TOPIC 218.

LOWER PART OF THE ABDOMINAL CAVITY

ABDOMINAL CAVITY → space in the trunk below the diaphragm. It is divided into the

abdominal cavity proper and pelvic cavity.

1. BORDERS

- Anterolateral:

Rectus abdominis

External oblique

Internal oblique

Transversus abdominis

- Posterior:

Lumbar segment of the spine

Psoas major

Quadratus lumborum

- Superior – diaphragm

- Inferior:

Iliac bones

Pelvic diaphragm

2. DIVISION

The abdominal cavity is divided into 2 storeys:

- UPPER STOREY

- LOWER STOREY

LOWER PART OF THE ABDOMINAL CAVITY

1. BORDERS

- Superior – transverse mesocolon

- Inferior – pelvic cavity

2. CONTENTS

- Right and left paracolic canals (gutters)

- Right and left mesenteric sinuses

- Mesentery
- Sigmoid mesocolon

- Duodenojejunal recess

- Superior and inferior ileocaecal recesses

- Large and small intestines

- Rectovesical pouch – in males

- Rectouterine pouch + uretrovesical pouch – in females

- Pelvic organs

PERITONEUM

- Serous membrane lining the abdominal and pelvic cavities

In males: closed

In females: communicates with the external environment by the uterine tubes

- Consists of 2 layers:

Parietal peritoneum

Visceral peritoneum

*Between them, the peritoneal cavity is located → contains peritoneal fluid

- The extraperitoneal tissue (tela subserosa) contains a large amount of fatty tissue that is

lodged between the peritoneum and the abdominal wall.

Richly developed on the posterior abdominal wall

Poorly developed on the anterior abdominal wall

1. PARIETAL PERITONEUM

- Fibrous tissue

- Lines the inner surface of the abdominal and pelvic cavities → forms the outer limit of

the peritoneal cavity

- Receives the same arterial and nerve supplies as the wall it lines

- More sensitive to pain because it is innervated by SOMATIC INNERVATION

oIn the pelvis – devoid of somatic innervation

2. VISCERAL PERITONEUM

- Composed of mesothelial cells

- Covers the outer surface of the abdominal visceral organs

- Receives the same arterial and nerve supplies as the organ it covers

- Innervated by AUTONOMIC INNERVATION

- Pain is only felt when the organ is distended or ischemic

RELATIONS OF VISCERAL ORGANS TO PERITONEUM

1. INTRAPERITONEAL ORGANS

- Completely (4 sides) covered by peritoneum

- Generally mobile → can be moved away to access deeper organs in surgery and prone to

herniation

- They are:

Stomach

Bulbus duodeni of the superior part of the duodenum

Jejunum

Ileum

Appendix

Transverse colon

Sigmoid colon

Supraampular part of the rectum

Spleen

Ovaries

2. MESOPERITONEAL ORGANS

- Covered by the peritoneum by 3 sides

- Degree of mobility is between the intraperitoneal and extraperitoneal organs

- They are:

Liver

Gall bladder

Ascending part of duodenum

Caecum

Ascending colon
Descending colon

Ampular part of the rectum

Urinary bladder (when distended)

Uterus

3. EXTRAPERITONEAL (RETROPERITONEAL) ORGANS

Covered by peritoneum by only 1 side

- Located in the retroperitoneal space

- Not movable at all

- They are:

Descending and horizontal parts of the duodenum

Anal canal

Pancreas

Kidneys

Adrenal glands

Ureters

Urinary bladder (when empty)

Major vessels like the abdominal aorta and the inferior vena cava

PERITONEAL FORMATION

1. MESENTERY

- Double layer peritoneum that occurs as a result of invagination of the peritoneum by the

small intestine.

- Connects the small intestine to the posterior abdominal wall

- Contains the neurovascular bundles that supply and drain the small intestine

- Forms the root of the mesentery (radix mesenterium) that divides the mesenteric sinus

into right and left.

oStarts from the 2nd lumbar vertebra and ends at the right iliac fossa

2. MESOCOLON

- It is the mesentery of the large intestine

- Contains the neurovascular bundles that supply and drain the parts of the large intestine
where they are connected to the posterior abdominal wall by mesocolon.

