The Peritoneum is largest serous membrane of the body. The peritoneum lines the internal surfaces of abdominal cavity. In male, it forms a closed sac while in female it connected to exterior by means of lateral ends of fallopian tubes of uterus. The peritoneum lines the internal surfaces of abdominal cavity, it covers the posterior surface of anterior abdominal wall, under (abdominal) surface of diaphragm and then anterior surface of posterior abdominal wall; and then it enters the pelvic cavity where it covers the anterior, posterior and lateral walls of pelvic cavity. When it lines the walls of abdominal cavity, it called as abdominal parietal peritoneum and when lines the walls of pelvic cavity then it called as pelvic parietal peritoneum. From the walls of abdominal cavity or from the walls of pelvic cavity, the folds of parietal peritoneum are reflected towards viscera’s; these folds of peritoneum are surround the viscera and then reflected back towards the walls. The layers of peritoneum that surround the viscera are called as visceral peritoneum, which form the outer most coat of viscera that is serous coat. That means the peritoneum consists of two layers, the outer layer which lines the internal surfaces of abdominal & pelvic cavities is called as parietal peritoneum and inner layer which closely applied to the viscera is called as visceral peritoneum. The parts of peritoneum, which are reflected from the cavities of body walls towards viscera, they have different names for e.g. peritoneal folds, ligaments, mesenteries, and omenta. These reflected parts of peritoneum usually always consist of two layers, and these are usually parts of parietal peritoneum. Between the parietal peritoneum and visceral peritoneum, there is a potential space, the peritoneal cavity. The free adjacent surfaces of two layers of peritoneum are lined by the flattened mesothelial cells which secret the serous fluid. The serous lubricates the adjacent surfaces of two layers of peritoneum. This forms a thin and smooth film of serous fluid. This allows the free movement of viscera along the walls of cavity and free movement between viscera. PERITONEAL CAVITY The serous-coated organs filled the abdominal cavity, so that the visceral surfaces of these viscera are in closed contact to each other and also these viscera are closely packed with in the abdominal cavity and they are in contact with the walls of abdominal cavity that is they are in close contact with parietal peritoneum. That is why the space between the parietal and visceral peritoneum is very narrow, slit like potential space, the peritoneal cavity that contains few ml. of serous fluid THE DIVISION OF PERITONEAL CAVITY At first, the peritoneal cavity is divided into two main cavities, the abdominal peritoneal cavity and pelvic peritoneal cavity. The abdominal peritonea cavity extends from the under surface of diaphragm, and then it extends downwards and backwards, to become continuous with the pelvic peritoneal cavity. As such, there is no line of demarcation between the abdominal and pelvic cavities. The structure, which separates the abdominal cavity from the pelvic cavity, is pelvic inlet. Now the abdominal peritoneal cavity is subdivided into two compartments, the larger compartment is the GREATER SAC or the CAVUM PEROTONI, which contains all the viscera of abdominal cavity and below it, becomes continuous with pelvic peritoneal cavity. Second compartment is the LESSER SAC or OMENTAL BURSA. It is supposed to be part of Greater sac or Diverticulum from the Greater sac. It lies behind the stomach and the lesser sac as such, does not contain any viscera. It provides the space for the expansion of stomach that is called as omental bursa. The two sacs are freely communicates with each other by means of a vertical foramen, the EPIPLOIC FOARMEN or FOARMEN OF WINSOLW or ADITUS TO THE LESSER SAC. The peritoneal cavity is potential space it contains few ml. of serous fluid, and it is present between the two layers of peritoneum. It does not contain any organ. While the abdominal & pelvic cavities are the actual spaces they are lined with the parietal peritoneum and contained the organs, which are invaginated with the visceral peritoneum.
