ANATOMY OF PERITONEUM

Dr. areiba haider

introduction
Derived from the Greek word
peritonaion=means to stretch out
Largest and most complex serous
membrane in the human body
Histological: 2 layers
Outer fibrous( for strength)
Inner lined with mesothelial cells
(secretary functions)

Why should we study it?

THE SURGICAL FLOOR

PATHOLOGY RELATED TO
PERITONEUM

ABDOMINAL TUBERCULOSIS

ASCITES

ASCITEIC TAP

PERITONITIS

GUT PERFORATIONS

DUODENAL PERFORATION

PERITONEAL DIALYSIS

PAY ATTENTION

General features

DEFINITION:
The peritoneum is a thin and largest
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: occurs as
infoldings that line and suspend the
abdominal viscera within the cavity
Peritoneal cavity the potential
space between the parietal and
visceral layer of peritoneum-

Comparative features
Parietal peritoneum
Somatopleuric layer of
lateral plate mesoderm
Nerve and blood
supply same as of the
body wall
Pain sensitive due to
somatic innervation
Loosely attached and
could be easily
stripped of

Visceral peritoneum
Splanchnopleuric layer
of lateral plate
mesoderm
Nerve and blood
supply same as that of
the underlying viscera
Pain insensitive
Becomes the part and
parcel of viscera

SEX DIFFERENCES
MALE

FEMALE

PERITONEUM IS A
CLOSED SAC LINED BY
MESOTHELIUM I.E
FLATTENED
EPITHELIUM

PERITONEAL CAVITY
COMMUNICATES WITH THE
EXTERIOR THROUGH THE
UTERINE TUBES
THE PERITONEUM
COVERING THE OVARIES IS
LINED BY CUBOIDAL
EPITHELIUM
THE PERITONEUM
COVERING THE FIMBRIA IS
LINED BY COLUMNAR
CILIATED EPITHELIUM

FUNCTIONS
Secretes a lubricating serous
fluid that continuously moistens
the associated organs
Cellular and humoral
immunological defense.
Allow the mobile viscera to
glide freely.
Healing and adhesions
Storage of fat

The relationship between viscera and peritoneum

Intraperitoneal viscera viscera completely surrounded by

peritoneum lying in the intraperitoneal space, example, stomach, 1 st
part of duodenum, jejunum, ileum, cecum, vermiform appendix,
transverse and sigmoid colons, liver ,spleen ,tail of pancrease , and
ovary, uterus and fallopian tubes.
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 except the tail, descending
and horizontal parts of duodenum, rectum, and proximal part of ureter.
Infraperitoneal viscera: distil ureters,urinary bladder .

Intraperitoneal viscera

Interperitoneal viscera

Retroperitoneal viscera

Structures which are formed by

peritoneum
Peritonial folds are given various
names
Prefix mes or meso (in the
middle of)followed by the
name of organ
-small intestine(enteron)
mesentery
Colonmesocolon
Large folds attached to the
stomach called OMENTA(cover )

Double layerd folds of

peritoneum that connect
the viscera to Abd. Wall or
to each other are called
LIGAMENTS

PERITONEAL FOLDS
Could be best understood by
recapitulating the embryology of gut
Developing gut----divisible into 3
parts
Each has its own blood suppy which
is the ventral branch of abd. Aorta
Coelicforegut
SMA---midgut
IMAhindgut

After embryonic folding..

 The caudal part of

the foregut is
connected to the
anterior and
posterior
abdominal walls
by the ventral &
dorsal mesentery
respectively

 The midgut and

the hindgut are
suspended in the
peritoneal cavity
from the
posterior
abdominal wall
by the dorsal
mesentery

Ventral mesogastrium
The ventral mesogastrium is divided
by the developing liver into a ventral
part and a dorsal part
Fate of ventral mesogastrium
Ventral part---falciform ligament
Triangular ligament
Coronary ligaments
Dorsal part ---lesser omentum

Dorsal mesogastrium
Caudal part becomes elongated to
form the greater omentum
Cranial most part will become the
gastrophrenic ligament
Spleen develops in cranial part n
divides it into dorsal and ventral
parts
Dorsal part makes linorenal ligament
Ventral makes the gastrosplenic
ligament

DIVISIONS
THE peritoneal cavity is
divided into 2 parts
1---The main larger part is
called as GREATER SAC
2----Smaller part situated
behind the stomach ,lesser
omentum and liver is
called as the LESSER SAC.
3THE two sacs
communicate with each
other through the EPIPLOIC
FORAMEN (OF WINSLOW)

PERITONEUM OF THE UPPER

ABDOMEN
Ligaments

two-layered folds of peritoneum

that attach the less mobile solid visCera to the
abdominal wall

Ligaments of liver
Falciform ligament of liver
Consists of double peritoneal layer
Extends from anterior abdominal wall (umbilicus) to liver
Cullens sign----acute haemorrhagic
Pancreatitis.

Ligaments of liver
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 contact with the diaphragm
Left and right triangular ligaments
formed by right extremity of
coronary ligament and left leaf of
falciform ligament, respectively

Ligaments of liver

LIGAMENTS OF LIVER
Hepatogastric ligament
Morisons pouch---most
dependant sitepathological
fluid accumulation
Hepatoduodenal ligament
Ligamentum teres hepatis---degenerated umbilical vein.

