Anatomy of

peritoneal spaces

DR VISHWANATH REDDY

PeritonumTHE PERITONEUM IS A THIN TRANSLUCENT ,SEROUS MEMBRANE LINED BY MESOTHELIAL CELL

THE PART THAT COVERS THE ABDOMINAL WALL IS CALLED THE PARIETAL

PERITONEUM

THE PART WHICH COVERS THE VISCUS IS CALLED THE VISCERAL

PERITONEUM

Definitions

LIGAMENT

-Two folds of peritoneum

-supporting structers

Mysentry

-two folds of peritoneum

-connecting to posterior abdominal wall

Omentum

- Connecting the stomach to other organs

Embryologic Characteristics

Peritoneal ligaments

Upper abdominal ligaments

-falciform ligament

-Triangular ligaments

-lesser omentum

-greater omentum

Falciform ligament

connects liver to the

posterior aspect of the

anterior abdominal wall just

to the right o the midline

.

TRIANGULAR LIGAMENTS

RIGHT – Seperats

right subphrenic

space from right sub

hepatic space

LEFT—short & dosent

compartmentalize

Lesser omentum

Gastro hepatic ligament

-attaches liver to lesser

curvature,

-left gactric artery

&coronary vein

Hepatoduodenal

ligament

-attaches liver to

duodenum

-CBD,hepatic artery&PV

GREATER OMENTUM

Gastrocolic ligament

Gastrosplenic

ligament

Gastrophrenic

ligament

The gastro splenic ligament

Connects the stomach to spleen

contains the short gastric vessels

It’s a major route of escape for

pancreatitis arising in the peripheral

body &tail

Spleno renal ligament

Posterior aspect of spleen to anterior pararenal space

Forms post-lat border of lesser sac

encloses tail of pancreas& distal splenic artery

ligaments of lower abdomen

Transverse mesocolon

Small bowel mesentry

Sigmoid mesocolon

Peritoneal spaces

potential space between the parietal & visceral peritoneum

contains a film that of fluid that lubricates the surface of the

peritoneum

not depicted on conventional radiologic studies or by cross

secectional imaging unless they are distended by fluid or air

-In men, the peritoneal cavity is

closed,

- in women, it communicates with

the extraperitoneal pelvis exteriorly

through the fallopian tubes, uterus

and vagina

Transverse mesocolon divides the

space in to

-supramesocolic

-inframesocolic

bilateral paracolic & pelvic spaces

are also peritoneal spaces

Peritoneal spaces

Supramesocolic space

Right -rightsubphrenic(subdiaphragmatic)

-rightsubhepatic(hepatorenal or mrrisonspouch)

Lesser sac (omental bursa)

Left

-left perihepatic space

-left subdiaphragmatic space

Left sided peritoneal spaces Perihepatic spaces-

Two left perihepatic spaces

The anterior perihepatic space

The posterior perihepatic

Left Subphrenic space

diaphragm ant& lat, stomach

post.

communicates with the post

subphrenic(perisplenic) space

The perisplenic space

surrounds most of the spleen

except for a portion of spleen

lying within the splenorenal

ligament

Right sided supra mesocolic spaces

The right sub

diaphragmatic space is

limited anteriorly by the

falciform ligament and

posteriorly by the hepatic

bare area .

Collections in this space

deform the surface of the

liver

Hepatorenal space –morrisons pouch

Just beneath the bare area the right

peritoneal space courses between

the posterior surface of segment 6

and the anterior renal fascia on its

way to the epiploic foramen

.

This relativel;y small potential space is

referred as to the hepato renal fossa

It is the most dependent portion of

the right supramesocolic spaces

Lesser sacLies behind the stomach

Ant to pancreas

Left margin-gastro splenic ligament

Right margin –medial surface of coronary

ligament

Caudal boundary –gastrocolic

reflection&mesocolon

Lesser sac

Superior recess-behind

stomach,lesser omentum& left lobe

Inf recess-lies behind the

stomach,extending into the layers

of GO

The sup & inf recess are separated by

a peritoneal fold that accompanies

the left gastric artery

Lesser sac boundaries

Foramen of winslow

Communication betn the greater & lesser

sac.

Ant margin –hepatoduodenal ligament

Roof-peritoneum covering caudate lobe

Post margin-peritoneum covering IVC

Floor-peritoneum covering 1st part of

duodenum

Foramen of winslow

Inframesocolic spaceslies below the transverse mesocolon and transverse colon as far as the true pelvis.

divided in two unequal spaces by the root of the mesentery of the small intestine.

It contains the right and left paracolic gutters lateral to the ascending and descending colon.

Smaller RIC is restricted inferiorly

by the junction of the distal small

bowel mesentry with the cecum

LIC opens into pelvis eccept

where it is bounded by the

sigmoid mesocolon

The paracolic gutters are located

lateral to the peritoneal

reflections of the ac&dc,the Rt

communicates freely with the

right supramesocolic spaces, Lt is

limited by the phrenicocolic

ligament

Pelvic peritoneal spaces The most dependent portion of the

peritoneal spaces in supine & erect

positions is in the pelvis

In males the rectovesical space lies

between the anterior mesorectal fascia &

post wall of the bladder

In females the retrouterine space (pouch

of douglas) lies betwn uterine wall & ant

mesorectal fascia

Peritoneal circulation

Water shed areas for fluid

collection

Ileocolic region,root of

sigmoid,pouch of douglas

Majority of the fluid is

cleared at the subphrenic

space by mesothelial

lymphatics