2 DEVELOPMENT OF PERITONEAL CAVITY & PERITONEUM The intra embryonic mesoderm on each side of the mid line differentiates into three potions, the medial potion i.e. paraxial potion, an intermediate potion and a lateral plat. The lateral plate again sub-divided into two layers, the somatic mesoderm layer and splanchic mesoderm layer. The splanchic mesoderm layer becomes continuous with the wall of the yolk sac and then they collectively surround a longitudinal body cavity, which is called intra embryonic coelom. This longitudinal intra embryonic coelom in future will form Pleural cavity, pericardial cavity and peritoneal cavity. The cells of the somatic mesoderm lining the intra- embryonic coelom, differentiated to from mesothelial cells and this forms the parietal layer of the serous membrane, lining outside the peritoneal, pleural and pericardial cavities. The cells of splanchic mesoderm layer will form the visceral layer of the serous membrane, covering abdominal organs, lung and heart During the earlier stages of development, the Foregut, the Midgut and the Hindgut are in close contact with mesenchymal tissue of posterior abdominal wall. At this stage, the connection between the gut and posterior abdominal wall is wider. As the growth becomes advance the connection between the developing gut and posterior abdominal wall reduced, and becomes narrow. Now only terminal the terminal part of foregut, all of midgut and most of part of hindgut are in contact of posterior abdominal wall. The mesenchymal tissue which lies between dorsal surfaces of gut and posterior abdominal wall is called as DORSAL MESOGASTRIUM or DORSAL MESENTARY. From the ventral surface of terminal part of foregut, that is abdominal part of esophagus and beginning of midgut that is stomach and proximal 2 to 3 cm. of duodenum are also connected to ventral wall of abdominal cavity, by means of mesenchymal tissue called as VNTERAL MESOGASTRIUM or VENTARAL MESNTARY. THE FORMATION OF VNTERAL MESOGASTRIUM The septum transversum is developed from the cervical myotomes. Due to proportional growth of the body, the septum transversum descends downwards and separates the peritoneal cavity from the pleural and pericardial cavities. The septum transversum differentiated, and will form fibrous pericardium, the supporting connective tissues of liver and capsule of liver and the ventral mesogastrium. THE FATE OF VENTRAL MESOGASTIRUM During the development of embryo, an endodermal tube is arising from the second part of duodenum which is called as HEPATIC BUD. The hepatic bud ascends upwards, forwards and laterally behind the first part of duodenum towards the ventral mesogastrium, which developed from the septum transversum. With in the ventral mesogastrium the hepatic bud divided and re-divided with in the ventral mesogastrium and forms the cellular structure of liver. While the ventral mesogastrium, which is mesodermal in origin form, the supporting connection of liver and capsule of liver. Remaining structures which are developed from ventral mesogastrium are: 1. Falciform ligament 2. Lesser omenta 3 Coronary ligament 4. Right triangular ligament. 5. Left triangular ligament FATE OF DORSAL MESOGASTRIUM 1. Gastrophrenic ligament. 3. Greater Omentum 5. Mesentery Proper 7. Sigmoid Mesocolon 2. Gastroslenic ligament 4. Leinorenal ligament 6. Transverse Mesocolon 8. Mesoappendix
THE INTRAPERITONEAL, RETROPERITONEAL & EXTRA PERITONEAL STRUTURES Some of the organs are freely lying within the abdominal cavity, invaginated with peritoneum. These are freely mobile within the abdominal cavity by means of peritoneum. These
