PERITONEUM AND PERITONEAL CAVITY

DR. OKONTA E M
INTRODUCTION

• This is the serous lining of the abdominal cavity,

composed of mesothelial cells and derived from the
mesoderm
• Consists of the parietal peritoneum and the visceral
peritoneum.
• Both types are made up of simple squamous epithelial
cells aka mesothelium.
• It provides support for the viscera, blood vessels and
lymph
The Peritoneum
The Peritoneum seen through the sagittal section of the
abdomen
INTRODUCTION

A. Parietal Peritoneum
• Lines the abdominal, pelvic walls and the inferior
surface of the diaphragm.
• Is innervated by somatic nerves such as the phrenic,
lower intercostal, subcostal, iliohypogastric, and
ilioinguinal nerves{PLISII}

B. Visceral Peritoneum
• Covers the viscera
• Is innervated by visceral nerves, and is insensitive to
pain.
INTRODUCTION
Abdominal viscera can be divided anatomically based on their
relationship to the peritoneum, namely: intraperitoneal and
retroperitoneal organs.
• Intraperitoneal organs are enclosed by visceral peritoneum,
both anteriorly and posterior, eg . the stomach, liver and
spleen.
• Retroperitoneal organs are covered by the parietal
peritoneum, on the anterior surface.
• Also the retroperitoneal organs are further divided into two
groups based on their embryological development:
– Primary retroperitoneal organs developed and remain outside of the
parietal peritoneum, eg oesophagus, rectum and kidneys.
– Secondary retroperitoneal organs eg the ascending and descending
colon.
Intraperitoneal and retroperitoneal organs
PERITONEAL REFLECTIONS
• This is te adaptations of the peritoneal folds in various
aspects of the abdominal cavity
• it is usually raised from the body wall by underlying blood
vessels, ducts, and sometimes ligaments formed by
obliterated fetal vessels (e.g., the umbilical folds on the
internal surface of the anterolateral abdominal wall).
• Some peritoneal folds contain blood vessels and bleed if
cut, such as the lateral umbilical folds, which contain the
inferior epigastric arteries.
• other examples of the peritoneal reflections includes
mesentery, omentum and peritoneal ligament
PERITONEAL REFLECTIONS: Omentum

• Is a fold of peritoneum extending from the stomach to nearby

abdominal organs.
1. Lesser Omentum: Is a double layer of peritoneum extending from
the porta hepatis of the liver to the lesser curvature of the stomach
and the beginning of the duodenum.
• Consists of the hepatogastric and hepatoduodenal ligaments which
forms the anterior wall of the lesser sac of the peritoneal cavity.
• Transmits the left and right gastric vessels, which run between its
two layers along the lesser curvature.
• Has a right free margin that contains the proper hepatic artery, bile
duct, and portal vein.
Curvatures of the stomach
PERITONEAL REFLECTION: Omentum
2. Greater Omentum: Is derived from the embryonic dorsal mesentery.
• Bears down like an apron from the greater curvature of the stomach,
thereby covering the transverse colon and other abdominal viscera.
• Transmits the right and left gastroepiploic vessels along the greater
curvature.
• Can cover the neck of a hernial sac, thereby preventing the
entrance of coils of the small intestine.
• It adheres to areas of inflammation and wraps itself around the
inflamed organs, thus preventing serious diffuse peritonitis {Peritonitis
is an inflammation of the peritoneum, characterized by an
accumulation of peritoneal fluid that contains fibrin and leukocytes
(puss)}
 PERITONEAL REFLECTIONS:
Ligaments associated with the greater omentum
Gastrolienal (Gastrosplenic) Ligament
• It stretches from the left portion of the greater curvature of the stomach to the hilus
of the spleen and contains the short gastric and left gastroepiploic vessels.
Lienorenal (Splenorenal) Ligament
• Courses from the hilus of the spleen to the left kidney and contains the splenic
vessels and the tail of the pancreas.
Gastrophrenic Ligament
• Courses from the upper part of the greater curvature of the stomach to the
diaphragm.
Gastrocolic Ligament
• Courses from the greater curvature of the stomach to the transverse colon.
PERITONEAL REFLECTIONS: Mesentery

