The peritoneum 腹膜

1. The peritoneum 腹膜 山东大学医学院 解剖教研室 李振华

2. General features • The peritoneum is a thin serous membrane that line the walls of the abdominal and pelvic cavities and cover the organs within these cavities • Parietal peritoneum 壁腹膜 －lines the walls of the abdominal and pelvic cavities • Visceral peritoneum 脏腹膜 －covers the organs • Peritoneal cavity 腹膜腔－the potential space between the parietal and visceral layer of peritoneum, in the mail, is a closed sac, but in the female, there is a communication with the exterior through the uterine tubes, the uterus, and the vagina

3. Function • Secretes a lubricating serous fluid that continuously moistens the associated organs • Absorb • Support viscera

4. Intraperitoneal viscera Interperitoneal viscera Retroperitoneal viscera The relationship between viscera and peritoneum • Intraperitoneal viscera 腹膜内位器官－viscera completely surrounded by peritoneum, example, stomach, superior part of duodenum, jejunum, ileum, cecum, vermiform appendix, transverse and sigmoid colons, spleen and ovary • Interperitoneal viscera 腹膜间位器官－most part of viscera surrounded by peritoneum, example, liver, gallbladder, ascending and descending colon, upper part of rectum, urinary bladder and uterus • Retroperitoneal viscera 腹膜外位器官－some organs lie on the posterior abdominal wall and are covered by peritoneum on their anterior surfaces only, example, kidney, suprarenal gland, pancreas, descending and horizontal parts of duodenum, middle and lower parts of rectum, and ureter

5. Interperitoneal viscera

6. Structures which are formed by peritoneum Omentum 网膜 －two-layered fold of peritoneum that extends from stomach to adjacent organs

7. Lessor omentum小网膜 －two-layered fold of peritoneum which extends from porta hepatis to lesser curvature of stomach and superior part of duodenum • Hepatogastric ligament 肝胃韧带－extends from porta hepatis to lesser curvature of stomach • Hepatoduodenal ligament 肝十二指肠韧带 • Extends from porta hepatis to superior part of duodenum • Contains common bile duct, proper hepatic a. and hepatic portal v.

8. Omental foramen网膜孔 • Behind the right border of hepatoduodenal ligament • Superior－caudate lobe of liver • Inferior－superior part of duodenum • Anterior－hepatodudenal ligament • Posterior－peritoneum covering the inferior vena cava

9. Greater omentum大网膜 －four-layered fold of peritoneum, the anterior two layers descend from the greater curvature of stomach and superior part of duodenum and hangs down like an apron in front of coils of small intestine, and then turns upward and attaches to the transverse colon. If an infection occurs in the intestine, plasma cells formed in the lymph nodes combat the infection and help prevent it from spreading to the peritoneum.

10. Lessor omentum Greater omentum

11. Omental bursa 网膜囊 Position－situated behind the lesser omentum and stomach Walls • Superior－peritoneum which covers the caudate lobe of liver and diaphragm • Anterior－formed by lesser omentum, peritoneum of posterior wall of stomach, and anterior two layers of greater omentum • Inferior－conjunctive area of anterior and posterior two layers of greater omentum • Posterior－formed by posterior two layers of greater omentum, transverse colon and transverse mesocolon, peritoneum covering pancreas, left kidney and suprarenal gland

12. Left－formed by the spleen, gastrosplenic ligament胃脾韧带and splenorenal ligament 脾肾韧带 • Right－formed by omental foramen The Omental bursa (lesser sac) communicates with the greater sac through the omental foramen.

13. Mesenteries or mesocolons－two-layered fold of peritoneum that attach part of the intestines to the posterior abdominal wall

14. Mesentery 肠系膜 －suspends the small intestine from the posterior abdominal wall • Broad and a fan-shaped • Consists of two peritoneal layers • Intestinal border－folded, 7 m long • Radix of mesentery • 15 cm long • Directed obliquely from left side of L2 to in front of right sacroiliac joint

16. Mesoappendix 阑尾系膜 • Triangular mesentery－extends from terminal part of ileum to appendix • Appendicular artery runs in free margin of the mesoappendix

17. Transverse mesocolon横结肠系膜－a double fold of peritoneum which connects the transverse colon to the posterior abdominal wall Sigmoid mesocolon 乙状结肠系膜－inverted V-shaped, with apex located in front of left ureter and division of common iliac artery

18. Ligaments 韧带 －two-layered folds of peritoneum that attached the lesser mobile solid visera to the abdominal wall Ligaments of liver • Falciform ligament of liver 镰状韧带 • Consists of double peritoneal layer • Extends from anterior abdominal wall (umbilicus) to live • Free border of ligament site of ligamentum teres