3 organs are called as ITRA- PERITONEAL ORGANS that are they are completely invaginated by the peritoneum. These organs are also called as organs PEDICULATED ORGANS. While other organs are lying within the abdominal cavity and they are plastered over posterior abdominal cavity by means of peritoneum. The anterior and lateral surfaces of these organs are covered with the parietal layer of peritoneum. They are called as RETO- PERITONEAL ORGANS. The suprarenal glands, kidneys & ureters are lying behind the peritoneum they do not have the serous coat. The aorta & inferior vena cava also lie behind the peritoneum. These organs are called as EXTRA- PERITONEAL ORGANS. The organs those are not completely invaginated with peritoneum and they are not freely mobile within the abdominal cavity are called as SESSILE ORGANS. The abdominal part of esophagus, stomach and proximal 2-3 cm. of duodenum are completely invaginated with peritoneum, the yare freely mobile within abdominal cavity. The remaining part of duodenum is plastered over the posterior abdominal wall. The jejunum & ileum are completely invaginated with peritoneum and they are freely mobile within the abdominal cavity, which called as MESENTARY PROPER. The appendix is completely invaginated with peritoneum, called as MESO- APPENDIX. The anterior & lateral surfaces of caecum, ascending colon & descending colon are covered with peritoneum and plastered over posterior abdominal wall. The transverse colon is completely invaginated with peritoneum and freely mobile within abdominal cavity on the peritoneum, called as TRANSVERSE MESOCOLON. Similarly, sigmoid colon is mobile on its mesentery, called as SIGMOID MESOCOLON. The anterior and lateral surfaces of upper one third of rectum & anterior surface of middle one third, these parts of rectum are covered with peritoneum and plastered over the posterior wall of pelvic cavity. At the level of lower one third of rectum the peritoneum is reflected forwards and does not cover the lower one third of rectum and anal canal are not covered with peritoneum The other organs like, liver & spleen are completely covered with peritoneum while only anterior surface of pancreas covered with peritoneum and plastered over posterior abdominal wall. REFLECTIONS OF PERITONEUM The parietal peritoneum lines the cavity of abdomen & pelvis. From the wall of these cavities the peritoneum is reflected towards the different organs. A layer of peritoneum is reflected towards the, invaginates the organ and reflected back towards the wall of cavity, this is called as reflections of peritoneum. The reflections of peritoneum have got different names; these are folds, mesentery, ligaments & omenta. By means of reflections of peritoneum the peritoneal cavity is divided into different compartments. These folds of peritoneum may present in vertical plane, called as VERTICAL DISPOTION OF PERITONEUM. Other folds may present in horizontal plane, called as HORIZONTAL DISPOTION OF PERITONEUM. RELECTIONS OF PERITONEUM ON THE POSTERIOR SURFACE OF ANTERIOR ABDOMINAL WALL ABOVE THE UMBILICUS On posterior surface of anterior abdominal wall at level of umbilicus a doubled layered fold of peritoneum raised from the wall, called as FALCIFORM LIGAMENT. It extends upwards, in midline from the umbilicus to the xiphoid process. The falciform ligament is triangular in shaped, has posterior free margin which contained LIGAMENTUM TERES. The ligamentum teres is remnants of left umbilical vein. The falciform ligament extends upwards in midline behind the linea alba up to xiphoid process and up to inferior border of liver. At inferior border of liver the ligamentum teres leave the falciform ligament, and enters the fissure for ligamentum teres on the inferior surface of liver. The falciform ligament consists of two layers, the right layer & the left layer. Now falciform ligament ascends upwards and slightly right of mid line between the diaphragm and anterior surface
