Peritoneum & cavities

Tracing peritoneum

2. Cavities of body

4. Peritoneum
•Large serous sac
•Lines inner surface of abdomino-
pelvic wall

5. Why different layers?
•Invaginatedby viscera from
different sides
•Invagination throws the peritoneum
into folds &
•Forms
•Parietal & visceral layers
•& potential spaces

6. Peritoneum -parts
•ParietalPeritoneum
•Lines the inner surface of
•Abdominal and pelvic walls and
•Lower surface
•Diaphragm
•Embryologicallyfrom somatopleuric
mesoderm
•Derives blood & nerve supply from body
wall
•VisceralPeritoneum
•Lines outer surface of viscera
•Firmly attaches with viscera
•Develops from splanchnopeuric
mesoderm
•Blood supply and nerve supply are the
sameas those ofunderlying viscera

7. Interperitonealorgans
•Most part of viscera surrounded by
peritoneum
•Stomach, Liver, gallbladder
•Tail of pancreas, spleen
•First part of duodenum, jejunum, ileum
•Transverse colon, sigmoid colon
•Upper part of rectum, urinary bladder and
uterus

8. Retroperitoneal organs
•Organs lie on the posterior abdominal
wall are covered by peritoneum on
their anterior surfaces
•Descending and horizontal parts of
duodenum, pancreas (head, neck & body)
•Ascending & descending colon
•Kidney, suprarenal gland, ureters
•Abdominal aorta & IVC
•Middle and lower parts of rectum

9. Secondary retroperitoneal organs
•Duodenum
•2
nd
and 3
rd
part
•Pancreas (except tail)
•Ascending colon
•Descending colon
•Upper rectum

10. Folds of Peritoneum -
types
•Many organs within abdomenare
suspended by folds of peritoneum
•Provide pathways for passageof
vessels, nerves and lymphatics
•Named after their attached organs
•Omentum
•Fold of peritoneum connecting stomach to
other organs
•Mesenteries
•Fold invests small intestine
•Mesocolon
•Fold invests large intestine
•Peritoneal ligaments
•Folds attached with other organs

11. Disposition –Vertical
•Start from
•Anterior abdominal wall
•At umbilical level
•Lines
•Inner aspect of anterior abdominal wall
•Trace
•Uptoant part of diaphragm (under surface)
•Right of median plane
•Falciformligament
•In free margin it contains
•Ligamentumtereshepatis
•Obliterated left umbilical vein (extends
from umbilicus to inferior surface of
liver)
•Also it contains para umbilical veins
•Tributaries to left branch of Portal vein

12. Disposition –Vertical
•Inferior surface of diaphragm to upper
surface of liver
•Falciformligament
•2 layers diverge to right & left
•On right (right layer of falciform)
•From diaphragm to right lobe of liver forms
•Superior layer of coronary ligament
•On left (left layer of falciformlig)
•From diaphragm to left lobe of liver forms
•Left triangular ligament (anterior layer)

13. Disposition –Vertical
•After covering the superior and anterior
surfaces of liver
•Reaches inferior surface of liver
•Right of Gall bladder
•Peritoneum passes down to
•Suprarenal & kidney as inferior layer of
coronary ligament
•Bare area
•Between the 2 layers of coronary ligament
•Right triangular ligament
•2 layers of coronary ligament unite to form
•Connects right lobe of liver with diaphragm

14. Disposition –Vertical
Ligamentumvenosum-remnant of ductus venosus
(oblitratedductus venosus), which shunted blood from
the umbilical vein to the IVC in fetal life
•On the left of gall bladder
•After covering quadrate lobe & left lobe
•Becomes posterior layer of left triangular ligament
•Then passes to
•Left margin of fissure for ligamentumvenosum& anterior lip
of porta hepatis&
•From anterior lip of porta hepatisto right and then posterior lip
of porta hepatis
•Covering caudate lobe & attached to right lip of fissure for
ligamentumvenosum
•These two layers form
•Lesser omentum
•Has inverted L shaped attachment

15. Omentum
•Peritoneal folds related to stomach
•Lesser omentum
•Greater omentum

16. Lesser omentum
•Connects liver to stomach
•Attachment
•Above to porta hepatis& fissure for
ligamentumvenosum
•Inferiorly to lesser curvature of the
stomach & 1
st
inch ofduodenum
•Parts
•Hepatogastric ligament
•Hepatoduodenal ligament
•Forms free margin
•Contains
•Portal vein (posteriorly)
•Hepatic artery (anterior & left)
•Bile duct (anterior & right)

