Ligaments and pouches of the peritoneum, their localization. Limited peritonitis
The abdominal cavity is the largest cavity of the human body. It is surrounded by intra-abdominal and intra-pelvic fascia, covering the following anatomical formations from the inside: at the top - the diaphragm, at the front and on both sides - the muscles of the abdominal wall, at the back - the lumbar vertebrae, the quadratus lumborum and iliopsoas muscles, at the bottom - the pelvic diaphragm.
In the abdominal cavity there is the peritoneal cavity (cavitas peritonei) - a slit-like space between the layers of the parietal (peritoneum parietale) and visceral (peritoneum viscerale) peritoneum, containing a small amount of serous fluid. It should be noted that in practical surgery the concept of “abdominal cavity” is often used instead of “peritoneal”. At the initial stages of development, the organs of the abdominal cavity are located next to the peritoneal sac and, gradually rotating, are immersed into it. The leaf of the parietal peritoneum lines the walls of the abdominal cavity, and the leaf of the visceral peritoneum covers the organs: some on all sides (the so-called intraperitoneal arrangement of organs), others on only three (mesoperitoneal), some on only one side (retroperitoneal). If the organs are not covered with a layer of visceral peritoneum, we are talking about their extraperitoneal location.
The following organs or parts of the abdominal organs are located intraperitoneally: stomach, jejunum, ileum, transverse colon, sigmoid colon, as well as the cecum with the appendix, the upper part of the duodenum, and the fallopian tubes.
Mesoperitoneally located are the liver, gallbladder, descending duodenum, ascending colon and descending colon, middle third of the rectum, uterus and bladder. The pancreas is covered by peritoneum only in front and occupies a retroperitoneal position. The prostate gland, the horizontal part of the duodenum and the lower third of the rectum, kidneys, adrenal glands and ureters are located extraperitoneally.
Floors of the abdominal cavity
The abdominal cavity is divided into two floors: upper and lower. Between them pass the transverse colon with mesentery (mesocolon transversum) or the line of fixation of the mesentery of the transverse colon to the posterior wall of the abdomen.
The upper floor of the abdominal cavity contains the liver, gallbladder, stomach, spleen, upper part of the duodenum and most of the pancreas. In addition, there are vital relatively limited spaces, or bags, connected to each other using narrow slots. These include the omental, hepatic and pregastric bursae.
The omental bursa (bursa omentalis), which looks like a slit, is located behind the stomach and lesser omentum. The omental bursa contains the anterior, posterior, inferior and left walls.
The anterior wall of the bursa consists of the lesser omentum (omentum minus), the posterior wall of the stomach and the gastrocolic ligament, which begins the part of the greater omentum located between the stomach and the transverse colon. Sometimes (if it is clearly visible) the gastrosplenic ligament is visible in the anterior wall of the omental bursa.
The lesser omentum is a duplication of the peritoneum, starting from the porta hepatis and ending in the lesser curvature of the stomach and the adjacent part of the duodenum. The omentum is divided into the hepatoduodenal, hepatogastric and gastrophrenic ligaments.
The posterior wall of the omental bursa is the parietal peritoneum, behind which are the pancreas, the upper part of the duodenum, the left kidney, the left adrenal gland, the inferior vena cava, the abdominal aorta and the abdominal trunk. On top of the bursa is the caudate lobe of the liver and part of the diaphragm, and on the left side are the spleen and gastrosplenic ligament (lig. gastrolienale).
The lower wall of the omental bursa is formed by the transverse colon and its mesentery.
Through the cavity of the said bursa in the radial direction (back to front) from the pancreas, two ligaments pass in the form of the letter “V”: gastropancreatic (lig. gastropancreaticum) and pyloropancreaticum (lig. pyloropancreaticum), separating the vestibule of the omental bursa from its cavity itself. The gastropancreatic ligament contains the left gastric artery. The cavity of the omental bursa is connected to the upper floor of the peritoneal cavity by the omental opening (foramen epiploicum), which represents the right wall of the bursa cavity. The width of the omental opening is 3-4 cm, and, if there are no adhesions, 1-2 fingers fit into it. Injuries to its anterior and posterior walls are especially dangerous, since in the thickness of the hepatoduodenal ligament there are large vessels, nerves and bile ducts, and at the back - the inferior vena cava.