4 of liver. On superior surface of the liver, the two layers of falciform ligament diverge from each other. THE FATE OF RIGHT LAYER OF FALCIFORM LIGAMENT The right layer of falciform ligament diverges towards the right lobe of liver. Now right layer is reflected from the diaphragm towards superior surface of right lobe of liver, this reflection of peritoneum forms SUPERIOR LAYER OR CORONARY LIGAMENT. The right layer of falciform ligament covers the superior and anterior surfaces of liver than it extends towards inferior border of liver, it turns around the inferior border of liver, and it covers the inferior surfaces of liver. It covers the inferior surface of liver where it forms the visceral peritoneum. From the inferior surface of liver it extends the posterior surface of liver. From the posterior surface of right lobe of liver, a layer of peritoneum is reflected to covers right suprarenal gland and upper part of right kidney, this is called as INFERIOR LAYER OF CORONARY LIGAMENT. From the right kidney the peritoneum passes downwards to covers the front of first or superior part of duodenum and right colic flexure. It also passes medially in front of short segment of inferior vena cava between the duodenum and liver where it becomes continuous with posterior wall of lesser sac. Superior & inferior layers of coronary ligament there is a large triangular area on posterior surface of right lobe of liver which is not covered with peritoneum, called as BARE AREA of liver. Here liver is directly in contact with diaphragm by means of aerolar tissue. The BARE AREA OF LIVER is triangular in shape the apex is directed towards right side and downwards. BOUNDARIES: BASE: by the groove for inferior vena cava, SUPERIOR: it is bounded by superior layer of coronary ligament; INFERIOR: it is bounded by inferior layer of coronary ligament. APEX: On the right side the superior & inferior layer of coronary ligament approaching towards each other and finally fused together. At point where two layers are meeting together, called as RIGTH TRIANGULAR LIGAMENT, which forms the APEX of bare area. By means of RIGHT TRIANGULAR LIGAMENT the liver is connected to diaphragm This is called as Major bare area of liver, there are other areas of liver which are not covered with peritoneum, and these are also called as bare areas of liver. These Bare Areas of liver are fossa for gall bladder, groove for inferior vena cava, porta hepatis, between attachments of two layers of falciform ligament, left triangular ligament, right triangular ligament & fissure for ligamentum teres. THE FATE OF LEFT LAYER OF FLCIFORM LIGAMENT The left layer of falciform ligament extends towards superior surface of left lobe of liver, at this point a layer of peritoneum is reflected from the anterior part of inferior surface of diaphragm towards the superior surface of left lobe of liver forming ANTERIOR LAYER OF LEFT TRIANGULAR LIGAMENT. This layer of peritoneum forms the visceral peritoneum of left lobe. This layer covers the superior, anterior and inferior surfaces of left lobe of liver. Form posterior surface of left lobe, a layer of peritoneum is towards the diaphragm, forms POSTERIOR LAYER OF LEFT TRIANGULAR LIGAMENT. This finally forms posterior wall of lesser sac and becomes with inferior layer of coronary ligament. The visceral peritoneum also extends into the fissure for ligamentum venosum. The fissure for ligamentum venosum has got two margins, the right margin which posteriorly becomes continuous with posterior margin of porta hepatis; while the left margin of fissure for ligamentum venosum posteriorly becomes continuous with anterior margin of porta hepatis in this they form an “L” shaped continues line, which provides attachment to peritoneum. From the margins of fissure for ligamentum venosum & porta hepatis a double layered fold of peritoneum is reflected towards the lesser curvature of stomach and proximal 2-3 cm. duodenum, which called as LESSER OMENTUM. THE LESSER OMENTUM The visceral peritoneum covers the liver, and also extends into the floor of fissure for ligamentum venosum, where it covers the floor, and then from left margin of fissure for ligamentum