1. Mesentery of the Small Intestine (Mesentery Proper)

• Is a double fold of peritoneum suspending the jejunum and the
ileum from the posterior abdominal wall and transmits nerves
and blood vessels to and from the small intestine.
• It forms the root that extends from the duodenojejunal flexure to
the right iliac fossa and measures approx 15 cm (6 in.) long.
• It has a free border that encloses the small intestine, which is
approximately 6 m (20 ft) long.
• Contains the superior mesenteric and intestinal (jejunal and
ileal) vessels, nerves, and lymphatics
PERITONEAL REFLECTIONS: Mesentery
2. Transverse Mesocolon
• Attaches the posterior surface of the transverse colon to the posterior
abdominal wall.
• Also fuses with the greater omentum to form the gastrocolic ligament.
• Contains the middle colic vessels, nerves, and lymphatics.
3. Sigmoid Mesocolon
• Attaches the sigmoid colon to the pelvic wall
• It contains the sigmoid vessels. Its line of
4. Mesoappendix
• Atthaches the appendix to the mesentery of the ileum
• contains the appendicular vessels.
PERITONEAL REFLECTIONS:The ligaments
1. Phrenicocolic Ligament
• Courses from the left colic flexure to the diaphragm.
2. Falciform Ligament
• It connects the liver to the diaphragm and the anterior
abdominal wall.
• It attaches onnects the branch of the portal vein with the
subcutaneous veins in the region of the umbilicus
• Contains the ligamentum teres hepatis and the
paraumbilical vein
PERITONEAL REFLECTIONS: The ligaments
3. Ligamentum Teres Hepatis (Round Ligament of the Liver)
• It is the remnant of the embryologic left umbilical vein, which
carries oxygenated blood from the placenta to the left branch of
the portal vein in the fetus. (The right umbilical vein is
obliterated during the embryonic period.)
• It forms the free margin of the falciform ligament
• courses from the umbilicus to the inferior (visceral) surface of
the liver, lying in the fissure that forms the left boundary of the
quadrate lobe of the liver.
4. Coronary Ligament
• It is a reflection of the diaphragmatic surface of the liver onto the
diaphragm
PERITONEAL REFLECTIONS:The ligaments
• Houses a triangular area of the right lobe, the bare area of the
liver.
• Has right and left extensions that form the right and left triangular
ligaments.
5. Ligamentum Venosum
• A remnant of the ductus venosus a narrow, trumpet-shaped
vessel which is seen in the fetal liver connecting the umbilical vein
directly to the caudal inferior vena cava or distal left hepatic vein
• Lies in the fissure on the inferior surface of the liver, forming the
left boundary of the caudate lobe of the liver.
PERITONEAL REFLECTIONS: The folds
1. Umbilical Folds
• Are five folds of peritoneum below the umbilicus,
including the median, medial, and lateral umbilical folds.
2. Rectouterine Fold
• Courses from the cervix of the uterus, along the side of
the rectum, to the posterior pelvic wall, forming the
rectouterine pouch (of Douglas).
3. Ileocecal Fold
• Courses from the terminal ileum to the cecum.
PERITONEAL CAVITY
• It is a potential space between the parietal and visceral
peritoneum and contains serous fluid that lubricates the
surface of the peritoneum and enhances free movements
of the viscera.
• It Is a completely closed sac in the male but is open in the
female through the uterine tubes, uterus, and vagina.
• It is divided into the lesser and greater sacs
• The greater sac is the main and larger part of the
peritoneal cavity while the lesser sac aka omental bursa
lies posterior to the stomach and lesser omentum
PERITONEAL CAVITY

Lesser Sac (Omental Bursa)

• It Is the space that lies behind the liver, lesser omentum,
stomach, and upper anterior part of the greater omentum.
• It Is a closed sac, except for its communication with the greater
sac through the epiploic (omental) foramen.
• Has three known recesses:
(a) superior recess, which is posterior to the stomach, lesser omentum,
and left lobe of the liver;
(b) inferior recess, which is posterior to the stomach, however extends
into the layers of the greater omentum; and
(c) splenic recess, which extends to the left at the hilus of the spleen
PERITONEAL CAVITY

Epiploic or Omental (Winslow) Foramen

• It is an opening between the lesser and greater sacs.
• It is bounded superiorly by peritoneum on the caudate
lobe of the liver, inferiorly by peritoneum on the first part of
the duodenum, anteriorly by the free edge of the lesser
omentum, and posteriorly by peritoneum covering the IVC
Epiploic or Omental (Winslow) Foramen
PERITONEAL CAVITY

Greater Sac
• It extends across the entire breadth of the abdomen and
from the diaphragm to the pelvic floor and has numerous
recesses.
1. Subphrenic (Suprahepatic) Recess
• Is the peritoneal pocket between the diaphragm and the
anterior and superior part of the liver and is separated into
right and left recesses by the falciform ligament.
PERITONEAL CAVITY

2. Subhepatic Recess or Hepatorenal Recess (Morrison

Pouch)
• Is a deep peritoneal pocket between the liver anteriorly
and the kidney and suprarenal gland posteriorly and
communicates with the lesser sac via the epiploic
foramen and the right paracolic gutter, thus the pelvic
cavity.
3. Paracolic Recesses (Gutters)
• Lie lateral to both the ascending colon (right paracolic
gutter) and the descending colon (left paracolic gutter).
CLINICAL CORRELATIONS
Peritonitis
• is inflammation and/or infection of the peritoneum. Some causes include infiltration
of fecal material from a burst appendix, a penetrating wound to the abdomen,
perforating ulcer that leaks stomach contents into the peritoneal cavity (lesser sac),
or poor sterile technique during abdominal surgery. Peritonitis can be treated by
rinsing the peritoneum with large amounts of sterile saline solution and giving
antibiotics.
Paracentesis (abdominal tap)
• is a procedure in which a needle is inserted 1 to 2 in. through the abdominal wall
into the peritoneal cavity to obtain a sample or drain fluid while the patient is sitting
upright. The entry site is usually the midline at approximately 2 cm below the
umbilicus or lateral to McBurney’s point, so s to avoid the inferior epigastric vessels
REFERENCES

• Chung, K W (2015) Board review series Anatomy 8thed

Wolters Kluwer: Philadelphia
• Harold, E (2019) Clinical Anatomy Applied Anatomy for
Students and Junior Doctors 14th ed Wiley Blackwell:
Oxford
• Moore K L (2014) Clinically Oriented Anatomy 7ed
Wolters Kluwer: Philadelphia
 THANKS FOR
YOUR ATTENTION