In addition, the omental bursa has a vestibule (vestibulum bursae omentalis), bounded above by the caudate lobe of the liver, below by the duodenum, and behind by the parietal peritoneum, which covers the inferior vena cava. This bag has an upper gland pocket (recess). Being in pre-
The omental bursa can be accessed by cutting the lesser omentum or gastrocolic ligament (the most commonly used method) or the mesentery of the transverse meningeal colon, as well as through the omental foramen.
The hepatic bursa is located between the right lobe of the liver and the diaphragm. Above and in front of it is the diaphragm, below is the superoposterior surface of the right lobe of the liver, behind is the right part of the coronary ligament of the liver (lig. coronarium), on the left is the falciform ligament dig. falciforme). The part of the hepatic bursa between the posterior surface of the right lobe of the liver, the diaphragm and the coronary ligament is called the right subphrenic (suprahepatic) space. Inferiorly it passes into the right lateral cable of the lower floor of the abdominal cavity.
Within the right subdiaphragmatic space, subdiaphragmatic ulcers can form as a complication of purulent cholecystitis, perforated gastric and duodenal ulcers.
As a result of injury to hollow organs, perforated stomach ulcers and other pathological conditions, air penetrates into the abdominal cavity, which, when the body is in an upright position, accumulates in the hepatic bursa. It can be detected during fluoroscopy.
The pregastric bursa (bursa pregastrica) is located in front of the stomach, and on top are the diaphragm and the left lobe of the liver, behind - the lesser omentum and the anterior wall of the stomach, in front - the anterior wall of the abdomen. On the right, the pregastric bursa is separated from the hepatic bursa by the falciform ligament and round ligament of the liver, and on the left it does not have a pronounced border.
Between the upper surface of the left lobe of the liver and the lower surface of the diaphragm, a gap is formed, or the left subphrenic space, delimited from the left lateral canal of the lower floor of the abdominal cavity by the permanent diaphragmatic-colic ligament.
The lower floor of the abdominal cavity is the space between the mesentery of the transverse colon and the pelvic cavity. The ascending colon and descending colon and the root of the mesentery of the small intestine divide it into 4 sections: the right and left lateral canals and the right and left mesenteric sinuses.
The right lateral canal is located between the right lateral abdominal wall and the ascending colon. At the top it reaches the right subdiaphragmatic space, at the bottom it continues into the right iliac fossa and into the small pelvis, since the right diaphragmatic-colic ligament is weakly expressed and sometimes completely absent. During the movement of the diaphragm, a suction action occurs in the hepatic bursa, so the infection in the right lateral canal spreads from bottom to top, into the right subdiaphragmatic space.
The left lateral canal passes between the descending colon and the left lateral abdominal wall. At the top it is covered by a well-defined and permanent left diaphragmatic-colic ligament, and at the bottom it passes into the left iliac fossa and the small pelvis.
The right mesenteric sinus (sinus mesentericus dexter) has the shape of a right triangle with the base directed upward. The boundaries of the sinus are: above - the transverse colon with mesentery, on the left and below - the mesentery of the small intestine, on the right - the ascending colon. In front, the mesenteric sinus is surrounded by the greater omentum. This anatomical formation is filled with loops of the small intestine.
The left mesenteric sinus (sinus mesentericus sinister) also has the shape of a right triangle, but with the base directed downward. It is larger in size than the right mesenteric sinus. The boundaries of this anatomical formation are: at the top - a small area of the transverse colon, on the left - the descending colon, on the right - the mesentery of the small intestine. In front, the left mesenteric sinus is covered with a greater omentum; from below it is open and passes directly into the pelvic cavity. This sinus is filled with loops of the small intestine. When the body is in an upright position, the upper sections of the sinuses are the deepest.
The mesenteric sinuses are connected through a gap between the mesentery of the transverse colon and the duodenojejunal flexure (flexura duodenojejunalis).
In places where the peritoneum passes from the walls of the abdominal cavity to the organs or from one organ to another, abdominal pockets are formed.
The upper and lower duodenal recess (recessus duodenalis superior et inferior) are located at the junction of the duodenum and the jejunum. Their depth varies within centimeters, but sometimes can increase sharply, as a result of which the depressions turn into a pocket located towards the retroperitoneal space. Thus, a hernial sac is formed into which loops of the small intestine can enter - a true internal hernia, or Treitz hernia.