5 venosum and the anterior margin of porta hepatis a layer of peritoneum is reflected towards lesser curvature of stomach and proximal 2-3cm. of duodenum, this is called as ANTERIOR LAYER of lesser omentum. Similarly a layer of peritoneum is reflected right margin of fissure for ligamentum venosum and the posterior margin of porta hepatis a layer of peritoneum are reflected towards lesser curvature of stomach and proximal 2-3cm. of duodenum, this is called as POSTERIOR LAYER of lesser omentum. The part of the lesser omentum connecting the liver to stomach is called the HEPATOGASTIRC LIGAMENT, while the part passing from the liver to duodenum is named as the HEPATO- DOUDENAL LIGAMENT. On the right side the anterior layer of lesser omentum passes in front of the HEPATIC ARTERY, BILE DUCT & PORTAL VEIN and then anterior layer turn round right side of these structures to become continuous behind these structures with posterior layer of lesser omentum. The posterior layer of lesser omentum forms the ANTERIOR WALL OF LESSER SAC. That means the lesser omentum has got right free border, which contained the hepatic artery, bile duct and portal vein. This border along with contained structures forms the anterior boundary of EPIPLOIC FORAMEN. The anterior layer of lesser omentum continuous downwards over the antero-superior surface of stomach and proximal 2-3 duodenum, to form the visceral peritoneum on this surface. While the posterior layer of lesser omentum descends downwards to cover the postero- inferior surface of stomach and proximal 2-3 cm. duodenum, to form the visceral peritoneum on this surface. After forming the visceral peritoneum of stomach proximal 2-3 cm. of duodenum the two layers of peritoneum are hanging downwards from the greater curvature of stomach and lower border of proximal part of duodenum, this called as GREATER OMENTUM. THE GREATER OMENTUM The two layers of lesser omentum after forming the visceral peritoneum over the anterosuperior & postero- inferior surfaces of stomach, approaching towards greater curvature of stomach & inferior border of duodenum and two layers descend downwards forming greater omentum. The greater omentum extending downwards, consists of two layer, named layer no; 1 & layer no; 2. The greater omentum is the most superficial structure of abdominal cavity. It lies in front of loops of small intestine. The two layers of greater omentum extending downwards for variable distance, then it curves backwards, and folded on itself and ascends upwards in front of loops small intestine. Now the greater omentum consists of four layers (or two folds the Anterior & Posterior), THE ANTERIOR FOLD consists of layer no; 1& 2, THE POSTERIOR FOLD consists of layer no; 3 & 4. Now the 3rd & 4th layers of posterior fold ascends upwards & adherent to anterosuperior aspect of transverse colon and superior layer of transverse mesocolon. The two layers ascend upwards and backwards to get attached to anterior surface of head of pancreas and anterior surface of body of pancreas. At this level the two layers, & get separated from each other and have got different course. During the development and in children the greater omentum consists of four layers the st nd rd 1 , 2 , 3 & 4th layers, which are lined by mesothelial cells, which secret serous fluid. So there is space between the 2nd & 3rd layer which is called as Infra colic part of lesser sac. This space rarely found in adult. The 2nd & 3rd layer lose their mesothelial lining and adherent to each other, & they are represented by the connective tissue. Below the level of transverse colon the greater omentum consists of two layers that are 1st & 4th layers while the 2nd & 3rd layers are represented by the connective tissue which bound 2nd & 3rd layers. But above the level of transverse colon the greater sac consists of all four layers. . THE FATE OF THIRD LAYER OF GREATER OMENTUM The third layer ascends upwards to superior surface of head of pancreas and anterior surface of body of pancreas. The 3rd layer also extending laterally & towards left side, towards the tail of pancreas and attached to superior & inferior margins of Hilum of Spleen. This layer covers all
