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|The peritoneum, coloured in blue|
|Gray's||subject #246 1149|
|The epiploic foramen, greater sac or general cavity (red) and lesser sac, or omental bursa (blue). (Areas outlined in blue and red correspond to above diagram.)|
The peritoneum is the serous membrane that forms the lining of the abdominal cavity or the coelom — it covers most of the intra-abdominal (or coelomic) organs — in higher vertebrates and some invertebrates (annelids, for instance). It is composed of a layer of mesothelium supported by a thin layer of connective tissue. The peritoneum both supports the abdominal organs and serves as a conduit for their blood and lymph vessels and nerves.
The abdominal cavity (the space bounded by the vertebrae, abdominal muscles, diaphragm and pelvic floor) should not be confused with the intraperitoneal space (located within the abdominal cavity, but wrapped in peritoneum). For example, a kidney is inside the abdominal cavity, but is retroperitoneal.
Although they ultimately form one continuous sheet, two types or layers of peritoneum and a potential space between them are referenced:
- The outer layer, called the parietal peritoneum, is attached to the abdominal wall.
- The inner layer, the visceral peritoneum, is wrapped around the internal organs that are located inside the intraperitoneal cavity.
- The potential space between these two layers is the peritoneal cavity; it is filled with a small amount (about 50 ml) of slippery serous fluid that allows the two layers to slide freely over each other.
- The term mesentery is often used to refer to a double layer of visceral peritoneum. There are often blood vessels, nerves, and other structures between these layers. It should be noted that the space between these two layers is technically outside of the peritoneal sac, and thus not in the peritoneal cavity.
There are two main regions of the peritoneum, connected by the epiploic foramen:
- the greater sac (or general cavity of the abdomen), represented in red in the diagrams above.
- the lesser sac (or omental bursa), represented in blue. The lesser sac is divided into two "omenta":
- The lesser omentum (or gastrohepatic) is attached to the lesser curvature of the stomach and the liver.
- The greater omentum (or gastrocolic) hangs from the greater curve of the stomach and loops down in front of the intestines before curving back upwards to attach to the transverse colon. In effect it is draped in front of the intestines like an apron and may serve as an insulating or protective layer.
|dorsal mesentery||* greater omentum||greater curvature of stomach (and spleen)|
|dorsal mesentery||** gastrosplenic ligament||stomach||spleen||short gastric artery, left gastro-omental artery|
|dorsal mesentery||** gastrophrenic ligament||stomach||diaphragm||left inferior phrenic artery|
|dorsal mesentery||** gastrocolic ligament||stomach||transverse colon||right gastro-omental artery -|
|dorsal mesentery||** splenorenal ligament||spleen||kidney||splenic artery, tail of pancreas|
|ventral mesentery||* lesser omentum||lesser curvature of the stomach (and duodenum)|
|ventral mesentery||** hepatogastric ligament||stomach||liver||right & left gastric artery|
|ventral mesentery||** hepatoduodenal ligament||duodenum||liver||hepatic artery proper, hepatic portal vein, bile duct|
|dorsal mesentery||* Mesentery proper||small intestine – jejunum and ileum||posterior abdominal wall||superior mesenteric artery|
|dorsal mesentery||* transverse mesocolon||transverse colon||posterior abdominal wall||middle colic|
|dorsal mesentery||* sigmoid mesocolon||sigmoid colon||pelvic wall||sigmoid arteries|
|dorsal mesentery||* mesoappendix||mesentery of ileum||appendix||appendicular artery|
|OTHER LIGAMENTS AND FOLDS|
|ventral mesentery||* falciform ligament||liver||thoracic diaphragm, anterior abdominal wall||round ligament of liver, paraumbilical veins|
|left umbilical vein||* round ligament of liver||liver||umbilicus|
|ventral mesentery||* coronary ligament||liver||thoracic diaphragm|
|ductus venosus||* ligamentum venosum||liver||liver|
|* phrenicocolic ligament||left colic flexure||thoracic diaphragm|
|ventral mesentery||* left triangular ligament, right triangular ligament||liver|
|* umbilical folds||urinary bladder|
|* ileocecal fold||ileum||cecum|
|* broad ligament of the uterus||uterus||pelvic wall||mesovarium, mesosalpinx, mesometrium|
|* ovarian ligament||uterus||inguinal canal|
|* suspensory ligament of the ovary||ovary||pelvic wall||ovarian artery|
In addition, in the pelvic cavity there are several structures that are usually named not for the peritoneum, but for the areas defined by the peritoneal folds:
|Name||Location||Genders possessing structure|
|Rectovesical pouch||between rectum and urinary bladder||male only|
|Rectouterine pouch||between rectum and uterus||female only|
|Vesicouterine pouch||between urinary bladder and uterus||female only|
|Pararectal fossa||surrounding rectum||male and female|
|Paravesical fossa||surrounding urinary bladder||male and female|
The peritoneum develops ultimately from the mesoderm of the trilaminar embryo. As the mesoderm differentiates, one region known as the lateral plate mesoderm splits to form two layers separated by an intraembryonic coelom. These two layers develop later into the visceral and parietal layers found in all serous cavities, including the peritoneum.
