Peritoneum II

To -MBBS 2nd YearDr Laxman Khanal

Asst prof. department of AnatomyBPKIHS, Dharan

06-09-2016

Q. All are the derivatives of dorsal mesogastrium excepta. Greater omentumb. Gastro splenic ligamentc. Splenorenal ligamentd. Lesser omentum

Q. Which of the following organ is secondary retroperitoneal organ?a. Kidneyb. Suprarenal glandc. Abdominal aortad. Duodenum

Q. Most dependent peritoneal space in supine position is-a. Pouch of Douglasb. Lesser sacc. Pouch of Morrisond. Rectovesicle pouch

Q. All of the following structure form the posterior boundary of Epiploic foramen except.a. IVCb. Rt suprarenal glandc. Lt suprarenal glandd. T12 vertebra

Lesser Sac

Parts of lesser sac1. Superior recess2. Inferior recess3. Splenic recess4. Omental bursa

Lesser sac

Position: Behind the lesser omentum and stomachWalls• Superior－peritoneum which covers the caudate lobe of

liver and diaphragm

• Anterior: lesser omentum, peritoneum of posterior wallof stomach, and anterior two layers of greater omentum

• Inferior: Continuative area of anterior and posterior twolayers of greater omentum

• Posterior: Posterior two layers of greater omentum,transverse colon and transverse mesocolon, peritoneumcovering pancreas, left kidney and suprarenal gland

Supra and infracolic compartment

• The transverse mesocolon divides the abdominalcavity into a supracolic compartment, containing thestomach, liver, and spleen, and an infracoliccompartment, containing the small intestine andascending and descending colon.

• The infracolic compartment is divided into right andleft infracolic spaces by the mesentery of the smallintestine.

• Free communication occurs between the supracolicand the infracolic compartments through theparacolic gutters

Supracolic

• Rt/Lt subphrenic space

• Right subhepatic space (hepatorenal pouch)

• Left subhepatic space

(Lesser Sac)

Infracolic

• Rt/Lt infracolic space

• Paracolic gutters

Subphrenic space

Subhepatic space

• Rt/Lt subphrenic space

• Right subhepatic space (hepatorenal pouch)

• Left subhepatic space

(Lesser Sac)

Rt subhepatic space(Hepatorenal pouch)

Lt subhepatic space(Lesser Sac)

Inf layer of coronary ligaments

Open to Rt paracolicgutter

Rt lobe of liver Rt Kidney

Morrison’s PouchHepatorenal pouchRt subhepatic pouch

• Most dependent part of the peritoneal cavity in supineposition

• Most common site of subphrenic abscess

Infracoliccompartment

• Rt/Lt infracolic space

• Paracolic gutters

Pelvic part of peritoneal cavity

• Vesicouterine pouch• Rectouterine pouch

• Most dependent part in sitting or standing position.

• Most common site of pelvic abscess.

Peritoneal recesses

• These are small spaces of peritoneal cavitywith in large peritoneal cavity. These areguarded by folds which contain blood vessel.

• Duodenal recesses• Caecal recess• Intersigmoid recesses

• Duodenal recesses

• Exist around the fourth part of the duodenum and theduodenojejunal junction forming a number of named recesses.

Paracecal recess

• Superior ileocecal recess (ant cecal artery)

• Inferior ileocecal recess (avascular)

• Retrocecal recess (contains appendix)

Urachus

Umb artery

Inf Epigastric vesses

Folds and fossa of anterior abdominal wall

Folds and fossas of anterior abdominal wall

• Median umbilical fold －contain the remnant ofurachus (median umbilicalligaments)

• Medial umbilical fold －contains remnants of theumbilical arteries (medialumbilical ligaments)

• Lateral umbilical foldcontains the inferiorepigastric vessels

Supravesical fossa

Medial inguinal fossa

Lateral inguinal fossa

Sites of paracentesis

Peritoneal dialysis VP Shunt