6 the surfaces of to form visceral layer of spleen. From the inferior margin of hilum of spleen a layer of peritoneum reflected downwards towards anterior surface of Left supra renal gland & upper part anterior surface of Left kidney, this layer of peritoneum is called as LIENO-RENAL LIGAMENT. Similarly a layer of peritoneum is reflected from superior margin of hilum of spleen towards posterior surface of fundus of stomach, layer of peritoneum is called as GASTRO-SPLENIC LIGAMENT. Now the 3rd layer of greater omentum ascends upwards behind the stomach up to inferior surface of diaphragm, where becomes continuous with the posterior layer of Left Triangular Ligament, to take part in the formation of posterior wall of lesser sac. As the 3 rd layer ascends upwards from posterior surface of fundus of stomach, a layer of peritoneum is reflected to inferior surface of diaphragm from posterior surface of fundus of stomach, named as GASTRO-PHERENIC LIGAMENT. THE FATE OF FOURTH LAYER OF GREATER OMENTUM The fourth layer of greater omentum is reflected from the anterior surface of head of pancreas & the anterior border of body of pancreas, downwards and forwards, towards posterior surface of transverse colon, this layer of peritoneum is called as SUPERIOR LAYER OF TRANSVERSE MESOCOLON. The superior layer of transverse mesocolon covers the posterior, superior, anterior, inferior & posterior surfaces of transverse colon to form the visceral layer (serous coat) of transverse colon. From the posterior surface of transverse colon the layer of peritoneum is reflected back towards the anterior surface of head of pancreas & the anterior border of body of pancreas, named as INFERIOR LAYER OF TRANSVERSE MESOCOLON. Now the 4th layer extending downwards, to cover the inferior surface of head of pancreas & anterior surface of body of pancreas. This layer also extending medially towards the right side to cover the 4th & 3rd parts of duodenum. At the third part of duodenum, the superior mesenteric vessels are arising, here a layer of peritoneum is reflected from the posterior wall of abdominal cavity around the axis of superior mesenteric vessels towards loops of jejunum & ileum, this layer of peritoneum is called as RIGHT LAYER OF MESENTERY PROPER. The right layer of mesentery proper covers all the surface of loops of jejunum & ileum, to form the serous coat or visceral peritoneum of small intestine. Then this layer is reflected back towards posterior wall of abdominal cavity as LEFT LAYER OF MESNTERY PROPER. The mesentery proper begins at doudeno-jejuneal flexure at the level of transverse process of 2nd lumbar vertebrae, this is called as root of mesentery proper, extending obliquely downwards and towards right side up to ileo- ceacal junction or right sacro- iliac joint. Now the 4th layer of mesentery proper descending downwards over the posterior abdominal wall as the parietal layer of peritoneum. As the 4th layer descending downwards it covers the Abdominal Aorta, the Inferior Vena Cava, the Ureters and Psoas Major. Finally it enters the pelvic cavity where it forms the parietal pelvic peritoneum. From the posterior wall of pelvic cavity a layer of peritoneum is towards the sigmoid colon as the ANTERIOR LAYER OF SIGMOID MESOCOLON. The anterior layer of sigmoid mesocolon covers all the surfaces of sigmoid colon to visceral peritoneum (serous coat). After covering the sigmoid colon, this layer of peritoneum reflected back towards posterior wall of pelvic cavity as POSTERIOR LAYER OF SIGMOID MESOCOLON. The peritoneum descending downwards with in pelvic cavity, to cover the anterior & lateral surfaces of upper one third of rectum, still descends downwards to cover the middle one third of rectum. Up to this level the reflections of peritoneum are similar in two sexes. Beyond this level, the reflections of peritoneum are different in two sexes.
THE REFLCTIONS OF PERITONEUM IN MALE At level of junction of upper two third & lower one third of Rectum a layer of peritoneum is reflected forwards to superior ends of Seminal Vesicles & upper surface of Urinary Bladder, as RECTO-VESICAL FOLD, which dips downwards as RECTO- VESICAL POUCH. The recto-