17. Lesser omentum
•Contents
•Hepatic artery, bile duct, portal vein
•In free margin -
•Rt. & lt. gastric vessels
•Along lesser curvature

18. Tracing lesser omentum
•Peritoneum from
•Anterior lip of porta hepatisand left lip of
fissure for ligamentumvenosum
•Posterior lip of porta hepatisand right lip
of fissure for ligamentumvenosum
•Continues downwards as lesser
omentumtowards lesser curvature of
stomach and first one inch of
duodenum
•Forms anterior boundary for upper part
of lesser sac

19. Tracing lesser omentum
•After reaching lesser curvature
•Two layers separates
•And covers the surfaces
•Reaches greater curvature
•Becomes anterior two layers of greater omentum

20. Tracing greater
omentum
•From greater curvature
•Anterior & posterior layers
comes downwards
•After awhile it returns back
towards anterior border of
pancreas
•So 4 layers are there
•Together they form Greater
omentum
•Space between 2
nd
& 3
rd
layer is
lesser sac
•Patent in fetal life
•But obliterated -after birth

21. Fate of 3
rd
& 4
th
layers
•Continuation of layers of lesser
omentum
•Forms 1
st
& 2
nd
layer of greater omentum
•While returns back to pancreas
•1
st
layer becomes 4
th
layer
•2
nd
layer becomes 3
rd
layer
•Third layer
•Runs upwards towards anterior border of
pancreas (infrontof transverse colon)
•Passes infrontof
•Anterior surface of pancreas, kidney and
suprarenal gland
•Reaches the liver
•Forms posterior wall of lesser sac

22. Fate of 3
rd
& 4
th
layers
•4
th
layer
•Runs towards anterior surface of head &
anterior border of body of Pancreas
•Then comes down to transverse colon as
upper layer of Transverse mesocolon
•Encloses transverse colon
•Then goes towards inferior surface of
pancreas –as inferior layer of
Transverse mesocolon
Fourth layer of Greater omentumand
Superior layer of Transverse mesocolonare
adherent –but separable.

23. Greater omentum
•Largest fold of peritoneum
•Hangs down like an apron
•In front of coils of small intestine
•Made of 4 layers
•Anterior 2 layers from Greater
curvature and 1
st
part of duodenum
•Extending downwards for a considerable
distance &
•Fold upon themselves to be 3
rd
& 4
th
layer
•To anterosuperiorsurface of
Tranasversecolon (head & ant border
of pancreas)

24. Greater omentum–parts &
contents
•Parts
•Gastrophrenicligament
•Gastrosplenicligament
•Gastrocolicligament
•Contents
•Rt. &Lt. gastroepiploic vessels
•Lymph nodes
•Fat
•Functions
•Store house of fat
•Limits the spread of infection

25. Transverse mesocolon
•Suspends transverse colon
•Attached to anterior
aspect of head & anterior
border of body of
pancreas
•Contains –Middle colic
art.

26. Root of mesentery
•Peritoneum from transverse mesocolon
•Covers lower part of anterior surface of
head of pancreas
•Passes to front of 3
rd
& 4
th
parts of
duodenum
•Then covers posterior abdominal wall
•Becomes folded between
•Duodenojejunalflexure(left of L2) to
ileocecal junction (rtsacroiliac joint)
•Forms root of mesentery

27. Mesentery
•Fan-shaped fold of peritoneum
•Suspends the coils of jejunum and
ileum from posterior abdominalwall
•Has 2 borders
•Attached
•Free

28. Mesentery -borders
•Attached border
•Known as root of mesentery
•Lies obliquely
•Extent
•From
•Duodenojejunalflexure (L2 –left side)
•To
•Ileocecal junction (Rt. Sacroiliac joint)
•Length -6 inches (15 cm)
•Structures crossed by it
•3
rd
part of duodenum, Abdominal aorta, IVC
•Rt. Psoas major,
•Rt. Gonadal vessels, Rt. Genitofemoral nerve &
Rt. ureter (medial to lateral)
•Rt. Sacroiliac jt

29. Mesentery -borders
•Free border
•Encloses jejunum and ileum
•6 meters in length
•Contents
•Jejunum, ileum
•Lymph nodes
•Jejunal& ilealbranches of superior
mesenteric artery& nerve plexus
•Fat