As an embryo develops, the various abdominal organs grow into the abdominal cavity from structures in the abdominal wall. In this process they become enveloped in a layer of peritoneum. The growing organs "take their blood vessels with them" from the abdominal wall, and these blood vessels become covered by peritoneum, forming a mesentery.
In one form of dialysis, the peritoneal dialysis, a glucose solution is run through a tube into the peritoneal cavity. The fluid is left there for a prescribed amount of time to absorb waste products, and then removed through the tube. The reason for this effect is the high number of arteries and veins in the peritoneal cavity. Through the mechanism of diffusion, waste products are removed from the blood.
Classification of abdominal structures
The structures in the abdomen are classified as intraperitoneal, retroperitoneal or infraperitoneal depending on whether they are covered with visceral peritoneum and whether they are attached by mesenteries (mensentery, mesocolon).
|Intraperitoneal||Retroperitoneal||Infraperitoneal / Subperitoneal|
|Stomach, First part of the duodenum [5 cm], jejunum, ileum, Cecum, appendix, transverse colon, sigmoid colon, Rectum, upper 1/3||The rest of the duodenum, ascending colon, descending colon, Rectum (middle 1/3)||Rectum (lower 1/3)|
|Kidneys, adrenal glands, proximal ureters, renal vessels||Urinary bladder, distal ureters|
|In women: Uterus, Fallopian tubes, ovaries||Gonadal blood vessels|
|Inferior vena cava, Aorta|
Structures that are intraperitoneal are generally mobile, while those that are retroperitoneal are relatively fixed in their location.
Some structures, such as the kidneys, are "primarily retroperitoneal", while others such as the majority of the duodenum, are "secondarily retroperitoneal", meaning that structure developed intraperitoneally but lost its mesentery and thus became retroperitoneal.
Peritoneum is derived from Greek via Latin. Peri- means around, while -ton- refers to stretching. Thus, peritoneum means stretched around or stretched over.
- Tortora, Gerard J., Anagnostakos, Reginald Merryweather, Nicholas P. (1984) Principles of Anatomy and Physiology, Harper & Row Publishers, New York ISBN 0-06-046656-1
Peritoneal ligaments, mesenteries, and folds
Hepatoduodenal ligament - Hepatogastric ligament
Gastrophrenic ligament - Gastrocolic ligament - Gastrosplenic ligament
Falciform ligament (Round ligament of liver, Ligamentum venosum) - Coronary ligament (Left triangular ligament, Right triangular ligament, Hepatorenal ligament)
Broad ligament of the uterus (Mesovarium, Mesosalpinx, Mesometrium) - Ovarian ligament - Suspensory ligament of the ovary
Splenorenal ligament - Phrenicocolic ligament - Pulmonary ligament
Transverse mesocolon - Sigmoid mesocolon - Mesoappendix
Umbilical folds (Supravesical fossa, Medial inguinal fossa, Lateral inguinal fossa) - Ileocecal fold
Rectouterine pouch - Vesicouterine excavation - Rectovesical excavation - Pararectal fossa - Paravesical fossa
Greater sac - Lesser sac - Foramen of Winslow
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