7 vesiclal pouch is most dependent part of peritoneal cavity in male. This fold of peritoneum covers the superior surface of urinary bladder up to apex of urinary bladder. From the apex of urinary bladder a fold of peritoneum is from posterior surface of anterior abdominal wall from the apex of urinary bladder up to umbilicus. This fold of peritoneum is called MEDIAN UMBILICAL FOLD which is produced by MEDAIN UMBILICAL LIGAMENT. The median umbilical ligament is produced by obliterated remnant of URACHUS. Here the reflections of peritoneum terminate. A point where the reflections of peritoneum begin as the Falciform Ligament and terminate as Median Umbilical fold. THE REFLCTIONS OF PERITONEUM IN FEMALE At level of junction of upper two third & lower one third of Rectum a layer of peritoneum is reflected forwards to the posterior fornix of vagina, this fold of peritoneum is called as RECTOUTERINE FOLD, which dips down to form RECTO-UTERINE POUCH or POUCH OF DOUGLAS. The recto-uterine pouch is most dependant part of peritoneal cavity in female. From the posterior fornix of vagina a layer of peritoneum ascends upwards to cover posterior wall of cervix and posterior wall of body of uterus up to posterior aspect of fundus of uterus. It covers the posterior surface of fundus then it curves upwards to cover the superior surface of fundus then curves forwards and downwards on to anterior surface of fundus of uterus, then extending downwards to cover the anterior wall of body of uterus up to anterior wall of cervix. At this level a fold of peritoneum is reflected forwards on to upper part of posterior surface of urinary bladder. This fold of peritoneum is named as UTERO-VESICAL FOLD which dips down and forms UTERO-VESICAL POUCH. A layer of peritoneum is extending laterally to cover the lateral wall of uterus; similarly a layer of peritoneum from the anterior wall of uterus is extending laterally to cover the lateral wall of uterus. At the lateral wall of uterus there are two layers of peritoneum, the anterior & posterior layers. These two layers are reflected from the lateral wall of uterus towards the lateral wall of pelvic cavity on each side of uterus. This reflection is called as BROAD LIGAMENT OF UTERUS. The broad ligament consists of two layers; and upper free margin which contained fallopian tube. The lateral end of fallopian tube opens in to peritoneal cavity. From the upper part of posterior surface of urinary bladder the peritoneum extending on to superior surface of urinary bladder. This layer of peritoneum covers the superior surface of urinary bladder up to apex of urinary bladder. From this point the reflections of peritoneum are similar in two sexes. THE VERTICAL FOLDS OF PERITONEUM ON POSTERIOR SURFACE ANTERIOR ABDOMINAL WALL There are six vertical folds are present over the posterior surface of anterior abdominal wall, one above the umbilical, that is FALCIFORM LIGFAMENT and five below the umbilicus. 1. MEDIAN UMBILICAL FOOLD, which is produced by Median Umbilical Ligament. 2. RIGTH & LEFT MEDIAL UMBILIACL FOLDS, which are produced by the MEDIAL UMBILICL LIGAMENTS. The medial umbilical ligament is produced by the remnant of obliterated distal part of Umbilical Artery which is a branch of Internal Iliac Artery in fetus. 3. RIGTH & LEFT LATERAL UMBILIACL FOLDS, which are produced by the LATERAL UMBILICL LIGAMENTS. The lateral umbilical ligament is produced by Inferior Epigasteric Vessels which are branches of External Iliac vessels. THE COMPARTMENTS OF PERTITONEAL CAVITY A-THE DIVISION OF PERITONEAL CAVITY ON BASES OF REGIONS 1. ABDOMINAL PERITONEAL CAVITY 2. PELVIC PERITONEAL CAVITY The abdominal peritoneal cavity further subdivided in to two compartments. 1. GREATER SAC, which occupied entire abdominal cavity. 2. LESSER SAC, which is actually a part of greater sac, it is thought that it is a Diverticulum from greater sac. The lesser sac lies behind the stomach, & it is potential space. It provides space for the expansion of stomach, and helps in the movement of stomach that’s why it is also called as OMENTAL BURSA.
