Introduction to Anatomy of

Abdominal Cavity
By
Dr Qamaruddin Baloch
Professor Of Surgery & Head Of Department
Al-Tibri Medical College & Hospital
Isra University Karachi Campus
Learning Objectives:

• Understand anatomical division of abdominal and pelvic cavity.

• Discuss the mechanism of injury and impact on body.
• Discuss individual organ injury
• Describe the philosophy of damage control surgery
Intraperitoneal Organs
Intraperitoneal organs are enveloped by visceral peritoneum, which covers the
organ both anteriorly and posteriorly. Examples include the stomach, liver
and spleen

Retroperitoneal Organs
Retroperitoneal organs are not associated with visceral peritoneum; they are only
covered in parietal peritoneum, and that peritoneum only covers their anterior
surface
A mesentery is double layer of visceral peritoneum. It connects an
intraperitoneal organ to (usually) the posterior abdominal wall. It
provides a pathway for nerves, blood vessels and lymphatics to travel
from the body wall to the viscera.
Omentum
• The omenta are sheets of visceral peritoneum that extend from
the stomach and proximal part of the duodenum to other abdominal
organs.

• The greater omentum consists of four layers of visceral peritoneum. It

descends from the greater curvature of the stomach and proximal
part of the duodenum, then folds back up and attaches to the
anterior surface of the transverse colon
• The lesser omentum is a double layer of visceral peritoneum, and is
considerably smaller than the greater and attaches from the lesser
curvature of the stomach and the proximal part of the duodenum to
the liver.

• It consists of two parts: the hepatogastric ligament (the flat, broad

sheet) and the hepatoduodenal ligament (the free edge, containing
the portal triad)
Greater & Lesser Sac
• The peritoneum has two divisions; Greater sac and Lesser sac
(omental bursa)

• The greater sac forms the main abdominal cavity and is further
divided by the transverse colon into the supracolic and infracolic
compartments
• The liver, stomach and spleen sit within the supracolic compartment,
while the small intestine, ascending and descending colon are held
within the infracolic.

• The lesser and greater sacs communicate via the omental foramen

• The lesser sac is the smaller of the two, it is a hollow space posterior
to the stomach intended to cushion its movements.
Stomach
• A hollow muscular organ found in the epigastric region

• It extends from the Oesophagus and ends at the junction with the duodenum

• The stomach has four parts:

• Cardia
• Corpus
• Fundus
• Pylorus
• Cardia – surrounds the superior opening of the stomach at the T11 level

• Fundus – the rounded, often gas filled portion superior to and left of the
cardia.

• Body – the large central portion inferior to the fundus.

• Pylorus – This area connects the stomach to the duodenum. It is divided

into the pyloric antrum, pyloric canal and pyloric sphincter. The pyloric
sphincter demarcates the transpyloric plane at the level of L1.
• There are two sphincters of the stomach, located at each orifice. They
control the passage of material entering and exiting the stomach.

Inferior Oesophageal Sphincter

• The Inferior oesophageal sphincter located at the T11 level which
marks the transition point between the oesophagus and stomach (in
contrast to the superior oesophageal sphincter, located in the
pharynx). It allows food to pass through the cardiac orifice and into
the stomach and is not under voluntary control.
Pyloric Sphincter
• The pyloric sphincter lies between the pylorus and the first part of the
duodenum. It controls of the exit of chyme (food and gastric acid
mixture) from the stomach.
• In contrast to the inferior oesophageal sphincter, this is an anatomical
sphincter. It contains smooth muscle, which constricts to limit the
discharge of stomach contents through the orifice.
Blood Supply
• The arterial supply to the stomach comes from the celiac trunk and
its branches. Anastomoses form along the lesser curvature by the
right and left gastric arteries and along the greater curvature by the
right and left gastro-omental arteries:

• Right gastric – branch of the common hepatic artery, which arises

from the coeliac trunk

• Left gastric – arises directly from the coeliac trunk

• Right gastro-omental – terminal branch of the gastroduodenal artery,
which arises from the common hepatic artery.
• Left gastro-omental – branch of the splenic artery, which arises from
the coeliac trunk.

• The veins of the stomach run parallel to the arteries. The right and left
gastric veins drain into the hepatic portal vein. The short gastric vein,
left and right gastro-omental veins ultimately drain into the superior
mesenteric vein
• The stomach receives innervation from the autonomic nervous
system:
• Parasympathetic nerve supply arises from the anterior and posterior
vagal trunks, derived from the vagus nerve.
• Sympathetic nerve supply arises from the T6-T9 spinal cord segments
and passes to the coeliac plexus via the greater splanchnic nerve. It
also carries some pain transmitting fibres.
Small Intestine
• The small intestine is an organ located within the gastrointestinal
tract.
• It is approximately 6.5m in the average person and assists in the
digestion and absorption of ingested food.

• It extends from the pylorus of the stomach to the ileocaecal junction,

where it meets the large intestine at the ileocaecal valve.
• Anatomically, the small bowel can be divided into three parts: the
duodenum, jejunum, and ileum.

• Most proximal portion of the small intestine is the duodenum.

• The duodenum can be divided into four parts: superior, descending,

inferior and ascending. Together these parts form a ‘C’ shape, that is
around 25cm long, and which wraps around the head of the pancreas.
• The jejunum and ileum are the distal two parts of the small intestine.
In contrast to the duodenum, they are intraperitoneal.
• They are attached to the posterior abdominal wall by mesentery (a
double layer of peritoneum).
• The jejunum begins at the duodenojejunal flexure. There is no clear
external demarcation between the jejunum and ileum – although the
two parts are macroscopically different. The ileum ends at the
ileocaecal junction.
• At this junction, the ileum invaginates into the cecum to form the
ileocecal valve

• Arterial supply of Ileum : by the gastroduodenal artery & the inferior

pancreaticoduodenal artery

• The arterial supply to the jejunum & ileum is from the superior
mesenteric artery which arises from the aorta at the level of the L1
vertebrae, immediately inferior to the coeliac trunk.
• Dilated jejunum has a stack-of-coins appearance because of plicae
circulares or valvulae conniventes (mucosal folds), while a dilated
ileum has the appearance of a cylindrical tube ("characterless").
Large Bowel
• The colon averages 150cm in length

• Can be divided into four parts (proximal to distal): Ascending,

Transverse, Descending and Sigmoid

• The maximum diameter of the cecum is 9 cm; the maximum diameter

of the colon is 6 cm
• The colon begins as the ascending colon, a retroperitoneal structure
which ascends superiorly from the cecum

• When it meets the right lobe of the liver, it turns 90 degrees to

move horizontally. This turn is known as the right colic flexure (or
hepatic flexure), and marks the start of the transverse colon.
• The transverse colon extends from the right colic flexure to
the spleen ,where it turns another 90 degrees to point inferiorly.
This turn is known as the left colic flexure (or splenic flexure)

• After the left colic flexure, the colon moves inferiorly towards the
pelvis – and is called the descending colon.
• The 40cm long sigmoid colon is located in the left lower quadrant of
the abdomen, extending from the left iliac fossa to the level of the S3
vertebra.
Blood Supply
• Ascending colon and proximal 2/3 of the transverse colon – derived
from the midgut (branches of Superior Mesenteric artery namely
ileocolic, right colic and middle colic)

• Distal 1/3 of the transverse colon, descending colon and sigmoid

colon – derived from the hindgut (branches of Inferior Mesenteric
artery Left colic & sigmoid artery)
THANK YOU