof the
lesser sac lies between
the gastrosplenic and
lienorenal ligaments.
109.
110. Clinical anatomy
• Strangulated internal hernia
into the lesser sac through
epiploic foramen is
approached through the
greater omentum because
the epiploic foramen cannot
be enlarged due to the
presence of important
syructures all around it.
111. • A posterior gastric ulcer may perforate into the lesser sac.
The leaking fluid passes out through epiploic foramen to
reach the hepatorenal pouch. sometimes in these cases, the
epiploic foramen is closed by adhesions.Then the lesser sac
becomes distended, and can be drained by a tube passed
through the lesser omentum.
113. • From a surgical point of view,the peritoneal cavity has two main
parts - tha abdomen and the pelvic cavity.
• The abdomen cavity is divided by the transverse colon and the
transverse mesocolon into the supracolic and infracolic
compartments.
• The supracolic compartment is subdivided bye the reflection of
peritoneum around the liver into a number of subphrenic spaces.
• The infracolic compartment is also subdivided, by the mesentary,
into the right and left parts.
• Further, the right paracolic gutter lies along the lateral side of the
ascending colon, and the left paracolic gutter along the lateral
side of the descending colon.
114.
115. Supracolic compartment/ subphrenic spaces
• Subphrenic spaces are present just below the diaphragm in
relation to the liver.
• classification:
• The intraperitoneal spaces are:
1.The left anterior space
2.The left posterior space
3.The right anterior space
4.The right posterior space
116. • The extraperitoneal spaces include:
1.The right extraperitoneal space
2.The left extraperitoneal space
3.Midline extraperitoneal space is the name given to bare area
of liver.
some details of these spaces are as follows.
A.The left anterior space or the left subphrenic space lies
between the left lobe of the liver and the diaphragm,in front
of the left triangular ligament.
117. B.The left posterior space or the left subhepatic space is
merely the lesser sac.
C.The right anterior space or right subphrenic space lies
between the right lobe of the liver and the diaphragm.
D.The right posterior space or right subhepatic space is also
called the hepatorenal pouch of morrison.
E.The left extraperitoneal space lies around the left
suprarenal gland and the upper pole of the left kidney.
F.Right extraperitoneal space lies around the upper pole of
right kidney.
G.The midline extraperitoneal space corresponds to the the
bare area of the liver. It lies between the bare area and the
diaphragm.
119. Hepatorenal pouch (Morrison's pouch)
• Boundaries:
• Anteriorly
1.The inferior surface of the right lobe of the liver
2.The gallbladder
posteriorly
1.The right suprarenal gland
2.The upper part of the right kidney
3.The second part of the duodenum
4.The hepatic flexure of the colon
5.The transverse mesocolon
6.A part of the head of the pancreas
120. Superiorly : The inferior
layer of the coronary
ligament.
Inferiorly: It opens into
the general peritoneal
cavity.
Left: Communicate with
omental bursa.
Right: Limited by
diaphragm.
121. Infracolic compartments
• Right infracolic compartment: It lies between the
ascending colon and the mesentary,below the
transverse mesocolon.It is triangular in shape with its
apex directed downwards.
• Left infracolic compatments: It lies between the
descending colon and the mesentary. It is also
triangular with its apex directed upwards. Inferiorly,it
opens freely into the pelvis.
123. Rectouterine pouch / pouch of douglas
• This is the most dependent part of the peritoneal cavity
when the body is in the upright position. In the supine
position, it is the most dependent part of the pelvic cavity.
• Boundaries:
• Anteriorly, by the uterus and the posterior fornix of the
vagina.
• Posteriorly, by the rectum.
• Inferiorly, by the recrovaginal fold of peritoneum.
124.
125. Clinical Anatomy
• Intraperitoneal subphrenic spaces may get distended by
collection of pus.These are called subphrenic abcesses.
• Hepatorenal space is of considerable importance as it is the
most dependent part of the abdominal cavity proper when
the body is supine.Fluids tend to collect here.This is the
commonest site of a subphrenic abscess,which may be
caused by spread of infection from the gallbladder,the
appendix ,or other organs in the region.
