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The peritoneum
General features
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The peritoneum is a thin serous
membrane that line the walls of the
abdominal and pelvic cavities and cover
the organs within these cavities
Parietal peritoneum －lines the walls of
the abdominal and pelvic cavities
Visceral peritoneum －covers the organs
Peritoneal cavity －the potential space
between the parietal and visceral layer of
peritoneum, in the male, is a closed sac,
but in the female, there is a
communication with the exterior through
the uterine tubes, the uterus, and the
vagina
Function
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Secretes a lubricating
serous fluid that
continuously moistens
the associated organs
Absorb
Support viscera
The relationship between viscera and peritoneum
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Intraperitoneal viscera －viscera completely surrounded by peritoneum, example,
stomach, superior part of duodenum, jejunum, ileum, cecum, vermiform appendix,
transverse and sigmoid colons, spleen and ovary
Interperitoneal viscera －most part of viscera surrounded by peritoneum,
example, liver, gallbladder, ascending and descending colon, upper part of rectum,
urinary bladder and uterus
Retroperitoneal viscera －some organs lie on the posterior abdominal wall and
are covered by peritoneum on their anterior surfaces only, example, kidney,
suprarenal gland, pancreas, descending and horizontal parts of duodenum, middle
and lower parts of rectum, and ureter
Intraperitoneal viscera
Interperitoneal viscera
Retroperitoneal viscera
Interperitoneal viscera
Structures which are formed by peritoneum
Omentum
－
two-layered fold of
peritoneum that
extends from stomach
to adjacent organs
Lessor omentum
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－two-layered fold of peritoneum
which extends from porta
hepatis to lesser curvature of
stomach and superior part of
duodenum
Hepatogastric ligament
－extends from porta hepatis to
lesser curvature of stomach
Hepatoduodenal ligament
Extends from porta hepatis to
superior part of duodenum
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Contains common bile duct,
proper hepatic a. and hepatic
portal v.
Omental foramen
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Behind the right border
of hepatoduodenal
ligament
Superior－caudate lobe
of liver
Inferior－superior part of
duodenum
Anterior－
hepatodudenal ligament
Posterior－peritoneum
covering the inferior
vena cava
Greater omentum
－four-layered fold of peritoneum,
the anterior two layers descend
from the greater curvature of
stomach and superior part of
duodenum and hangs down like
an apron in front of coils of small
intestine, and then turns upward
and attaches to the transverse
colon. If an infection occurs in
the intestine, plasma cells
formed in the lymph nodes
combat the infection and help
prevent it from spreading to the
peritoneum.
Lessor omentum
Greater omentum
Omental bursa
Position－situated behind the lesser
omentum and stomach
Walls
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Superior－peritoneum which covers the
caudate lobe of liver and diaphragm
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Anterior－formed by lesser omentum,
peritoneum of posterior wall of stomach,
and anterior two layers of greater
omentum
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Inferior－conjunctive area of anterior
and posterior two layers of greater
omentum
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Posterior－formed by posterior two
layers of greater omentum, transverse
colon and transverse mesocolon,
peritoneum covering pancreas, left
kidney and suprarenal gland
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Left－formed by the
spleen, gastrosplenic
ligament and
splenorenal ligament
Right－formed by
omental foramen
The Omental bursa (lesser
sac) communicates with
the greater sac through
the omental foramen.
Mesenteries or mesocolons－
two-layered fold of peritoneum
that attach part of the
intestines to the posterior
abdominal wall
Mesentery
－suspends the small intestine
from the posterior
abdominal wall
 Broad and a fan-shaped
 Consists of two peritoneal
layers
 Intestinal border－folded, 7
m long
 Radix of mesentery
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15 cm long
Directed obliquely from left
side of L2 to in front of right
sacroiliac joint
Mesoappendix
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Triangular mesentery－
extends from terminal part
of ileum to appendix
Appendicular artery runs
in free margin of the
mesoappendix
Transverse mesocolon
－a double fold of
peritoneum which connects
the transverse colon to the
posterior abdominal wall
Sigmoid mesocolon
－inverted V-shaped, with
apex located in front of left
ureter and division of
common iliac artery
Ligaments
－two-layered folds of
peritoneum that attached the
lesser mobile solid visera to
the abdominal wall
Ligaments of liver
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Falciform ligament of liver
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Consists of double peritoneal
layer
Extends from anterior
abdominal wall (umbilicus) to
live
Free border of ligament site of
ligamentum teres
Coronary ligament
－the area between upper
and lower parts of the
coronary ligament is the
bare area of live, this area
is devoid of peritoneum and
lies in contract with the
diaphragm
 Left and right triangular
ligaments
－formed by right extremity of
coronary ligament and left
leaf of falciform ligament,
respectively
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Hepatogastric ligament
Hepatoduodenal ligament
Ligamentum teres hepatis
Ligaments of spleen
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Gastrosplenic ligament －a double layer of peritoneum that
connects the fundus of stomach to hilum of spleen. In this double
layer of peritoneum are the short gastric and left gastroepiploic
vessels
Splenorenal ligament －extends between the hilum of spleen and