- Types of mesocolon:

Mesocolon transversum – connects the transverse colon to the posterior

abdominal wall

Mesocolon sigmoideum – connects the sigmoid colon to the posterior abdominal

wall

Mesoappendix (mesenteriolum appendicis vermiformis) – connects the appendix

to the posterior abdominal wall

3. OMENTUM

Duplicature of the mesentery which contains a large amount of fatty tissue.

- LESSER OMENTUM (Omentum Minus)

oStretches from the portal triad to the lesser curvature of the stomach and

proximal part of the duodenum

Formed by:

Hepatogastric ligament

Hepatoduodenal ligament

- GREATER OMENTUM (Omentum Majus)

Stretches from the greater curvature of the stomach to the transverse colon and

covers loops of the small intestine

Formed by 4 peritoneal layers → which are fused to form 2 laminae:

Anterior lamina

Starts from the greater curvature of the stomach and descends

anterior to the transverse colon

Descends almost up to the pubic bones and ascens to form the

posterior lamina.

The ligament which connects the stomach to the transverse colon

= gastrocolic ligament

Posterior lamina

Blends with the transverse colon and ascends up to the anterior

border of the pancreas where it is separated into 2 layers:

1 covers the anterior part of the pancreas and goes up to

the diaphragm

2 covers the inferior part of the pancreas and is continuous

with the mesocolon transversum

4. LIGAMENTS

- Connect the adjacent organs or connect the organ to the abdominal wall

- The nomenclature of the ligament reflects the organs that it connects:

Falciform ligament – connects the liver to the abdominal wall

Coronary ligament – connects the liver to the diaphragm

Triangular ligament of the liver

Hepatogastric ligament – connects the liver to the lesser curvature of the stomach

Hepatoduodenal ligament – connects the liver to the duodenum

Hepatocolic ligament – connects the liver to the colon

Hepatorenal ligament – connects the liver to the right kidney

Gastrophrenic ligament – connects the stomach to the diaphragm

Gastrolienal (gastrosplenic) ligament – connects the stomach to the spleen

Gastrocolic ligament – connects the stomach to the transverse colon

Gastropancreatic ligament – connects the stomach to the pancreas

Phrenicoesophageal ligament – connects the diaphragm to the oesophagus

Phrenicocolic ligament – connects the diaphragm to the colon

Phrenicorenal ligament – connects the diaphragm to the kidney

Phrenicolienal ligament – connects the diaphragm to the spleen

Pancreaticolienal ligament – connects the pancreas to the spleen

Lienorenal ligament – connects the spleen to the left kidney

Pyloropancreatic ligament – connects the pylorus to the pancreas

Duodenorenal ligament – connects the duodenum to the right kidney

5. RECESSES

They are pouches that are formed by the peritoneal folds. They are places of retroperitoneal
herniation.

- Duodenojejunal recess

- Superior ileocaecal recess

- Inferior ileocaecal recess

- Retrocaecal recess

- Intersigmoid recess

6. FOLDS

They are the reflection of the peritoneum that rises from the abdominal wall by the

underlying structures.

- Gastropancreatic fold

- Ileocaecal fold

- Superior duodenal fold

- Inferior duodenal fold

- Median umbilical fold

- Medial umbilical fold

- Lateral umbilical fold

7. SINUSES

There are 2 sinuses, which are the right and left mesenteric sinuses

- RIGHT MESENTERIC SINUS

Closed

BORDERS

Medial – root of the mesentery

Lateral – ascending colon

Superior – transverse colon

- LEFT MESENTERIC SINUS

Communicates with the lesser pelvis

BORDERS

Medial – descending colon

Lateral – root of the mesentery

Inferior – sigmoid colon

8. PARACOLIC CANALS (lateral abdominal canals)

They consist of 2 paracolic canals, which are the right and left.

- RIGHT PARACOLIC CANAL

Communicates with the right hepatic bursa

BORDERS

Medial – ascending colon

Lateral – parietal peritoneum

Inferior – caecum

- LEFT PARACOLIC CANAL

Communicates with the lesser pelvis

BORDERS

Medial – descending colon

Lateral – parietal peritoneum

Superior – phrenicocolic ligament