30. Meso-appendix
•Δ-gular fold
•Suspends appendix
•From post surface of lower end
of mesentery
•Appendicular artery

31. Peritoneum in Pelvis
•After covers the structures of
posterior abdominal wall
•Reaches pelvis
•First invests sigmoid colon from pelvic
wall
•Sigmoid mesocolon
•Then covers Rectum
•Upper third on front & sides
•Middle part on front only
Tracing the peritoneum anteriorly differs
in male & female

32. Sigmoid
mesocolon
•Suspends sigmoid colon
•Attached to post abdominal and
pelvic walls like inverted V
•Apex of V lies on ureter at
bifurcation of Lt. com iliac
artery
•Lt limb –along upper ½ of Lt,
Ext iliac
•Contents –Superior rectal
vessels

33. Peritoneum -Pelvis
•In male
•From rectum to seminal vesicle
•Then upper surface of urinary bladder
•Forms rectovesicalpouch
•From apex of UB to inner surface of
anterior abdominal wall till umbilicus
•In female
•From rectum to posterior fornix of vagina
•And covers supravaginalcervix, body and
fundus
•Forms rectouterine pouch (pouch of Douglas)
•Then covers anterior surface of body
•From body to UB
•Forms uterovesicalpouch

34. Female pelvis
•Communicates with extraperitoneal
pelvis exteriorly
•Through fallopian tubes, uterus and
vagina

35. Folds in anterior abdominal wall
•Median umbilical fold
•Remnant of urachus(median
umbilical ligaments)
•Medial umbilical fold
•Remnants of umbilical arteries
(medial umbilical ligaments)
•Lateral umbilical fold
•Inferior epigastric vessels

36. Fossae of anterior abdominalwall

38. Peritoneal cavity -Divisions
•Transverse mesocolondivides the
peritoneal cavity in to
•Supramesocolicspace
•Also known as subphrenicspaces
•Inframesocolicspace
•Bilateral paracolic& pelvic spaces
are also peritoneal spaces

39. Supra colic space
•Alsoknown as subphrenicspaces
•Boundaries
•Superiorly
•Diaphragm
•Inferiorly
•Transverse colon
•In front
•Ant abdominal wall
•Behind
•Lesser omentum, stomach, greater
omentum

40. Supracoliccompartment
•Supracoliccompartment contains
•Stomach, liver, and spleen
•Infracoliccompartment contains
•Small intestine and ascending & descending
colons
•Infracoliccompartment is divided into
•Right and left infracolicspaces by the
mesentery of small intestine
•Communication occurs between the
supracolicand infracoliccompartments
•Through paracolicgutters

41. •Right
•Right anterior subphrenic
(subdiaphragmatic)
•Right posterior subphrenic(hepatorenal
or Morrisonspouch)
•Right extraperitoneal
•Left
•Left anterior intraperitoneal / left
suprahepatic/ subphrenic
•Left posterior intraperitoneal / left
subhepatic
•Left extraperitoneal
Supracoliccompartment -Spaces

42. Right anterior intraperitoneal / subphrenic/ suprahepatic
•Presents
•Right of falciformligament
•Boundaries
•In front
•Ant abdominal wall & diaphragm
•Behind
•Superior anterior & right lateral surface of right
lobe of liver, superior layer of coronary
ligament
•Below
•Communicates with right posterior
intraperitoneal compartment
•Above
•Diaphragm

43. Morrison’s Pouch / Hepatorenalpouch /
Rtsubhepaticpouch
•Right posterior subphrenicspace
•Most dependent part of peritoneal cavity in
upper abdomen
•Boundaries
•In Front
•Inferior surface of rt. lobe of liver and Gall bladder
•Behind
•Anterior surface of rt. kidney& rt. supra renal gland
•Rt. Colic flexure & 2
nd
part of duodenum
•Above
•Inflayer of coronary ligament
•Below
•Communicate with infracolicpart of peritoneal cavity
•Left
•Communicate withomental bursa
•Right
•Limited bydiaphragm

44. Morrison’s Pouch Hepatorenalpouch Rtsubhepaticpouch
•Most dependent part of abdomen
proper
•Commonest site of subphrenicabscess
•From
•Perforated peptic ulcer of stomach &
duodenum

45. Right extraperitonealspace
•Bare area of liver presents
•Liver directly related to diaphragm
•Boundaries
•Left
•IVC
•Right
•Rt. triangular ligament
•Above
•Superior layer of coronary ligament
•Below
•Inferior layer of coronary ligament
•Clinical anatomy
•Common site for
•Amoebic liver abscess