The superior and inferior ileocecal pouches form where the ileum meets the cecum. In this case, the upper one is located between the upper edge of the terminal part of the ileum and the inner surface of the ascending colon, and the lower one is between the lower surface of the terminal part of the ileum and the wall of the cecum.
The postcolic recess (recessus retrocaecalis) in the form of a depression in the parietal peritoneum on the posterior wall of the abdomen is located behind the cecum.
The intersigmoid recess (recessus intersigmoideus) is a funnel-shaped or cylindrical formation with a round or oval inlet.
It is surrounded in front by the mesentery of the sigmoid colon, and behind by the parietal peritoneum, opening slightly into the left lateral canal of the peritoneal cavity. In the intersigmoid recess, as in those described above, an internal hernia can form.
The abdominal cavity contains a small amount of fluid (30 cc), which moistens the surface of the internal organs, making them easily move inside the cavity.
The article was prepared and edited by: surgeonUpper floor of the abdominal cavity
Top floor bounded above by the diaphragm, on the sides by the lateral walls of the abdominal cavity, covered with the parietal peritoneum, and below by the transverse colon and its mesentery.
The upper floor contains the stomach, liver with gall bladder, spleen, upper part of the duodenum and pancreas. The upper floor of the peritoneal cavity is divided into three relatively delimited sacs, or bursae: hepatic, pregastric and omental.
Hepatic bursa
Hepatic bursa located to the right of the falciform ligament of the liver and covers the right lobe of the liver. The retroperitoneal upper pole of the right kidney and the adrenal gland protrude into the hepatic bursa.
Pregastric bursa
Pregastric bursa located in the frontal plane, to the left of the falciform ligament of the liver and anterior to the stomach. In front, the pregastric bursa is limited by the anterior abdominal wall. The upper wall of this bag is formed by the diaphragm. The pregastric bursa contains the left lobe of the liver and the spleen.
Omental bag
Omental bag,bursa omentalis, located behind the stomach and lesser omentum.
It is bounded above by the caudate lobe of the liver, below by the posterior plate of the greater omentum, fused with the mesentery of the transverse colon, in front by the posterior surface of the stomach, lesser omentum and gastrocolic ligament, and behind by the peritoneum.
The cavity of the omental bursa is a slit located in the frontal plane.
At the top it has an upper gland recess, recessus superior omentalis, which is located between the lumbar part of the diaphragm behind and the posterior surface of the caudate lobe of the liver in front.
The omental bag also has a lower omental recess, recessus inferior omentalis, which is located between the gastrocolic ligament in front and above and the posterior plate of the greater omentum, fused with the transverse colon and its mesentery, behind and below.
Stuffing bag through the stuffing box hole, foramen epiploicum, communicates with the hepatic bursa. The hole is located behind the hepatoduodenal ligament, at its free right edge.
Small seal
Between the gates of the liver at the top, the lesser curvature of the stomach and the upper part of the duodenum at the bottom, a duplication of the peritoneum is formed, called lesser omentum,omentum minus.
The left side of the lesser omentum represents the hepatogastric ligament, lig. hepatogastricum, and the right one - the hepatoduodenal ligament, lig. hepatoduodenal.
In the right edge of the lesser omentum (in the transverse duodenal ligament) between the layers of the peritoneum there are located the common bile duct, the portal vein and the proper hepatic artery.
