ANAT 221

THE PERITONEUM
• This is a serous membrane which lines the
abdominal cavity.
• These line the anterior, posterior, under the
diaphragm as well as the pelvic floor.
• These cells are phagocytic in nature.
• The membrane that lines the abdominal wall
is called parietal peritoneum.
• While visceral peritoneum lines the viscera.
• In some areas they are stretched thin such as transversalis fascia
on the anterior abdominal wall.
• Though thick in some areas such as iliac fascia, psoas fascia,
parietal pelvic fascia.
• The peritoneum reflects over the viscera, connecting it to the
abdominal wall, to another viscera.
• The double fold supporting the small intestines are called
mesentery, for the larger intestines, are called mesocolon, eg.
Transverse mesocolon, sigmiod mesocolon and mesoappendix.
• Lesser omentum connects the stomach to the liver, while the
greater omentum hangs down from the lower part of the
stomach.
• Peritoneal folds of the ant. Abdominal wall
• The posterior part of the anterior abdominal wall peritoneum
has six folds
• Falciform lig. Which consists of two adherent layers of the
peritoneum, located above the umbilicus to the right of the
mid line.
• It’s attached to the notch on the anterior surface of the liver.
• The upper border is attached to the under surface of the
diaphragm. While the free inferior border contains the
ligamentum teres (the obliterated remains of the left
umbilical vein)
• Below the umbilicus;
• Central fold-median umbilical fold, contains the
median umbilical lig( reminant of urachus)
• Laterally, medial umbilical fold ( on both sides)-
containing the medial umbilical lig., obliterated
remains of umbilical artery.
• Further laterally, the lateral umbilical fold,
containing the inferior epigastric artery.( don’t
reach the umbilicus)
 PERITONEAL CAVITY
• Greater sac;
• The entire peritoneal cavity.
• The parietal peritonuem is in contact with the
visceral peritoneum.
• Potential space between them is lined with
fluid, to glide over one another.
• Lesser sac;
• Known also as omental bursa.
• Found behind the stomach, a diverticulum of the
peritoneal cavity, connects with the greater sac via a
slit in front of the IVC.
• BOUNDARIES:
• Ant. Wall-
• 1.posterior layer of lesser omentum
• 2. peritonuem over the posterior wall of the stomach
• 3. posterior of the two folds of the greater
omentum.
• Post. Wall-
• 1. anterior of the two posterior layers of the
greater omentum.
• 2. ant. Of the two posterior layers of the G.
omentum over the transverse colon and
mesocolon
• 3. peritoneum over the anterior borders of the
pancrease
• 4. Peritoneum over the front of the body and
neck of the pancrease.
• 5. peritoneum over the upper part of the left
kidney, left suprarenal gland, commencement of
abdominal aorta, coeliac artery( plexus and
nodes)
• 6. part of the diaphragm
• Greater omentum- is a double fold of the
peritoneum.
• Descend from the greater curvature of the
stomach, lie over the coils of the intestines.
• Folds backwards to the transverse colon and
mesocolon.
• Contains adipose tissues and macrophages.
• Called the policeman of the abdomen doe it’s
role.
• The fold between the greater curvature of the
stomach and the transverse colon is often
referred to as gastrocolic omentum
• Right and left gastroepiploic vessels runs
between the omentum.
• Splenorenal and gastrosplenic lig. Are
derivative of the peritoneum on the left of the
greater curvature of the stomach.
• Gastrosplenic lig. Is from the greater
curvature of the stomach to the hilum of the
spleen.
• Splenorenal lig. Is from the ant. Surface of the
left kidney to the greater curvature of the
stomach.
• Lesser omentum- peritoneal fold between the
liver and the lesser curvature of the stomach.
• Extends on the lesser curvature as far as the
first 2cm of the doudenum on the right and the
right side of the abdominal oesophagus.
• Epiploic foramen of Winslow- the free border of
the lesser omentum over the duodenum.
• A slit about 2.5cm at the right of the lesser sac.
• Boundaries;
• 1. upper boundary, the caudate part of the liver
• 2. lower boundary is the first part of the
duodenum
• 3. inferior boundary is the IVC.
• 4. anterior boundary, is the free margin of the
lesser omentum, containing the portal vein, and
ant. To it the hepartic artery and bile duct.
• Peritoneal cavity is divided into
• 1. supracolic compartment
• 2. infracolic compartment
• 3. pelvic compartment
• The attachment of the transverse mesocolon
to the posterior abdominal wall, separates the
supracolic from the infracolic compartments.
• When the greater omentum is lifted, the
transverse colon, stomach and mesocolon are
lifted with it.
• The infracolic compartment is brought in to
view.
• Liver attachment subdivides the supra
compartment into right and left
subphrenic(subdiaphragmatic )compartments
• Behind the right lobe of the liver and infront
of the right kidney is the hepatorenal pouch of
Morison.
• Communicates with the right paracolic gutter
• To left, the space via the epiploic foramen of
Winslow communicates with the left
subhepatic space.
• Infracolic space below the transverse colon, is div.
Into 2 by attachment of the root of the mesentry.
• The root of the mesentery begins on the left at the
doudenojejunal junction.
• Runs from left to right at an angle of 45 degrees.
• Crosses the third part of duodenum, superior
mesenteric artery lie between it’s fold,aorta, IVC,
psoas muscle, ureter to the right iliac fossa.
• It’s 15cm long.
• Depth of the mesentery at it’s deepest part about
20cm.
• Right infracolic space; apex lies below the
ilioceacal junction, right border is the ascending
colon, it’s upper border is the attachment of the
transverse colon.
• Left infracolic space; larger than the right.
• Quadrilateral in shape.
• Communicates with the pelvic brim below.
• Sigmoid mesocolon attachment is an inverted
v in shape.
• Limbs diverge from each other at the
bifurcation of common iliac vessels.
 NERVE SUPPLY TO THE PERITONEUM

• Parietal peritoneum is supplied by segmental

spinal nerves that innervates the adjacent
muscles.
• In the pelviis the obturator nerve is the main
nerve supply.
• Visceral peritoneum is supplied by the afferent
nerves travel with the autonomic supply to
the viscera.
 RETROPERITONEAL SPACE
• Structures found behind the peritoneum include;
• Aorta
• Inferior vena cava
• Cisternal chyli
• Lymph nodes and vessels
• Nerves (mostly lumbar pleexus branches)
• Kidneys,uretrs, pancrease, ascending and
descending colon.