Peritoneum and Retroperitoneum
Swati Goyal in Essentials of Abdomino-Pelvic Sonography, 2018
Small bowel mesentery is a specialized peritoneal fold extending from the second lumbar vertebra to the right iliac fossa containing blood vessels, nerves, lymph nodes, and fat. It connects jejunum and ileum to posterior abdominal wall and is difficult to appreciate if ascites is not present (Table 12.1). Omentum: Specialized peritoneal folds.Lesser omentum: Connects the lesser curvature of the stomach and proximal duodenum with the liver.Greater omentum: Descends from the greater curvature of the stomach.Foramen of Winslow (Epiploic foramen): Passage between greater and lesser sac.
Anatomy
J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan in An Atlas of Gynecologic Oncology, 2018
Various terms are used to describe parts of the peritoneum/mesentery (Figure 4.5). The small intestine mesentery is referred to as “the mesentery,” but other mesenteries of specific parts of the GI tract are named accordingly: mesoesophagus, mesogastrium, transverse and sigmoid mesocolons, and mesoappendix. Omentum describes a double-layered extension of peritoneum passing from the stomach and proximal duodenum to adjacent organs. The greater omentum descends from the greater curvature of the stomach and then ascends to the anterior transverse colon and mesocolon. Similarly, the lesser omentum extends from the lesser curvature of the stomach and duodenum to the liver. Peritoneal ligaments are named based on which organs or parts of the abdominal wall they connect: falciform ligament, hepatogastric, hepatoduodenal ligament (thickened free edge of the lesser omentum conducting the portal triad), gastrophrenic ligament, gastrosplenic ligament, and gastrocolic ligament.
Peritoneal metastases
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
The peritoneal cavity is a serous sac (or coelom) lying between the parietal and visceral peritoneum (Figure 33.1). It consists of a series of communicating potential spaces not normally seen on imaging unless distended by fluid or air. The visceral peritoneum covers the abdominal organs, and the parietal peritoneum lies against the abdominal wall and retroperitoneum, resulting in an extensive surface area as a potential site of tumour deposition. The greater omentum consists of four layers of peritoneum, two from the greater curve of the stomach and two from the transverse mesocolon, which fuse and pass anterior to the small bowel—this is often involved by metastases. The lesser omentum (or gastrohepatic ligament) joins the lesser curve of the stomach to the liver. Ligaments are peritoneal folds connecting abdominal organs. A mesentery is a peritoneal fold joining the small bowel or parts of the colon to the posterior abdominal wall and containing blood vessels, lymphatics, and nerves (3). Ligaments and mesenteries are suspended by the visceral peritoneum and so are not truly intraperitoneal (4).
The mesentery: an ADME perspective on a ‘new’ organ
Published in Drug Metabolism Reviews, 2018
Aneesh A. Argikar, Upendra A. Argikar
The development of mesentery during and after the embryonic stage has been covered in great detail elsewhere (Martini and Tallitsch 2014). To summarize the embryonic development, the endoderm forms the hindgut and the foregut. During the initial months of the embryo, the gut is just a simple tube. This simple digestive tube is suspended by the mesentery. After gradually disappearing, the ventral mesentery remains in two places, on the ventral surface of the stomach known as lesser omentum and between the liver and anterior abdominal wall known as falciform ligament. The lesser omentum provides stability to the stomach and also provides a way for the blood vessels and other structures to enter and leave the liver. As the embryo grows, the dorsal mesentery enlarges and forms a pouch called the greater omentum. The literature on the expression of enzymes and transporters in the embryonic and fetal mesentery was not available.
Surgical treatment of therapy-resistant reflux after Roux-en-Y gastric bypass. A case series of the modified Nissen fundoplication
Published in Acta Chirurgica Belgica, 2020
Jan Colpaert, Julie Horevoets, Leander Maes, Gilles Uijtterhaegen, Bruno Dillemans
In essence, a laparoscopic 360° fundoplication was performed to reinforce the LES by wrapping the excluded stomach around the distal esophagus. The patient was put in beach chair position and a pneumoperitoneum of 15 mmHg was established. One scope trocar and four utility trocars were placed, using the same position as the initial gastric bypass surgery (Figure 1) [13]. After initial adhesiolysis from the previous surgery the excluded stomach is carefully isolated by dividing the short gastric vessels with harmonic scissors. Subsequently the lesser omentum (or hepatogastric ligament) is opened at the pars flaccida and dissection continues toward the diaphragm to expose the right crus. Further blunt dissection is used to separate the right crus from the esophagus. The dissection is then continued to free the esophagus circumferentially.
Intraoperative measurement of pressure gradient in median arcuate ligament syndrome as a rationale for radical surgical approach
Published in Acta Chirurgica Belgica, 2018
Tomas Grus, Lukas Lambert, Tomas Vidim, Gabriela Grusova, Tomas Klika
All eight patients were treated by open surgical procedure under general anesthesia. Briefly, from the upper midline laparotomy, an incision of the lesser omentum was made to expose the omental bursa. From this access, the diaphragmatic crura were carefully dissected to visualize CA and the aorta. Intra-arterial systolic pressure was peroperatively measured in the left radial artery and in the left gastric artery with a standard set for invasive monitoring of arterial pressure (monitor: Marquette Solar 8000M, GE Medical Systems, WI; arterial catheterization set: ARROW® 22Ga, Arrow International, PA). Then the MAL was divided and dissection of fibrous tissue including the celiac gangion around the CA was performed. After skeletonization of the CA, the intra-arterial pressure was re-measured. If the gradient exceeded 15 mm Hg (all patients), a bypass with a reinforced PTFE prosthesis (VascuGraft SOFT straight HELIX, B BraunMeisungen AG, Germany, Ø = 7 mm) was constructed under systemic heparinization (Heparin, Zentiva, Czech Republic, 1.5 mg/kg) [8]. The proximal anastomosis was connected to the aorta just below the diaphragm at the level of the dissected diaphragmatic crura. The distal anastomosis was constructed as end-to-end (n = 4) or end-to-side (n = 2) anastomosis to the CA below the level of the stenosis, or as an end-to-side anastomosis to the common hepatic artery (n = 2). In the four patients, where an end-to-side anastomosis, whether to the CA or the common hepatic artery, was created, care was taken to form a long distal anastomosis with a small angle between the graft and the donor artery in order to reduce formation of neointimal hyperplasia [9]. After the bypass procedure, the effect of heparin was cancelled by a corresponding dose of protaminsulphate (Protamin ME, Meda Pharma, Germany), and the intra-arterial pressure was measured again. Finally, the omental bursa and the midline laparotomy were closed.
Related Knowledge Centers
- Ductus Venosus
- Hepatoduodenal Ligament
- Peritoneum
- Porta Hepatis
- Liver
- Duodenum
- Curvatures of The Stomach
- Hepatogastric Ligament
- Omental Foramen
- Hepatophrenic Ligament