entities, except:
1) hepatic bursa
2) subhepatic space
3) pelvic cavity
4) cavities of the omental bursa
5) right mesenteric sinus
8.025. The left lateral canal of the abdominal cavity communicates with:
1) hepatic bursa
2) subhepatic space
3) pelvic cavity
4) the cavity of the omental bursa
5) left mesenteric sinus
8.026. The lesser omentum consists of the following three ligaments:
1) diaphragmatic-gastric
2) gastrosplenic
3) gastrocolic
4) hepatoduodenal
5) hepatic-gastric
8.027. In relation to the spinal column, the gallbladder is located at the level of the vertebra:
1) X chest
2) XI chest
3) XII chest
4) I lumbar
5) II lumbar
8.028. All formations are adjacent to the gallbladder, except:
2) pyloric part of the stomach
3) hepatic flexure of the transverse colon
4) head of the pancreas
5) ascending duodenum
8.029. Knowledge of the constituent sides of the Calot triangle is necessary when performing:
1) cholecystostomy
2) cholecystojejunostomy
3) cholecystoduodenoanastomosis
4) cholecystectomy
5) liver resection
8.030. Establish the corresponding anatomical formations that form the walls of the omental bursa:
1) upper A) mesentery of the transverse colon
2) lower B) stomach
3) anterior B) gastrocolic ligament
4) rear D) small seal
D) posterior layer of the parietal peritoneum
E) transverse colon
G) caudate lobe of the liver
8.031. All formations are adjacent to the posterior wall of the stomach, except:
1) left lobe of the liver
2) posterior layer of the parietal peritoneum
3) pancreas
4) spleen
5) abdominal aorta
8.032. All formations are adjacent to the stomach in front, except:
1) left lobe of the liver
2) transverse colon
3) right lobe of the liver
4) anterior abdominal wall
5) small intestine
8.033. Establish the corresponding anatomical structures that form the boundaries of the omental foramen:
1) superior A) hepatoduodenal ligament
2) inferior B) hepatorenal ligament and inferior vena cava
3) anterior B) renal-duodenal ligament and
duodenum
D) caudate lobe of the liver
8.034. In a patient with a perforation of an ulcer of the posterior wall of the stomach, gastric contents ended up in the right iliac fossa near the cecum, where they caused symptoms simulating an attack of appendicitis. Indicate 4 formations that make up the sequential route of entry of gastric contents into this area:
1) subhepatic fissure
2) right side channel
3) right mesenteric sinus
4) pregastric bursa
5) stuffing box
6) gland hole
7) gap in front of the transverse colon
8.035. Of the four peritoneal formations of the lower floor of the abdominal cavity, it freely communicates with the peritoneal bursae of the upper floor:
1) left mesenteric sinus
2) left side channel
3) right mesenteric sinus
4) right side channel
8.036. Messages from the right and left mesenteric sinuses:
1) between the loops of the small intestine and the anterior abdominal wall
2) through the hole in the root of the mesentery of the small intestine
3) through holes in the mesentery of the transverse colon
4) between the beginning of the root of the mesentery of the small intestine and the mesentery of the transverse colon
5) not reported
8.037. Of the four peritoneal formations of the lower floor of the abdominal cavity, one does not communicate with the peritoneal floor of the small pelvis:
1) left mesenteric sinus
2) left side channel
3) right mesenteric sinus
4) right side channel
8.038. The most likely route of spread of purulent peritonitis from the right mesenteric sinus is:
2) left mesenteric sinus
3) left side channel
4) right side channel
5) peritoneal floor of the small pelvis
8.039. The most likely routes of spread of purulent peritonitis from the left mesenteric sinus are two:
1) upper floor of the abdominal cavity
2) left side channel
3) right mesenteric sinus
4) right side channel
5) peritoneal floor of the small pelvis
8.040. The lateral border of the right mesenteric sinus is:
1) root of the mesentery of the sigmoid colon
2) root of the mesentery of the small intestine
3) medial edge of the ascending colon
4) right side wall of the abdomen
5) lateral edge of the ascending colon
8.041. The most likely ways of spreading purulent peritonitis from the right lateral canal are two:
1) hepatic bursa
2) left mesenteric sinus
3) left side channel
4) right mesenteric sinus
5) peritoneal floor of the small pelvis
8.042. The most likely route of spread of purulent peritonitis from the left lateral canal is:
1) upper floor of the abdominal cavity
2) left mesenteric sinus
3) right mesenteric sinus
4) right side channel
5) peritoneal floor of the small pelvis
Intra-abdominal hernias can occur in the following three
Places of the lower floor of the abdominal cavity, in accordance with the dis-
position of the peritoneal pockets:
1) behind the duodenum-jejunal flexure
2) in the area of the ileocecal angle
3) in the area of the hepatic flexure of the colon
4) in the area of the splenic flexure of the colon
5) behind the mesentery of the sigmoid colon
6) in front of the mesentery of the sigmoid colon
In a patient, purulent appendicitis was complicated by the formation
Floors of the abdominal cavity
The peritoneal cavity is divided into two floors by the transverse colon and its mesentery:
Top floor– located above the transverse colon and its mesentery. Contents: liver, spleen, stomach, partially duodenum; right and left hepatic, subhepatic, pregastric and omental bursae.
