anatomy of Peritoneal spaces

anatomy of peritoneal spaces

1. Anatomy of peritoneal spaces Dr vishwanath reddy

2. Peritonum The peritoneum is a thin translucent ,serous membrane lined by mesothelial cell The part that covers the abdominal wall is called the parietal peritoneum The part which covers the viscus is called the visceral peritoneum

3. Definitions LIGAMENT -Two folds of peritoneum -supporting structers Mysentry -two folds of peritoneum -connecting to posterior abdominal wall Omentum - Connecting the stomach to other organs

4. Embryologic Characteristics

5. Peritoneal ligaments Upper abdominal ligaments - falciform ligament -Triangular ligaments -lesser omentum -greater omentum

6. Falciform ligament connects liver to the posterior aspect of the anterior abdominal wall just to the right o the midline .

7. TRIANGULAR LIGAMENTS RIGHT – Seperats right subphrenic space from right sub hepatic space LEFT—short & dosent compartmentalize

8. Lesser omentum G astro hepatic ligament -attaches liver to lesser curvature, -left gactric artery &coronary vein Hepatoduodenal ligament -attaches liver to duodenum - CBD,hepatic artery&PV

9. GREATER OMENTUM Gastrocolic ligament Gastrosplenic ligament Gastrophrenic ligament

10. The gastro splenic ligament Connects the stomach to spleen contains the short gastric vessels It’s a major route of escape for pancreatitis arising in the peripheral body &tail

11. Spleno renal ligament Posterior aspect of spleen to anterior pararenal space Forms post- lat border of lesser sac encloses tail of pancreas& distal splenic artery

12. ligaments of lower abdomen Transverse mesocolon Small bowel mesentry Sigmoid mesocolon

13. The transverse mesocolon transverse colon to the retroperitoneum and contains the middle colic vessels small bowel mesentry attaches the small bowel to the retroperitoneum and extends from the ligament of treitz to the ileocecal valve It cointains the superior mesenteric vessels and their branches The sigmoid mesocolon attaches the sigmoid colon to the posterior pelvic wall and cointains the haemorrhoidal and sigmoid vessels

14. Peritoneal spaces potential space between the parietal & visceral peritoneum contains a film that of fluid that lubricates the surface of the peritoneum not depicted on conventional radiologic studies or by cross secectional imaging unless they are distended by fluid or air

15. -In men, the peritoneal cavity is closed, - in women, it communicates with the extraperitoneal pelvis exteriorly through the fallopian tubes, uterus and vagina

16. Transverse mesocolon divides the space in to - supramesocolic - inframesocolic bilateral paracolic & pelvic spaces are also peritoneal spaces

17. Peritoneal spaces

18. Supramesocolic space Right - rightsubphrenic ( subdiaphragmatic ) - rightsubhepatic ( hepatorenal or mrrisons pouch) Lesser sac ( omental bursa) Left -left perihepatic space -left subdiaphragmatic space

19. Left sided peritoneal spaces Perihepatic spaces- Two left perihepatic spaces The anterior perihepatic space The posterior perihepatic

20. Left Subphrenic space diaphragm ant& lat , stomach post. communicates with the post subphrenic ( perisplenic ) space The perisplenic space surrounds most of the spleen except for a portion of spleen lying within the splenorenal ligament

21. Right sided supra mesocolic spaces The right sub diaphragmatic space is limited anteriorly by the falciform ligament and posteriorly by the hepatic bare area . Collections in this space deform the surface of the liver

22. Hepatorenal space – morrisons pouch Just beneath the bare area the right peritoneal space courses between the posterior surface of segment 6 and the anterior renal fascia on its way to the epiploic foramen . This relativel;y small potential space is referred as to the hepato renal fossa It is the most dependent portion of the right supramesocolic spaces

23. Lesser sac Lies behind the stomach Ant to pancreas Left margin-gastro splenic ligament Right margin –medial surface of coronary ligament Caudal boundary – gastrocolic reflection&mesocolon

24. Lesser sac Superior recess-behind stomach,lesser omentum & left lobe Inf recess-lies behind the stomach,extending into the layers of GO The sup & inf recess are separated by a peritoneal fold that accompanies the left gastric artery

25. Lesser sac boundaries

26. Foramen of winslow Communication betn the greater & lesser sac. Ant margin – hepatoduodenal ligament Roof-peritoneum covering caudate lobe Post margin-peritoneum covering IVC Floor-peritoneum covering 1 st part of duodenum

27. Foramen of winslow

28. Inframesocolic spaces lies below the transverse mesocolon and transverse colon as far as the true pelvis . divided in two unequal spaces by the root of the mesentery of the small intestine . It contains the right and left paracolic gutters lateral to the ascending and descending colon .

29. Smaller RIC is restricted inferiorly by the junction of the distal small bowel mesentry with the cecum LIC opens into pelvis eccept where it is bounded by the sigmoid mesocolon The paracolic gutters are located lateral to the peritoneal reflections of the ac&dc,the Rt communicates freely with the right supramesocolic spaces, Lt is limited by the phrenicocolic ligament

30. Pelvic peritoneal spaces The most dependent portion of the peritoneal spaces in supine & erect positions is in the pelvis In males the rectovesical space lies between the anterior mesorectal fascia & post wall of the bladder In females the retrouterine space (pouch of douglas ) lies betwn uterine wall & ant mesorectal fascia

31. Peritoneal circulation Water shed areas for fluid collection Ileocolic region,root of sigmoid,pouch of douglas Majority of the fluid is cleared at the subphrenic space by mesothelial lymphatics