Ligaments of liver

Ligaments of liver

Ligament of liver

Ligaments of spleen
Ligaments of spleen

Gastrosplenic ligament a double layer of

peritoneum that connects the greater curvature
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
Phrenicocolic ligament:fold of peritoneum
that supports the spleen called
sustentaculum lenis

LIGAMENTS OF SPLEEN

Ligaments of spleen

Spleen ligaments

significance
If the peritoneal attachments of
spleen are not recognized during
surgery then the splenic capsule is at
a risk of injury and there may be
subsequent serious bleeding
Downward traction on the
phrenicocolic ligament during the
handling of descending colon..may
cause rupture of splenic capsule.

GASTRIC OMENTA
Omentum
------two-layered fold of
peritoneum separated by a
variable amount of
connective tissue that
extends from stomach to
adjacent organs

The lesser omentum

Lesser omentum

two-layered fold of peritoneum

which extends from porta hepatis to lesser curvature of
stomach and 1st part of duodenum
Gastrohepatic ligament extends from porta hepatis
to lesser curvature of stomach
Contains the right and left gastric vessels,branches of
vagus nerve

Hepatoduodenal ligament

Extends from porta hepatis to superior part of duodenum

Contains common bile duct, proper hepatic a. and hepatic
portal v.

LESSER OMENTUM

LIGAMENTS OF STOMACH

GREATER OMENTUM
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.

GREATER 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, stomach
anterior two layers of greater omentum,quadrate
lobe of liver
Posterior formed by posterior two layers of
greater omentum, transverse colon and
transverse mesocolon, peritoneum covering
pancreas, left kidney and suprarenal
Left lateral margin by left kidney and adrenal
gland and rt margin has the epiploic foramen

OMENTAL FORAMEN
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

OMENTAL FORAMEN

LIGAMENTS OF STOMACH
Ligaments of stomach

Hepatogastric ligament
Gastrosplenic ligament
Gastrophrenic ligament
Gastrocolic ligament

Gastropancrestic ligament

Peritoneum of the lower

abdomen
Mesenteries or mesocolons twolayered fold of peritoneum that
attach part of the intestines to the
posterior abdominal wall
Mesentery of the small intestine
Transverse mesocolon
Mesoappendix
Sigmoid mesocolon

Mesentery of small intestine

Complex-- fan likeformed from the two
layers of peritoneum
Root of mesentery----lies along a line
running diagonally from the
duodenojejunal flexure on the left side
of L2 to the right sacroilial joint
15cm in length
Along the intestinal attachment its 5m
Contains superior mesenteric vessels

Mesentery of small intestine

Mesentery of small intestine

Transverse mesocolon
A broad fold of peritoneum that is
reflected anteriorly from the post abd.
Wall.
It suspends the trns.colon into the
peritoneal cavity
Root of transverse mesocolon: lies along
an oblique line passing from the 2nd part of
duodenum,over the head and neck of
pancrease,above the duodenojejunal
junction to the spleenic flexure.

Tansverse mesocolon
It contains middle colic vessels and
their branches
Branches of superior mesenteric
plexus
lymphatics

Transverse mesocolon

mesoappendix
Mesoappendix
Triangular mesentery extends from
terminal part of ileum to appendix
Appendicular artery runs in free
margin of the mesoappendix

mesoappendix

Sigmoid mesocolon
Sigmoid mesocolon :
root>:inverted V-shaped, with apex
located in front of left ureter and
near the division of left common iliac
artery
Upper left end lies on psoas major
Lower right end pass into pelvis
towards midline at third sacral
vertebra

Sigmoid mesocolon

Peritoneal subdivisions
The transverse colon and transverse mesocolon divides the
greater sac into supracolic and infracolic compartment.

Supramesocolic compartments :
1- RT. subphrenic space diaphragm,sup,ant,and rt lateral
surfaces of liver..on left falciform ligament and behind by
sup. Layer of coronary ligament.
2.Rt Subhepatic space --- lies between the rt lobe of
liver and rt kidney
Sup---inf layer of coronary ligament
Latrt lat abd wall
Post---rt kidney
Med2nd part of duodenum,head of pancrease,transverse
mesocolon
3-lesser sac

Peritoneal subdivisions

rt.Subphrenic space

Rt subhepatic space

Peritoneal subdivisions
Left subprenic space:lies bt diap.,ant and sup surfaces of
lt lobe of liver,ant sup surfce of stomach and diaphragmatic
surface of spleen
Inf and medially bounded by the 3 lig of spleen
Bounded at rt by falciform ligament
Post---bt fundus of stomach and diaphragm and ant division
---bt left dome of diaphragm and spleen
Left perihepatic space:
Divided into ant and post parts
Lt ant ----bt anterosuperior surface of lt lobe of liver and
diaphragm
Lt post.---inf to left lobe of liver extend into the fissure for
lig.venosum

Left subphrrenic
space/perihepatic

Inframesocolic
compartment
Rt infracolic space: triangular
space
Lies post and inf to the transverse
mesocolon and to the rt of small
intestinal mesentery
Vermiform appendix lies in it
Left infracolic space:
Lies post and inf to the trnsverse
colonand to the left of mesentery of
small intestine

Paracolic gutters
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

Paracolic gutters

Recesses of peritoneal
cavity

Duodenal recess
Superior
Inferior
Paraduodenal
Retroduodenal
Dudenojejunal
mesentericoparietal

Caecal recesses
Superior iliocaecal
Inferior iliocaecal
retrocaecal