Ground floor–located below the transverse colon and its mesentery. Contents: loops of jejunum and ileum; cecum and vermiform appendix;
colon; lateral canals and mesenteric sinuses. The root of the mesentery of the transverse colon goes from right to left from the right kidney, slightly below its middle, to the middle of the left. On its way it crosses: the middle of the descending part of the duodenum; head of the pancreas
of the gland and runs along the upper edge of the gland body.
Right hepatic bursa located between the diaphragm and the right lobe of the liver and limited behind the right coronary
ligament of the liver, on the left – the falciform ligament, and on the right and below it opens into the subhepatic bursa and the right lateral canal.
Left hepatic bursa lies between the diaphragm and the left lobe of the liver and is bounded posteriorly by the left coronary ligament of the liver, on the right by the falciform ligament, on the left by the left triangular ligament of the liver, and in front communicates with the pregastric bursa.
Pregastric bursa is located between the stomach and the left lobe of the liver and is limited in front by the lower surface of the left lobe of the liver, behind by the lesser omentum and the anterior wall of the stomach, above by the hilum of the liver and communicates with the subhepatic bursa and the lower floor of the abdominal cavity through the preepiploic fissure.
Subhepatic bursa it is limited in front and above by the lower surface of the right lobe of the liver, below - by the transverse colon and its mesentery, on the left - by the porta hepatis and on the right it opens into the right lateral canal.
Omental bag forms a closed pocket behind the stomach and consists of the vestibule and the gastro-pancreatic sac.
Vestibule of the omental bursa limited at the top of the tail-
that lobe of the liver, in front - the lesser omentum, below - the duodenum, behind - the parietal part of the peritoneum lying on the aorta and the inferior vena cava.
Stuffing box hole bounded in front by the hepatoduodenal ligament, which contains the hepatic artery, common bile duct and portal vein, below by the duodenal-renal ligament, behind by the hepatorenal ligament, above by the caudate lobe of the liver.
Gastropancreatic sac limited front rear
the lower surface of the lesser omentum, the posterior surface of the stomach and the posterior surface of the gastrocolic ligament, behind - the parietal peritoneum lining the pancreas, aorta and inferior vena cava, above - the caudate lobe of the liver, below - the mesentery of the transverse colon, on the left - the gland - splenic and renal-splenic ligaments.
Topographic anatomy of the stomach Holotopy: left hypochondrium, epigastric region proper -
Skeletotopia:
cardiac foramen – to the left of Th XI (behind the cartilage of the VII rib);
bottom – Th X (V rib along the left midclavicular line); pylorus – L1 (VIII right rib in the midline).
Syntopy: at the top – the diaphragm and the left lobe of the liver, at the back
and on the left - the pancreas, left kidney, adrenal gland and spleen, in front - the abdominal wall, below - the transverse colon and its mesentery.
Gastric ligaments:
Hepatogastric ligament-between the porta hepatis and the lesser curvature of the stomach; contains the left and right gastric arteries, veins, branches of the vagus trunks, lymphatic vessels and nodes.
Phrenoesophageal ligament-between the diaphragm,
esophagus and cardiac part of the stomach; contains a branch of the left gastric artery.
Gastrophrenic ligament is formed as a result of the transition of the parietal peritoneum from the diaphragm to the anterior wall of the fundus and partially the cardiac part of the stomach.
Gastrosplenic ligament-between the spleen and the greater curvature of the stomach; contains short arteries and veins of the stomach.
Gastrocolic ligament– between the greater curvature of the stomach and the transverse colon; contains the right and left gastroepiploic arteries.
Gastropancreatic ligament is formed during the transition
de peritoneum from the upper edge of the pancreas to the posterior wall of the body, cardia and fundus of the stomach; contains the left gastric artery.
Blood supply to the stomach provided by the celiac axis system.
Left gastric artery is divided into ascending esophageal and descending branches, which, passing along the lesser curvature of the stomach from left to right, give off anterior and posterior branches.
Right gastric artery begins with the proper hepatic artery. As part of the hepatoduodenal ligament, the artery reaches the pyloric
The lower part of the stomach and between the leaves of the lesser omentum along the lesser curvature is directed to the left towards the left gastric artery, forming the arterial arch of the lesser curvature of the stomach.