46. Left anterior intraperitoneal
•Lies on left of falciformligament
•Boundaries
•In front
•Ant abdominal wall
•Behind
•Lt triangular ligament
•Lt. lobe of liver
•Stomach & spleen

47. Left posterior intraperitoneal
•It is lesser sac

48. Lesser Sac
•Position
•Behind the lesser omentumandstomach
walls

49. Lesser sac
•Boundaries
•Superior
•Peritoneum which covers the caudate lobe of liver
anddiaphragm
•Anterior
•Lesser omentum
•Peritoneum of posterior wall of stomach
•And anterior two layers of greateromentum
•Posterior
•Posterior two layers of greater omentum
•Transverse colon & transverse mesocolon
•Peritoneum covering pancreas, left kidney and
suprarenalgland
•Inferior
•Continuity of anterior and posterior two layers of
greateromentum

50. Lesser Sac
•Right border
•From above downwards
•Deficient above
•Epiploic foramen
•Peritoneum covering
•Posterior surface of proximal part of
duodenum to the head of pancreas
•Left border
•From above downwards
•Gastrophrenicligament
•Gastrosplenicand lienorenal
ligament
•Left border of greater omentum

51. Parts of lesser sac
•Body
•Lies behind lesser omentum&
stomach
•Superior recess
•Lies behind caudate lobe of liver
•Splenic recess
•Between gastrosplenicand
lienorenal ligament
•Inferior recess
•Lies between the folds of greater
omentum

52. Epiploic foramen
•Communication between
•Lesser and greater sac
•Location
•T -12 vertebra level
•Boundaries
•Anteriorly
•Free margin of lesser omentum
•Contains
•Front right to left
•Bile duct & hepatic artery
•Behind
•Portal vein
•Posteriorly
•IVC (covered by peritoneum)
•Superiorly
•Caudate process of liver
•Inferiorly
•1
st
part of duodenum

53. Epiploic foramen
•Boundaries
•Anteriorly
•Free margin of lesser omentum
•Contains
•Front right to left
•Bile duct & hepatic
artery
•Behind
•Portal vein
•Posteriorly
•IVC (covered by peritoneum)
•Superiorly
•Caudate process of liver
•Inferiorly
•1
st
part of duodenum

54. Applied anatomy
•Internal abdominal hernia
•Occasionally a loop of intestine may
enter into lesser sac
•Through epiploic foramen
•None of the boundaries can be incised
to reduce the hernia
•Pushing the herniated loop out of lesser
sac by inserting the index finger into it
through ant. 2 layers of greater omentum

55. InfracolicCompartments
•Lies below the transverse colon &
mesocolonand behind the greater
omentum
•Divided into w by root of mesentery
•Right infracolicCompartment
•Left infracolicCompartment

56. Right infracoliccompartmet
•Boundaries
•Above
•Transvers colon & mesocolon
•On right
•Ascending colon
•On left
•Root of Mesentery
•Below
•Closed

57. Left infracoliccompartmet
•Lies left of root of mesentery
•Boundaries
•In front
•Anterior abdominal wall
•Above
•Transverse mesocolon
•Below
•Open with pelvis
•On right
•Root of mesentery
•On left
•Descending colon

58. Paracolicgutters
•Longitudinal channels
•Lined by peritoneum
•Lies along the sides of ascending &
descending colons
•Right & left paracolicgutters
•Right paracolicgutter
•Lies lateral to ascending colon
•Communication
•BeweenHepato-renal pouch (above)
& pelvis (below)
•Left paracolicgutter
•Lies lateral to descending colon
•Above it is separated from
•Spleen & lienorenal space by
Phrenico-colic ligament
•Below it is communicated with
pelvis
•

59. Rectouterine Pouch (Pouch of
Douglas)
•Boundaries:
•Anteriorly: uterus and posterior fornix of vagina
•Posteriorly: rectum
•Inferiorly (floor): rectovaginal fold of
peritoneum
•Clinical anatomy
•Most dependent part of peritoneal cavity
•Pus collected here
•Can be drained through rectum or posterior fornix of
vagina

60. Applied anatomy
•Ascites
•Excessive accumulation of peritoneal fluid
in peritoneal cavity
•Commonly due to
•Cirrhosis
•TB & Malignancy
•Paracentesis
•Draining fluid
•Peritonitis
•Infection & inflammation of peritoneum
•May result in fatal
•Minimize the damage of peritoneum