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PERITONEUM (HORIZONTAL DISPOSITION) Learning objectives At the end of the lecture, students should be able to know: • What is peritoneum? • Arrangement of peritoneum? • In transverse section of abdomen? • In transverse section of male pelvis? • In transverse section of female pelvis? HORIZONTAL TRACING OF PERITONEUM PARIETAL PERITONEUM • Peritoneum is a thin serous membrane that lines wall of abdominal and pelvic cavities and clothing the abdominal and pelvic viscera. • It can be regarded as a balloon into which the organs are pressed into from outside. • The parietal peritoneum lines the wall of abdominal and pelvic cavities. The visceral peritoneum covers the organs. • The potential space between the parietal and visceral layer which is in effect the inside space of the balloon is called peritoneal cavity. • In males it is close cavity but in females there is a communication with the exterior through uterine tubes, the uterus and the vagina. • The best way to try to visualize the peritoneum and its reflections is to examine sagittal and cross sections through the abdomen. After looking at images of these sections. Horizontal Disposition of the Peritoneum • Below the transverse colon the arrangement is simple, as it includes only the main cavity. • above the level of the transverse colon it is more complicated on account of the existence of the omental bursa. Below the transverse colon it may be considered in the two regions, viz., in the pelvis and in the abdomen proper. HORIZONTAL TRACING OF THE PERITONIUM • Horizontal disposition of peritoneum below the transverse colon the arrangement is simple but differ at the: – *Pelvis – *Lower abdominal level – *Upper abdominal level HORIZONTAL TRACING ABOVE THE LEVEL OF TRANVERSE COLON • Starting on the anterior abdominal wall to the left of falciform ligament the peritoneum can be traced in sequence: 1) Left layer of falciform ligament 2) Over the liver to the porta hepatis 3) Anterior layer of lesser Omentum 4) Front of stomach HORIZONTAL TRACING ABOVE THE LEVEL OF TRANVERSE COLON 5) Left layer of Gastro Splenic Ligament 6) Over the surface of Spleen 7) Left layer of Lienorenal Ligament 8) Posterior abdominal wall, infront of Left kidney, thus back to Anterior Abdominal Wall. • The peritoneum of right layer of falciform ligament passes on to the liver and form there to: 1) Posterior layer of lesser omentum 2) Posterior wall of stomach 3) Right layer of gastrosplenic and Lienorenal Ligaments 4) Posterior abdominal wall, and back across the midline to reach the anterior abdominal wall. HORIZONTAL TRACING BELOW THE LEVEL OF TRANVERSE COLON • On the back of anterior abdominal wall, we see number of peritoneal fold and fossae, starting from median plane these are as follows. 1) Median Umbilical fold, raised by Median Umbilical Ligament remanant of Urachus. 2) Medial inguinal fossa 3) Medial umbilical fold, raised by obliterated umbilical artery. HORIZONTAL TRACING BELOW THE LEVEL OF TRANVERSE COLON 4) Lateral inguinal fossa 5) Lateral Inguinal fold raised by inferior epigastric vessels. 6) The femoral fossa, overlying femoral septum. • • • Further laterally the peritoneum passes over the lateral part of abdominal wall to reach the posterior abdominal wall. Near the midline, the peritoneum becomes continuous with the two layer Mensentery and thus reaches the small intestine. At this level we also see the greater omentum made up of 4 layers. It lies between the intestine and anterior abdominal wall. HORIZONTAL TRACING OF PERITONEUM IN LESSER PELVIS ( MALE) • • • • • • Note the following: 1) The recto vessical pouch 2) The para rectal fossae 3) The sacrogenital folds forming the lateral limit of recto vesical pouch. 4) The pararectal fossae 5) Paravesical fossae Peritoneum of Male Pelvis HORIZONTAL TRACING OF PERITONEUM IN LESSER PELVIS (FEMALE) 1) The uterus and broad ligament form transverse partition across the pelvis. 2) The pararectal and paravesical fossae 3) The recto uterine pouch. REFERENCES • Textbook of anatomy by Gray’s. • Textbook of Anatomy by Keith.L.Moore.