anterior aspect of left kidney. The splenic vessels lies within this
ligament, as well as the tail of pancreas
Phrenicosplenic ligament
Splenocolic ligament
Ligaments of stomach
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Hepatogastric ligament
Gastrosplenic ligament
Gastrophrenic ligament
Gastrocolic ligament
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Gastropancrestic ligament
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Folds and recesses of posterior abdominal
wall
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Superior duodenal
fold and recess
Inferior duodenal fold
and recess
Intersigmoid recess
－formed by the
inverted V attachment
of sigmoid mesocolon
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Retrocecal recess
－in which the appendix
frequenty lies
Hepatorenal recess
－lies between the right
lobe of liver, right
kidney, and right colic
flexure, and is the
lowest parts of the
peritoneal cavity when
the subject is supine
Folds and fossas of anterior abdominal wall
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Medial umbilical fold －
contain the remnant of
urachus (median umbilical
ligaments)
Medial umbilical fold －
contains remnants of the
umbilical arteries (medial
umbilical ligaments)
Lateral umbilical fold －
contains the inferior epigastric
vessels
Supravesical fossa
Medial inguinal fossa
Lateral inguinal fossa
Pouches
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In male－rectovesical
pouch
In female
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Rectouterine pouch
－between rectum and
uterus
Vesicouterine pouch
－between bladder and
uterus
Peritoneal subdivisions
The transverse colon and transverse
mesocolon divides the greater sac
into supracolic and infracolic
compartments.
Supracolic
compartments (subphrenic
space)－lies between diaphragm
and transverse colon and
transverse mesocolon
Suprahepatic recess lies
between the diaphragm and live－
the falciform ligament divides it into
right and left suprahepatic recesses
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Left suprahepatic
recesses
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left anterior suprahepatic
spaces
left posterior
suprahepatic spaces
Right suprahepatic
recesses
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right anterior
suprahepatic spaces
right posterior
suprahepatic spaces
bare area of live
(extraperitoneal space)
Infrahepatic recess
lies between the live and
transverse colon and
transverse mesocolon－the
ligamentum teres hepatic
divides it into right and left
infrahepatic recesses
 Right infrahepatic
recesses (hepatorenal
recess)
 Left infrahepatic recesses
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left anterior infrahepatic space
left posterior infrahepatic space
Infracolic compartments
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－lies below the transverse colon
and transverse mesocolon
Right paracolic sulcus (gutter)
－lies lateral to the ascending colon.
It communicates with the
hepatorenal recess and the pelvic
cavity. It provides a route for the
spread of infection between the
pelvic and the upper abdominal
region.
Left paracolic sulcus (gutter)
－lies lateral to the descending
colon. It is separated from the area
around the spleen by the
phrenicocolic ligament, a fold of
peritoneum that passes from the
colic flexure to the diaphragm.
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Right mesenteric sinus
－triangular space, lies between root
of mesentery, ascending colon, right
2/3 of transverse colon and
transverse mesocolon
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Left mesenteric sinus
－lies between root of mesentery,
descending colon, right 1/3 of
transverse colon and transverse
mesocolon, its widens below where
it is continuous with the cavity of the
pelvis
Dissection and Observation
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superficial structures
Three flat muscles , vessels and nerves
rectus abdominis
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rectus sheath
inguinal region
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inguinal canal
inguinal triangle
Relationships of abdominal viscera
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First layer－live, gallbladder, stomach
Second layer－duodenum, pancreas, spleen
Third layer－suprarenal gland, kidney, ureter,
inferior vena cava, abdominal aorta, nerves
and lymphatics
Relationships of the stomach
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Anterior:
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Live (right part)
Diaphragm (left upper part)
Anterior abdominal wall (left
lower part)
Posterior－separated by
peritonum of lesser sac from
the following (“stumach-bed”)
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Pancreas
Left suprarenal gland
Left kidney
Spleen
Transverse colon and
transvers mesoclon
Arteries of stomach
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Left and right gastric
arteries arise from
celiac trunk and
proper hepatic artery,
repectively. These two
vessels run in lesser
omentum along lesser
curvature , and
anastomose end-toend.
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Right and left gastroepiploic
arteries arise from the
gastroduodenal and splenic
artery, repectively. These two
vessels pass into the greater
omentum, run parallel to the
greater curvature, and
anastomose end-to-end.
Short gastric arteries,
branches of splenic artery,
course through the
gastrosplenic ligament and
supply the fundus of stomach.
Posterior gastric artery (72%)
arise from the splenic artery,
course through the
gastrophrenic ligament and
supply the posterior wall of
fundus of stomach.
Venous drainage
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Right and left gastric veins empty directly into hepatic portal vein.
Left gastroepiploic and short gastric veins drain into hepatic portal
vein via the splenic vein.
Right gastroepiploic vein join either superior mesenteric vein.