8 The lesser sac freely communicates with greater sac by means of a vertical foramen which is called as EPIPLOIC FORAMEN. The lesser sac divided in to two parts the upper part or SUPRA- COLIC PART above the Transverse Colon & the lower part or INFRA-COLIC PART below the Transverse colon. The infra colic part of lesser sac rarely present in adult because fusion of 2nd & 3rd layer of greater sac and it is represented by the connective tissue. BOUNDARIES OF LESSER SAC ANTERIOR BOUNDARY: - stomach and posterior layer of lesser omentum. LEFT BOUNDARY: - hilum of spleen and the two ligaments which are attached to the hilum of spleen that are lieno-renal ligament & gastro- splenic ligament. RIGHT BOUNDARY: - Epiploic foramen. ROOF: - Peritoneum covering the Quadrate lobe of liver. POSTERIOR BOUNDARY: - peritoneum covering the part of diaphragm, the pancreas, the left supra-renal gland and left kidney. FLOOR: - The transverse colon, attached to the lowest part of pancreas. THE EPIPLOIC FORAMEN or FORAMEN OF WINSLOW or ADITUS TO LESSER SAC It is vertical slit like aperture about 2.5 cm. long in vertical direction & it communicates the greater sac to lesser sac. BOUNADRIES SUPERIOR: - Caudate process of liver. INFERIOR: - 1st part or superior part of duodenum. POSTERIOR: -Inferior Vena Cava ANTERIOR: - Right free margin of lesser omentum, which contained the Hepatic Artery, anterior & on the left side, the Bile duct, anterior & on right side, and Portal Vein posteriorly. That means the Epiploic foramen lies between two great veins of abdominal cavity, the portal vein, anteriorly and inferior vena cava posteriorly. B- THE DIVISION OF PERITONEAL CAVITY ON BASES OF REFLCTION OF PERITONEUM The transverse mesocolon attached over the posterior wall of abdominal cavity at level of nd 2 lumbar vertebra. The transverse mesocolon extending form right to left side begins as right colic flexure, on lower part of anterior surface of right kidney, than it crosses the centre of 2nd part of duodenum, and then attaches to anterior surface of head of pancreas and anterior border of pancreas, finally to lower part of anterior surface of left kidney. By means of attachment of transverse mesocolon to posterior wall of abdominal cavity, the peritoneal cavity is divided into two compartments. I – SUPRA-COLIC COMPARTMENT II – INFRA-COLIC COMPARTMENT I – SUPRA-COLIC COMPARTMENS Due reflections of peritoneum around the liver the supra-colic compartment further subdivided in to four compartments 1. RIGHT SUB-DIAPHRAGMATIC or RIGHT SUB-PHRENIC or RIGHT ANTERIOR COMPARTMENT. 2. LEFT SUB-DIAPHRAGMATIC or LEFT SUB-PHRENIC or LEFT ANTERIOR COMPARTMENT. 3. RIGHT SUB-HEPATIC or RIGHT POTSTERIOR COMPARTMENT or HEPATORENAL POUCH OF MORISON. 4. LEFT SUB-HEPATIC or LEFT POTSTERIOR COMPARTMENT or LESSER SAC. RIGHT SUB-DIAPHRAGMATIC or RIGHT SUB-PHRENIC or RIGHT ANTERIOR COMPARTMENT This compartment lies between diaphragm and superior, anterior & right lateral surfaces of right lobe of liver. Bounded on the left & front by the right layer of falciform ligament and on the right & behind by the superior layer of coronary ligament.
9 LEFT SUB-DIAPHRAGMATIC or LEFT SUB-PHRENIC or LEFT ANTERIOR COMPARTMENT This compartment lies between diaphragm and anterior & superior of left lobe of liver, the anterosuperior of stomach & the diaphragmatic surface of spleen. Bounded on the right & front by the left layer of falciform ligament and behind by the anterior layer of left triangular ligament. RIGHT SUB-HEPATIC or RIGHT POTSTERIOR COMPARTMENT or HEPATO-RENAL POUCH OF MORISON Bounded ABOVE & INFRONT by the inferior surface of right lobe of liver and gall bladder BELOW & BEHIND by the right supra-renal gland upper part of anterior surface of right kidney, the 2nd part of duodenum, the right colic flexure, the transverse mesocolon and part of head of pancreas. ABOVE & BEHIND, this space extends between the right kidney and liver as far as the inferior layer of coronary ligament & the right triangular ligament. LEFT SUB-HEPATIC or LEFT POTSTERIOR COMPARTMENT or LESSER SAC This is actually lesser sac. II – INFRA-COLIC COMPARTMENT By means of attachment of mesentery proper over the posterior wall of abdominal cavity, divides the Infra-colic compartment in to two; I – RIGHT OR UPPER INFRA-COLIC COMPARTMENT II -LEFT OR LOWER INFRA-COLIC COMPARTMENT RIGHT OR UPPER INFRA-COLIC COMPARTMENT