PERITONEUM

• THE PERITONEUM
• The endothelial/serous lining of the
primitive coelomic cavity of the embryo
becomes
• the thoracic pleura
• the abdominal peritoneum.
• Peritoneum serous membrane lining
abdominal cavity
• Parietal Peritoneum
• Invaginated by ingrowing viscera which
thus come to be covered by a serous
membrane
• visceral peritoneum
• The viscera are attached by messentary to
other organs or posterior abdominal wall
where they continue with parietal
peritoneum.
• Creates the Peritoneal Cavity.
• In the male, the peritoneal cavity is
completely closed
• In the female it is perforated by the
openings of the uterine tubes which
constitute a possible pathway of
infection from the exterior.
• The mesenteries and layers of the
peritoneum
• The transverse colon, stomach,
spleen and liver each have attached
to them two ‘mesenteries’ double
layers of peritoneum
• containing arteries and their
accompanying veins, nerves and
lymphatics
• The small intestine and sigmoid colon
have only one.
• All the other viscera are
retroperitoneal.
• ORGANS AND THEIR MESSENTARIES AND
BLOOD VESSELS.
• The liver
• 1. The falciform ligament and the two layers of
the coronary ligament with their sharp edges,
the left and right triangular ligaments.
• Form the layers of the coronary ligament.
• bounds the bare area of liver.
• liver is directly in contact with the diaphragm
• the obliterated umbilical artery in the free edge of the
falciform ligament and numerous small veins in the
bare area
• 2. The lesser omentum.
• the stretch of messentary from the liver to the lesser curveture of the stomach.
• The small intestine:
• 1. Mesentery of the small intestine
• the superior mesenteric artery and its
branches.
• The sigmoid colon:
• (1) The sigmoid mesocolon
• the sigmoid arteries and their
branches.
• The peritoneal cavity.
• Definition
• Starting at the transverse mesocolon.
• Its two layers are attached to the anterior surface
of the pancreas
• the second part of the duodenum
• the front of the left kidney.
• They envelop the transverse colon and
continue downwards to form the posterior two
layers of the greater omentum, which hangs
down over the coils of the small intestine.
• They then turn back on themselves to form the
anterior two layers of the omentum and these
reach the greater curvature of the stomach.
• The four layers of the omentum are fused and
impregnated with fat.
• The greater omentum
• The Greater Omentum plays an
important role in limiting the spread
of infection in the peritoneal cavity.
• From its attachment to the pancreas;
• the lower layer of the transverse
mesocolon turns downwards to
become the parietal peritoneum of the
posterior abdominal wall(PAW)
• From the PAW it is reflected to form
the mesentery of
• the small intestine
• and the sigmoid mesocolon.
• The upper layer of the transverse
mesocolon
• passes upwards to form the parietal
peritoneum of the posterior abdominal
wall
• covering the upper part of the pancreas
• the left kidney and its suprarenal
• the aorta
• and the origin of the coeliac artery (the
‘stomach bed’).
• It thus forms the posterior wall of the
omental bursa.
• It then covers the diaphragm and
continues onto the anterior abdominal
wall.
• From the diaphragm and anterior
abdominal wall
• it is reflected onto the liver to form
its ‘mesentery’ in the form of the two
layers of the falciform ligament.
• At the liver, the left layer of the
falciform ligament folds back on itself
to form the sharp edge of the left
triangular ligament
• while the right layer turns back on
itself to form the upper and lower
layers of the coronary ligament with
its sharp-edged right triangular
ligament.
• The layers of the coronary ligament
are widely separated to form a large
area of liver between them the bare
area
• directly in contact with the
diaphragm.
• The inferior vena cava is
embedded in the bare area.
• From the undersurface of the liver
another ‘mesentery’ passes from
• the fissure for the ligamentum venosum
to the lesser curvature of the stomach to
form the lesser omentum.
• The lesser omentum splits to enclose
the stomach
• and is continuous with the two layers of
the greater omentum already described.
• The lesser omentum has a right free
border which contains
• the portal vein,
• the hepatic artery
• and the common bile duct.
• In the region of the spleen there are
two more ‘mesenteries’ which are
continuous with the lesser and
greater omenta.
• These are
• the lienorenal ligament
• a double layer of peritoneum reflected
from the front of the left kidney to the
hilum of the spleen
• and the gastrosplenic ligament
• which passes from the hilum of the
spleen to the greater curvature of the
stomach.
• The mesentery of the small intestine
• Attached to the posterior abdominal
wall from the duodenojejunal flexure
to the ileocolic junction.
• The sigmoid mesocolon
• Passes from a V-shaped attachment
on the posterior abdominal wall to
the sigmoid colon.
• The general peritoneal cavity
• comprises the main cavity
• the greater sac
• and a diverticulum from it the
• omental bursa (lesser sac).
• The omental bursa lies between the
stomach and the stomach bed to allow
free movement of the stomach.
• It lies behind
• the stomach,
• the lesser omentum
• and the caudate lobe of the liver
• It lies in front of the structures of the
stomach bed.
• The left border is formed by the hilum
of the spleen and the lienorenal and
gastrosplenic ligaments.
• The communication between the
greater and lesser sacs is the epiploic
foramen ( foramen of Winslow).
• It lies behind the free border of the
lesser omentum and its contained
structures
• below the caudate process of the liver,
• in front of the inferior vena cava
• and above the first part of the
duodenum.
• The subphrenic spaces are part of the
greater sac that lies between the
diaphragm and the upper surface of
the liver.
• There are right and left spaces,
separated by the falciform ligament.
• Parietal peritoneum in the pelvis
• Covers the upper two-thirds of the
rectum.
• In the female it is reflected onto the
posterior fornix of the vagina and
the back of the uterus to form the
recto-uterine pouch (pouch of
Douglas).
• In the male it passes onto the back
of the bladder to form the
rectovesical pouch.
• The anterior abdominal wall
• The peritoneum of the deep surface of the
anterior abdominal wall
• shows a central ridge from the apex of the
bladder to the umbilicus produced by the
median umbilical ligament.
• This is the remains of the embryonic
urachus.
• Two medial umbilical ligaments converge to
the umbilicus from the pelvis.
• They represent the obliterated umbilical
arteries of the fetus.
• The ligamentum teres is a fibrous band in
the free margin of the falciform ligament.
• It represents the obliterated left umbilical
vein.