Peritoneum

MUHAMMAD RAMZAN UL REHMAN ..... STUDYLOVERS.COM 1

The peritoneum
BY MUHAMMAD RAMZAN UL REHMAN

General features
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 mail, 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
Secretes a lubricating serous
fluid that continuously
moistens the associated
organs
Absorb
Support viscera

The relationship between viscera and peritoneum
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
Retroperitoneal viscera

Structures which are formed by peritoneum
Omentum －two-layered fold
of peritoneum that extends from
stomach to adjacent organs

Lessor omentum
－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
◦ Contains common bile duct, proper
hepatic a. and hepatic portal v.

Omental foramen
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
Superior－peritoneum which covers the
caudate lobe of liver and diaphragm
Anterior－formed by lesser omentum,
peritoneum of posterior wall of stomach, and
anterior two layers of greater omentum
Inferior－conjunctive area of anterior and
posterior two layers of greater omentum
Posterior－formed by posterior two layers
of greater omentum, transverse colon and
transverse mesocolon, peritoneum covering
pancreas, left kidney and suprarenal gland

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
◦15 cm long
◦Directed obliquely from left side of
L2 to in front of right sacroiliac
joint

Mesoappendix
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
Falciform ligament of liverhl
◦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

Hepatogastric ligament
Hepatoduodenal ligament
Ligamentum teres hepatis

Ligaments of spleen
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
Hepatogastric ligament
Gastrosplenic ligament
Gastrophrenic ligament
Gastrocolic ligament
Gastropancrestic ligament

Folds and recesses of posterior abdominal wall
Superior duodenal fold and recess
Inferior duodenal fold and recess
Intersigmoid recess －
formed by the inverted V attachment
of sigmoid mesocolon

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
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
In male－rectovesical
pouch
In female
◦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

Left suprahepatic recesses
◦left anterior suprahepatic
spaces
◦left posterior suprahepatic
spaces
Right suprahepatic recesses
◦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
◦left anterior infrahepatic space
◦left posterior infrahepatic space

Infracolic compartments －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.

Right mesenteric sinus －
triangular space, lies between root of
mesentery, ascending colon, right 2/3 of
transverse colon and transverse mesocolon
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

Thank You
MUHAMMAD RAMZAN UL REHAMN

Peritoneum

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Peritoneum