Peritoneum

Introduction


Thin serous membrane lines the abdominal walls and the pelvic cavities. Made of mesothelium. Between the peritoneum and the fascia of the walls there is connective tissue called the extraperitoneal tissue. Parietal


Lines the walls of the abdomen and pelvis Covers the organs

Visceral


Potential space between two layers is the peritoneal cavity.

 

In males this is a closed cavity In females, there is communication with the exterior through the uterine tubes the uterus and the vagina.

Divided into two parts:



Greater Sac


Extends from diaphragm down to the pevis. Behind the stomach.

Lesser Sac


Both are in communication with each other via an oval window called the opening in the lesser sac or the Epiploic foramen.

Intra- / Retro- peritoneal organs:



Used to describe relationship between organs and the peritoneal coverings Intraperitoneal:
 




Totally covered by visceral peritoneum. Stomach, First part of the duodenum [5 cm], jejunum, ileum, Cecum, appendix, transverse colon, sigmoid colon, Rectum (upper 1/3) Liver, Spleen, tail of pancreas Partially covered by visceral peritoneum. The rest of the duodenum, ascending colon, descending colon, Rectum (middle 1/3), Pancreas (except tail), Kidneys, adrenal glands, proximal ureters, renal vessels, Aorta, Inferior Vena Cava.

Retroperitoneal:
 

No organ within the peritoneal cavity.

Peritoneal Ligaments


Two layered folds of the peritoneum that connect solid viscera to abdominal walls
  

Greater and lesser omentum Falciform ligament Right and left triangular ligaments

Omenta


Greater and lesser omentum Two layered fold of peritoneum that connect stomach to other viscera. Greater omentum:
 

Stomach to transverse colon Double layer falls infront of the small intestine and folds back on itself to attach to the transverse colon. So that it is made up of four layers. The functions of the greater omentum are:
 

 

Fat deposition, having varying amounts of adipose tissue Immune contribution, having milky spots of macrophage collections Infection and wound isolation

Encompass the following three:



Gastrocolic ligament - to transverse colon Gastrosplenic ligament - to spleen Gastrophrenic ligament - to thoracic diaphragm +/- The splenorenal ligament (from the left kidney to the spleen)

Lesser omentum:
 

The lesser omentum is extremely thin Extends from the liver to the lesser curvature of the stomach and the start of the duodenum. Divide it into two parts:


hepatogastric ligament: the portion connecting to the lesser curvature of the stomach hepatoduodenal ligament: the portion connecting to the duodenum

Mesenteries


Double layer of peritoneum that suspends parts of the intestine from the post. Abdominal wall. Mesenteries in the body:


Mesentery (proper) - surrounds parts of the small intestine (the jejunum and the ileum) Mesocolon - surrounds parts of the colon Meso-appendix - peritoneum of the vermiform appendix Transverse mesocolon - peritoneum of the transverse colon Sigmoid mesocolon - peritoneum of the sigmoid colon

   

The peritoneal ligaments, omenta, and mesenteries all permit passage of blood vessels, lymphatics and nerves.

Spaces


Greater Sac:


also known as the general cavity (of the abdomen) or peritoneum of the peritoneal cavity proper. The cavity in the abdomen that is inside the peritoneum but outside of the lesser sac. Connected with the lesser sac via the epiploic foramen (Foramen of Winslow)

Lesser Sac:
   

Behind the stomach and lesser omentum. Upwards: as far as diaphragm Downwards: between the layers of greater omentum. Left margin: Spleen, and gastrosplenic and splenicorenal ligament Right margin: opens into greater sac, via epiploic foramen. Anteriorly: Free border of lesser om., Bile duct, hepatic art. Posteriorly: Inferior Vena Cava. Superiorly: Caudate process of caudate lobe of liver Inferiorly: First part of Duodenum.

 

Boundaries of Epiploic foramen:



  

Duodenal Recesses:
 

Close to the duodenojejunal junction. May be four pocket-like pouches of peritoneum.



Superior duodenal, Inferior duodenal, para-duodenal, and retro-duodenal recesses. Cecal Recesses:


Folds of peritoneum close to cecum Three peritoneal recesses



Superior ileocecal, Inferior ilocecal, retrocecal. Intersigmoid Recess:



Situated at the apex of the inverted, V-shaped root of sigmoid colon.

Sub-phrenic Spaces:


Right and Left anterior sub-phrenic spaces, between diaphragm and liver on each side of the falciform lig. Right posterior sub-phrenic space lies between the right lobe of the liver, the right kidney and the right colic flexure.

Paracolic Gutters:


Lie on lateral and medial sides of the ascending and descending colons.