Left gastroepiploic artery is a branch of the splenic artery and is located between the leaves of the gastrosplenic and gastrocolic ligaments along the greater curvature of the stomach.
Right gastroepiploic artery It begins with the gastroduodenal artery and goes from right to left along the greater curvature of the stomach towards the left gastroepiploic artery, forming a second arterial arch along the greater curvature of the stomach.
Short gastric arteries 2-7 branches arise from the splenic artery and, passing in the gastrosplenic ligament, reach the bottom along the greater curvature
The veins of the stomach accompany the arteries of the same name and flow into the portal vein or one of its roots.
In the lower floor of the abdominal cavity. There are two lateral peritoneal canals (right and left) and two mesenteric - mesenteric sinuses (right and left).
Right subphrenic space, or right hepatic bursa, bursa hepatica dextra,
bounded above and in front by the diaphragm, below by the superoposterior surface of the right lobe
liver, behind - the right coronary and right triangular ligaments of the liver, on the left - the falciform
liver ligament. Within its boundaries, so-called subphrenic abscesses often form, developing as complications of purulent appendicitis, cholecystitis, perforated ulcers of the stomach, duodenum, etc. Inflammatory exudate rises here most often along the right lateral canal from the right iliac fossa or from the subhepatic space along the outer edge of the liver.
The left subdiaphragmatic space consists of two sections widely communicating with each other: the pregastric bursa, the left hepatic bursa,
The space between the left lobe of the liver below and the diaphragm above and in front, bursa hepatica sinistra, is limited on the right by the falciform ligament, behind by the left part of the coronary ligament and the left triangular ligament of the liver.
Pregastric bursa, bursa pregastrica,
limited posteriorly by the lesser omentum and stomach, anteriorly and superiorly by the diaphragm, the left lobe of the liver and the anterior abdominal wall, and on the right by the falciform and round ligaments of the liver.
Particular attention should be paid to the lateral section of the bursa pregastrica, located lateral to the greater curvature of the stomach and containing the spleen. This section is limited to the left and posterior lig. phrenicolienale, above - lig. Gastrolien a l and diaphragm, below - lig. phrenicocolicum.
This space is located around the spleen, is called the blind sac of the spleen, saccus caecus lienis, and can, during inflammatory processes, be delimited from the medial section of the bursa pregastrica.
The left subphrenic space is separated from the left lateral canal by a well-defined left diaphragmatic-colic ligament, lig. phrenicocolicum sinistrum, and has no free communication with it. Abscesses arising in the left subdiaphragmatic space as a result of complications of perforated stomach ulcers, purulent liver diseases, etc. can spread from the left into the blind sac of the spleen, and in front descend between the anterior wall of the stomach and the upper surface of the left lobe of the liver to the transverse colon and below.
The subhepatic space, bursa subhepatica, is located between the lower surface of the right lobe of the liver and the mesocolon with the transverse colon, to the right of the porta hepatis and the omental foramen. Although this space is united from a morphological point of view, pathomorphologically it can be divided into
anterior and posterior sections. Almost the entire peritoneal surface of the gallbladder and the upper outer surface of the duodenum face the anterior section of this space. The posterior section, located at the posterior edge of the liver, to the right of the spine, is the least accessible area under the liver space - a recess called the hepato-renal recess. Abscess-
Symptoms that arise as a result of perforation of a duodenal ulcer or purulent cholecystitis are most often located in the anterior section; periappendiceal abscess spreads mainly to the posterior part of the subhepatic space.
The omental bursa, bursa omentalis, is located behind the stomach, looks like a slit and is the most isolated space in the upper floor of the abdominal cavity. Free entry into the omental bursa is possible only through the omental opening, foramen epiploicum, located near the porta hepatis. It is limited in front by the hepatoduodenal ligament, lig. hepatoduodenale, behind - the parietal peritoneum covering v. cava inferior, and hepatorenal ligament, lig. hepatorenal; above - the caudate lobe of the liver and below - the renal-duodenal ligament, lig. duodenorenale, and pars superior duodeni. The gland hole has different sizes. During inflammatory processes it can be closed
adhesions, resulting in the omental bursa being completely isolated.