19. Coronary ligament 冠状韧带－the area between upper and lower parts of the coronary ligament is the bare area of live, this area is devoid of peritoneum and lies in contract with the diaphragm • Left and right triangular ligaments 左、右三角韧带－formed by right extremity of coronary ligament and left leaf of falciform ligament, respectively

20. Hepatogastric ligament 肝胃韧带 • Hepatoduodenal ligament 肝十二指肠韧带 • Ligamentum teres hepatis 肝圆韧带

21. Ligaments of spleen • Gastrosplenic ligament 胃脾韧带－a double layer of peritoneum that connects the fundus of stomach to hilum of spleen. In this double layer of peritoneum are the short gastric and left gastroepiploic vessels • Splenorenal ligament 脾肾韧带－extends between the hilum of spleen and anterior aspect of left kidney. The splenic vessels lies within this ligament, as well as the tail of pancreas • Phrenicosplenic ligament 膈脾韧带 • Splenocolic ligament脾结肠韧带

22. Ligaments of stomach • Hepatogastric ligament 肝胃韧带 • Gastrosplenic ligament 胃脾韧带 • Gastrophrenic ligament 胃膈韧带 • Gastrocolic ligament 胃结肠韧带 • Gastropancrestic ligament 胃胰韧带

23. Folds and recesses of posterior abdominal wall • Superior duodenal fold and recess 十二指肠上襞和上隐窝 • Inferior duodenal fold and recess 十二指肠下襞和下隐窝 • Intersigmoid recess乙状结肠间隐窝－formed by the inverted V attachment of sigmoid mesocolon

24. Retrocecal recess 盲肠后隐窝－in which the appendix frequenty lies • Hepatorenal recess 肝肾隐窝－lies between the right lobe of liver, right kidney, and right colic flexure, and is the lowest parts of the peritoneal cavity when the subject is supine

25. Folds and fossas of anterior abdominal wall • Medial umbilical fold 脐正中襞－contain the remnant of urachus (median umbilical ligaments) • Medial umbilical fold脐内侧襞－contains remnants of the umbilical arteries (medial umbilical ligaments) • Lateral umbilical fold 脐外侧襞－contains the inferior epigastric vessels • Supravesical fossa 膀胱上窝 • Medial inguinal fossa 腹股沟内侧窝 • Lateral inguinal fossa 腹股沟外侧窝

26. Pouches • In male－rectovesical pouch 直肠膀胱陷窝 • In female • Rectouterine pouch直肠子宫陷窝－between rectum and uterus • Vesicouterine pouch 膀胱子宫陷窝－between bladder and uterus

27. Peritoneal subdivisions The transverse colon and transverse mesocolon divides the greater sac into supracolic and infracolic compartments. Supracolic compartments结肠上区(subphrenic space)－lies between diaphragm and transverse colon and transverse mesocolon Suprahepatic recess肝上间隙lies between the diaphragm and live－the falciform ligament divides it into right and left suprahepatic recesses

28. Left suprahepatic recesses左肝上间隙 • left anterior suprahepatic spaces • left posterior suprahepatic spaces • Right suprahepatic recesses右肝上间隙 • right anterior suprahepatic spaces • right posterior suprahepatic spaces • bare area of live (extraperitoneal space)

29. Infrahepatic recess 肝下间隙 lies between the live and transverse colon and transverse mesocolon－the ligamentum teres hepatic divides it into right and left infrahepatic recesses • Right infrahepatic recesses 右肝下间隙 (hepatorenal recess) • Left infrahepatic recesses 左肝下间隙 • left anterior infrahepatic space • left posterior infrahepatic space

30. Infracolic compartments结肠下区 －lies below the transverse colon and transverse mesocolon • Right paracolic sulcus (gutter) 右结肠旁沟－lies lateral to the ascending colon. It communicates with the hepatorenal recess and the pelvic cavity. It provides a route for the spread of infection between the pelvic and the upper abdominal region. • Left paracolic sulcus (gutter) 左结肠旁沟 －lies lateral to the descending colon. It is separated from the area around the spleen by the phrenicocolic ligament, a fold of peritoneum that passes from the colic flexure to the diaphragm.

31. Right mesenteric sinus右肠系膜窦－triangular space, lies between root of mesentery, ascending colon, right 2/3 of transverse colon and transverse mesocolon • Left mesenteric sinus左肠系膜窦－lies between root of mesentery, descending colon, right 1/3 of transverse colon and transverse mesocolon, its widens below where it is continuous with the cavity of the pelvis • 上下流通，左沟不畅，右窦封闭，左入盆腔。