Lymphatics of stomach
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Right and left gastric ln. lie
along the same vessels and
finally to the celiac ln.
Right and left gastroomental ln.
lie along the same vessels, the
former drain into subpyloric ln.,
the latter drain into splinic ln.
Supra- and subpyloric ln.
receive lymphatics from pyloric
part and finally to the celiac ln.
Splenic ln. receive lymphatics
from fundus and left third of
stomach, and finally to the celiac
ln.
Nerve supply
Parasympathetic innervation by
anterior (left) and posterior (right)
vagal trunks
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The anterior trunk divides into
anterior gastric and hepatic
branches
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The posterior trunk divides into
posterior gastric and celiac
branches
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The anterior and posterior gastric
branches descend on the anterior
and posterior surfaces of the
stomach as a rule about 1 to 2 cm
from the lesser curvature and
parallel to it in the lesser omentum
as far as the pyloric antrum to fan
out into branches called “crow’s foot”
to supply the pyloric part
Sympathetic innervation
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Mainly from celiac ganglia
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Affent and effent fibers derives from
thoracic segments (T5 －L1
The duodenum
Relationships of superior part
 Anteriorly
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Posteriorly
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Commom bile duct
Gastroduodenal a.
Hepatic portal v.
Inferior vena cava
Superioely
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Quadrate lobe of live
Gallbladder
Omental foramen
Inferiorly
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Head of pancreas
Relationships of
descending part
 Anteriorly
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Posteriorly
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Right renal hilum and ureter
Right renal vessels
Medially
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Live
Transverse colon and
mesocolon
Loops of small intestine
Head of pancreas
Common bile duct and
pancreatic duct
Laterally
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Right colic flexure
Relationships of horizontal
part
 Superiorly
 Head of pancreas
 Inferiorly
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Anteriorly
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Loops of small intestine
Radix of mesentery
Superior mesenteric a. and
v.
Posteriorly
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Right ureter
Inferior vena cava
Abdominal aorta
Relationships of ascending part
 Right
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Head of pancreas and abdominal aorta
Left
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Left kidney and ureter
Relationships of liver
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Diaphragmatic surface－
separated by diaphragm from
the following
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Right costodiaphramatic
recess and lung
Cardiac base
Visceral surface
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Left lobe is related to the
stomach and abdominal part
of esophagus
Right lobe is related to the
right colic flexure anteroly,
gallbladder and superior
duodenal flexure medially,
right kidney, superarenal gland
posteriorly
Divisions and relations of common bile duct
Supraduodenal segment
 Descends along the right
margin of hepatoduodenal lig.
 To the right of proper hepatic a.
 Anterior to hepatic portal v.
Retroduodenal segment
 Behind the superior part of
duodenum
 Anterior to the vena cava
 To the right of the hepatic
portal v.
Pancreatic segment
 Lies in a groove between
posterior surface of head of
pancreas and duodenum
Intraduodenal segment
 Enters the wall of
descending part of
duodenum obliquely where
jions the pancreatic duct to
form the hepatopancreatic
ampulla
 opens at the major
duodenal papilla
Relationships of spleen
Diaphragmatic surface
－diaphragm
Visceral surface
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Anteriorly－fundus of
stomach
Posteriorly－left
suprarenal gland and
kidney
Inferiorly－tail of
pancreas and left colic
flexure
Divisions and relations of pancreas
Head of pancreas
 Located in C-shapes curvature
of doudenum
 Anteriorly
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Transverse mesocolon
Posteriorly
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Inferior vena cava
Right renal vessels
Common bile duct
Neck of pancreas
 Anteriorly－pylorus
 Posteriorly－commencement pf
hepatic portal v. (formed by union of
splenic and superior mesenteric
veins
Body of pancreas
 Anteriorly
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Posteriorly
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Separated from stomach by
omental bursa
Abdominal aorta
Left suprarenal gland
Left kidney
Left renal vessels
Spleen vein
Superiorly
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Celiac trunk
Celiac plexus
Splenic a.
Tail of pancreeas
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Runs in spleicorenal
ligament to reach hilum
of spleen
Accompanies with
splenic vessels
Blood supply
 Arteries
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Superior
pancreaticoduodenal a.
Inferior
pancreaticoduodenal a.
Veins－follow arteries,
draining directly into
superior mesenteric and
hepatic portal veins
Celiac trunk
Left gastric a.
Left branch
Right branch
Cystic a.
Short gastric a.
Common
hepatic a.
Splenic a.
Right gastric a.
Proper hepatic a.
Gastroduodenal a.
Splemic branches
Left gastrioeploic a.
Right gastroepiploic a.
Superior pancreaticoduodenal a.
Middle colic a.
Inf. pancresticodudenal a.
Right colic a.
Ileocolic a.
Appendicular a.
Superior
Mesenteric v.
Superior
mesenteric a.
Jejunal and ileal a.
Inferior mesenteric v.
Inferior mesenteric a.
Left colic a.
Sigmoid a.
Superior rectal a.