The shape of the omental bursa is very complex and varies individually. In it one can distinguish the anterior, posterior, upper, lower and left walls, and on the right - the vestibule of the omental bursa.
The vestibule of the omental bursa, vestibulum bursae omentalis, its rightmost part, is located behind the hepatoduodenal ligament and is bounded above by the caudate lobe of the liver and the peritoneum covering it, below by the duodenum, and behind by the parietal peritoneum covering the inferior vena cava.
The anterior wall of the omental bursa is the lesser omentum (lig. hepatogastricum and lig. hepatoduodenale), the posterior wall of the stomach and lig. gastrocolicum; posterior - the parietal layer of the peritoneum, covering here the pancreas, aorta, inferior vena cava and nerve plexuses of the upper floor of the abdominal cavity;
upper - the caudate lobe of the liver and partially the diaphragm; lower - transverse mesentery
colon; on the left - the spleen and its ligaments - lig. gastrolienal et phrenicolienale.
The omental bursa can also be the site of the formation of purulent processes due to perforated stomach ulcers, purulent diseases of the pancreas, etc. In such cases, the inflammatory process is limited to the boundaries of the omental bursa, and when the omental foramen becomes overgrown with adhesions, it remains isolated from the rest of the abdominal cavity.
Surgical access to the omental bursa is most often carried out by dissecting the lig. gastrocolicum is closer to the left flexure of the colon, through the mesocolon transversum.
The right mesenteric sinus (sinus mesentericus dexter) is located to the right of the root of the mesentery; medially and inferiorly it is limited by the mesentery of the small intestine, superiorly by the mesentery of the transverse colon, and on the right by the ascending colon. The parietal peritoneum lining this sinus adheres to the posterior abdominal wall; behind it lie the right kidney, ureter, blood vessels for the cecum and ascending part of the colon.
The left mesenteric sinus (sinus mesentericus sinister) is slightly longer than the right one. Its boundaries: above - the mesentery of the transverse colon (level of the II lumbar vertebra), laterally - the descending part of the colon and the mesentery of the sigmoid colon, medially - the mesentery of the small intestine. The left sinus has no lower border and continues into the pelvic cavity. Under the parietal peritoneum pass the aorta, veins and arteries to the rectum, sigmoid and descending part of the colon; The left ureter and the lower pole of the kidney are also located there.
In the middle floor of the peritoneal cavity, the right and left lateral canals are distinguished.
The right lateral canal (canalis lateralis dexter) is a narrow gap, which is limited by the lateral wall of the abdomen and the ascending part of the colon. From above, the canal continues into the hepatic bursa (bursa hepatica), and from below, through the iliac fossa, it communicates with the lower floor of the peritoneal cavity (pelvic cavity).
The left lateral canal (canalis lateralis sinister) is located between the lateral wall and the descending colon. At the top it is limited by the phrenic-colic ligament (lig. phrenicocolicum dextrum), at the bottom the canal opens into the iliac fossa.
In the middle floor of the peritoneal cavity there are numerous depressions formed by folds of the peritoneum and organs. The deepest of them are located near the beginning of the jejunum, the terminal part of the ileum, the cecum and in the mesentery of the sigmoid colon. Here we describe only those pockets that occur constantly and are clearly defined.
The duodenum-jejunal recess (recessus duodenojejunalis) is limited by the peritoneal fold of the root of the mesentery of the colon and flexura duodenojejunalis. The depth of the depression ranges from 1 to 4 cm. It is characteristic that the fold of the peritoneum that limits this depression contains smooth muscle bundles.
The superior ileocecal recess (recessus ileocecalis superior) is located in the upper corner formed by the cecum and the terminal section of the jejunum. This depression is noticeably expressed in 75% of cases.
The lower ileocecal recess (recessus ileocecalis inferior) is located in the lower corner between the jejunum and the cecum. On the lateral side it is also limited by the vermiform appendix along with its mesentery. The depth of the recess is 3-8 cm.
The postcolic recess (recessus retrocecalis) is unstable, formed due to folds during the transition of the parietal peritoneum to the visceral one and is located behind the cecum. The depth of the recess ranges from 1 to 11 cm, which depends on the length of the cecum.
The intersigmoid recess (recessus intersigmoideus) is located in the mesentery of the sigmoid colon on the left.
