Peritoneal cavity

Peritoneal spaces

 Supra-mesocolic Peritoneal spaces

 Infra-mesocolic
Peritoneal spaces
Peritoneal spaces
Supra-mesocolic
space
 Sub-phrenic space
 Falciform ligament separate right from the left
Peritoneal spaces

 Falciform ligament
Peritoneal spaces

Sub hepatic
spaces
 Right subhepatic space “morison pouch”
 Left sub-hepatic space “lesser sac
Peritoneal spaces

 Right sub hepatic “Morrison pouch ”hepato-renal pouch

Peritoneal spaces

 Left sub-hepatic “lesser sac”

 malignant ascites
 Ascites normally don't enter the lesser sac
Peritoneal spaces

Infra-meseocolic
 Right and left infra-mesocolic spaces spaces

 Right and left parabolic spaces

Peritoneal spaces

 Rght and left infracolic spaces sperated by root of small mesentery

 Right and left parcolic gutters lateral to the colon
Peritoneal spaces

 Left para-colic gutter sperted from the left sub-phrenic space by phrenico-colic ligament
Peritoneal spaces

Pelvic spaces
 Recto-uterine “doglas pouch”
 Vesico-uterine pouch
Mesentery
mesetery

 Mesentery two layer of visceral peritoneum connect the bowel to the posterior abdominal
wall
Mesentery
mesnetry
 Posterior to the bowel
 Contain vessels supplying the bowel
Omentum omentum

 Multilayer fold of peritoneum that connect the somach to the adjacent organs
 Lesser omentum “connect the lesser curv to the liver”.
 Greater mentum : hang like aprone anterior to the small bowel and connect the greater
curve to the transverse colon
Omentum
Greater omentum

 Anterior to the transverse colon

 Anterior to the small bowel
peritonitis

 Inflammatory process involve the peritoneum cavity

 SBP in cases of chronic ascites
 Inflammatory condition diverticulitis ,appendicitis
 Perforation of viscus
 Poste operative, intervention or peritonea dialysis
 Pain, fever vomiting
peritonitis

 Diffuse and uniform thickening and enhancement of the peritoneum.

 High attenuating ascites.
peritonitis

 Loculation of ascites
peritonitis

 Ectopic air loculi “bacterial gas forming “ or perforated viscus

 Bacterial perotinitis
peritonitis

 Sclerosing peritonitis
 Recurrent peritonitis leads to calcification “ “cocoon sign”
 Chronic peritoneal dialysis
peritonitis

 Sclerosing peritonitis
Sclerosing mesenteritis
mesenteric paniculitis

 Idiopathic fat necrosis or inflalamation or fibrosis of the mesentery

 Stages fat necrosis then inflammation then fibrosis ”retractile mesentritis”
 Abdominal pain may symptoms of intestinal obstruction in chronic form
Sclerosing mesenteritis
mesenteric paniculitis
 Misty “increased attenuation “ of the mesentery
 90% affect the jejunal bowel loops “to the left of the midline
 Pseudo capsule sign “<3 mm”
 Cluster of enlarged mesenteric lymph nodes
 Preservation of fat halo sign characteristic “ seen around the enlarged lymph nodes
Sclerosing mesenteritis Chronic phase

mesenteric paniculitis
“retractile
mesenteritis”

 Discrete mesenteric soft tissue lesion

 May show internal calcification
 Tether the bower, Narrow the vessels and induce ischemia
Sclerosing mesenteritis
mesenteric paniculitis
 Mass with stellate appearance and desmoplastic reaction
Sclerosing mesenteritis Differential diagnosis
mesenteric paniculitis Carcinoid tumor

Ileal bowel lops “right

side” Jejunal lobs
Enhanced mucosal lesion mesnetry”left side”
or metastatic liver Fat halo sign
Mesenteric Desmoid
aggressive fibromatosis
Desmoid =tendon
like

 Locally aggressive mesenchymal tumor of the fibrous tissue

 Occur at the abdominal wall or mesentery
 High association with Gardner syndrome (fap and osteomas)or familial polyposis coli
 Women in a child baring period
 Vary in size and can reach large size
 High recurrence rate after operation yet do not metastasize
Mesenteric Desmoid
aggressive fibromatosis

 Mesentric Well defined soft tissue mass lesion

Mesenteric Desmoid
aggressive fibromatosis

 Narrowing of the vessels

 Displacing bowel
Mesenteric Desmoid
aggressive fibromatosis
Rapid rate of growth
Mesenteric Desmoid
aggressive fibromatosis
 May be iso low or hyperdense to the muscle
 But rare to be avidly enhanced after contrast enhancement
Mesenteric Desmoid
aggressive fibromatosis
 The signal is usually high at T2WI but can be low
Mesenteric Desmoid
aggressive fibromatosis
Peritoneal (abdominal )mesothelioma

 Primary malignancy of the peritoneum

 Arise from mesothelial cells(pleura-pericardium-peritoneum and tunica vaginalis)
 Heavily exposure to asbestos is one of the predisposing factor
 Occur in old age
 Abdominal pain and distension
Peritoneal (abdominal )mesothelioma

 Diffuse Peritoneal based masses

 Pleural calcific plaques ”asbestos” ”is the clue of diagnosis”.
 50% in peritoneal mesothelioma as compared to 20% pleural mesothelioma “heavy exposure
to asbestos is needed for peritoneal as compared to pleura)
Peritoneal (abdominal )mesothelioma

 Sheets of peritoneal mases

 Calcification in peritoneal masses is very uncommon
Peritoneal (abdominal )mesothelioma

 Spreads along serosal surfaces and can directly invade adjacent viscera, especially colon and
live
Peritoneal (abdominal )mesothelioma
Peritoneal metastasis
peritoneal carcinimatosis

 Common disease
 Spread from (ovarian or GIT ,pancreatic ,gall bladder adenocarcinoma)
 Either spreading through the peritoneal surfaces or heamtogenous spread "less
common”.abdoiminal pain ,distension ,hard mass
Peritoneal metastasis
peritoneal carcinimatosis 3 pattern

Micro-nodular pattern
Nodular pattern Omental cake
Fat stranding and micro
Discrete nodule >5 mm Sheets or confluent masses
nodularity
Peritoneal metastasis
peritoneal carcinimatosis
Peritoneal metastasis
peritoneal carcinimatosis
Peritoneal metastasis
peritoneal carcinimatosis
Massive ascites
 Primary ovarian tumor
Peritoneal metastasis
peritoneal carcinimatosis
Deposits
Peritoneal metastasis
peritoneal carcinimatosis


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