• The floor of the rectouterine pouch is 5.5 cm from the anus,
and can be easily felt with a finger passed through the
rectum or the vagina.The correspinding rectovesical pouch in
males lies 7.5 cm above the anus.
126. 1-4 are sites of intraperitoneal subphrenic abscesses
128. • Peritoneal foosae are small pockets of the peritoneal cavity
enclosed by small, inconstant folds of peritoneum. They
commonly occur at the transitional zones between the
absorbed and unabsorbed parts of the mesentery. These are
best observed in foetuses , and are mostly obliterated in
adults. Sometimes they persist to form potential sites for
internal hernia and their strangulation.
Classification
• Lesser Sac
• The lesser sac is the largest recess. It is always present,and
has been described earlier.
129. Duodenal fossae or recesses
Recesses name Present in % Location Orifice
1. Superior duodenal recess 50% of subjects It is situated at the level of
L2 vartrbra. About 2cm
deep
Its orifice looks downwards
2. Inferior duodenal recess 75% of subjects It is situated at the level of
L3 vertebrae. About 3cm
deep
Its orifice looks upwards
3. Paraduodenal recess 20% of subjects Inferior mesenteric vein lies
in the free edge of the
peritoneal fold.
Its orifice looks to the
right.
4. The retroduodenal recess It is present occasionally. It is the largest of the
duodenal recesses. It is 8 to
10 cm deep.
Its orifice looks to the left.
5. The duodenojejunal or
mesocolic recess.
20% of subjects. It is about 3 cm deep. Its orifice looks downwards
and to the right.
6. The mesentericoparietal
recesses or fossa of
Waldeyer.
1% of subjects. It lies behind the upper
part of the mesentery.
Its orifice looks to the left.
The superior mesenteric
vessels lie in the fold of
peritoneum covering this
fossa
130.
131. Caecal Fossoe
1 The superior ileocaecal recess is
quite commonly present. It is
formed by a vascular fold present
between the ileum and the
ascending colon. Its orifice looks
downwards and to the left.
2 The inferior ileocaecal recess is covered by the bloodless fold of
Treves. The orifice of the recess looks downwards and to the left.
3 The retrocaecal recess lies behind the caecum. It often contains the
appendix.Its orifice looks downwards.
132. The lntersigmoid Recess
This recess is constantly present
in the foetus and in early
infancy, but may disappear with
age. It lies behind the apex of
the sigmoid mesocolon. Its
orifice looks downwards.
133. CLINICAL ANATOMY
●Internalhernia: May
occur in the opening of
lesser sac. It may also
occur in between
paraduodenal recesses.
One has to remember
the inferior mesenteric
vein in the
paraduodenal fold
during reduction of the
hernia.
134. ● Pain of foregut derived
structures is felt in the
epigastric area.
●Pain of midgut derived
structures is felt in the
periumbilical area.
● Pain of hindgut derived
sttuctures is felt in the
suprapubic area.
135. • DEVETOPMENT OF GUT AND ITS FOLDS
• The primitive gut is formed by incorporation of secondary yolk
sac into the embryo. The gut is divided into the following.
1.Pharyngeal gut (from buccopharyngeal membrane to
tracheobronchial diverticulum).
2.Foregut situated caudal to pharyngeal gut till the origin of
hepatic bud.
3 Midgut extends from origin to hepatic bud downwards. Its
terminal point is the junction of right two-thirds and left one-
third of transverse colon of adult. It communicates with the
yolk sac.
4 Hindgut spans between the end of midgut and the cloacal
membrane.
136.
137. Dorsal mesentery is double fold of peritoneum connecting the
caudal part of foregut, midgut and most of the hindgut to the
posterior abdominal wall. It is subdivided into mesogastrium and
mesoduodenum for foregut, into dorsal mesentery proper for
jejunum and ileum; and mesentery of vermiform appendix,
transverse and pelvic mesocolons for large intestine. Ventral
mesentery only exists ventral to the foregut. It is a derivative of
the septum transversum.
