Full transcript of “Peritoneum, Peritoneal Cavity, Lesser Sac, Greater Sac and Peritoneal Recesses, Dr Adel Bondok”. Click a timestamp to open the video at that moment. Need another video? Use the YouTube transcript generator.
0:10 Hello everyone. This is Dr. Adel Banduk, professor of anatomy and neuroscience Mansoura University, Egypt. I will talk about the peritoneum. What is the peritoneum? What is the organization of the peritoneum? It is organized into two layers, a peritoneum and a visceral layer. We'll talk about the peritoneal folds like lesser momentum and greater momentum functions, blood supply and nerve supply. Then the peritoneal cavity and the peritoneal recesses or spaces. Regarding the peritoneum, the definition of the peritoneum. The peritoneum is a serious membrane
0:59 lining the abdominal wall and surrounding the viscera. lining the abdominal wall, anterior abdominal wall and the posterior abdominal wall and the surrounding the viscera. Okay, this is the ascending colon. Okay, this is a parietal layer of the peritoneum and this is the visceral layer of the peritoneum. So it is a serous membrane like the pleura and the pericardium. Regarding the organization, it is organized into two layers, parietal layer lining the abdominal wall, anterior abdominal wall, and the posterior abdominal wall, and the visceral layer surrounding the visceral and the form folds, which
1:45 suspend the organ from the posterior abdominal wall. The space between the parietal layer and the visceral layer is the peritoneal cavity. Okay, regarding the peritoneal folds, Peritoneal folds which suspend the organs from the posterior abdominal wall. I will talk about the formation and the names. Regarding the formation, some organs are retroperitoneal, are covered only anteriorly with peritoneum. So these organs, like the kidney, they don't have peritoneal folds. Other organs are also retroperitoneal, like the ascending colon and the descending
2:33 colon. They are covered in front and the sides with peritoneum. So these organs, they don't have folds. Okay. This is the ascending colon covered in front and the sides. Okay. Okay, ascending colon, descending colon, covered in front and sides. So they don't have folds. Other organs, like the small intestine, are completely covered with peritoneum and suspended from the posterior abdominal wall by a fold of peritoneum, which is called the mesentery. This one, this is the mesentery. Okay, regarding the names, if the fold is attached to the stomach, it is called omentum. So omentum,
3:19 omentum in case of the stomach, like the lesser omentum and the greater omentum. Okay. If it is attached to the small intestine, okay, this is a small intestine. Okay. It is called the mesentery. If it is attached to the colon, it is called the mesocolon. If it is attached to the large intestine, okay, mesocolon. If it is attached to the liver and the spleen, it's called the ligament. like falciform ligament between the liver and the anterior abdominal wall coronary and the triangular ligaments between the liver and the diaphragm gastrosplenic ligament between the spleen and the stomach and the line or in a ligament between the spleen and the kidney
4:10 so we have seven major peritoneal faults The seven major peritoneal folds are okay. This is the liver, stomach, transversiculum, and pancreas. The first one is the lesser omentum. This is the lesser omentum between the liver and the stomach. It is also called gastro-hepatic ligament. Okay. Second one, this one. It is the greater omentum. The greater omentum connecting the stomach with the transverse colon. We can call it gastrocholic ligament. The third one is the mesentery of the small intestine between the small intestine and the posterior abdominal wall. Okay, this is the mesentery of the small intestine. And then transverse
4:56 mesocolon and also sigmoid mesocolon. Okay, and falciform ligament between the liver and the anterior abdominal wall. gastro-splinic ligament between the spleen and the stomach and the line or renal ligament between the spleen and the kidney. We'll see these ligaments in the other slides. Okay, regarding the omenta, lesser omentum, this is the stomach, okay? This is the stomach, lesser omentum, this is the lesser omentum, and this is the greater omentum, okay? Greater omentum. So lesser omentum and greater omentum. Regarding the lesser omentum, this is the lesser omentum.
5:45 The lesser omentum, it extends between the lesser curvature of the stomach. This is the lesser curvature of the stomach. And the first part of the duodenum. Okay, lesser curvature and the first part of the duodenum to the liver. Where? To fissure for ligamentum venosa and porta hepatis. This lesser omentum has two parts. One connecting the liver with the stomach. This part is called gastro-hebatic ligament or hepatogastric ligament. Okay. The other one connecting the liver with the deuterum, hepatodiodenal ligament. So hepatogastric ligament and hepatodiodenal ligaments are the two parts of the lesser
6:32 omentum. I will talk about the details when I discuss the stomach. Then this is the greater momentum. Okay, greater momentum. And this also the greater momentum. The greater momentum is formed of four layers, anterior two layers and the posterior two layers. It extends from the greater curvature of the stomach. This is the stomach. Okay, stomach extends between the greater curvature of the stomach till the transverse colon. This is the transverse colon. Okay, anterior two layers and the posterior two layers and between the anterior two layers and the posterior two layers is the cavity of the lesser sac. Okay, so the
7:19 greater momentum between the greater curvature of the stomach and the transverse colon. Then the mesocolon. This is the transverse colon. Okay, and this is the transverse mesocolon Transversy mesocolon actually connecting the transversy colon with the body of the pancreas. Okay. Transversy mesocolon. So regarding the colon, which parts of the colon have mesocolon? This is the first one. This is the transversy mesocolon. Okay. It's attached to the transversy colon. This is the second one. It is a
8:08 sigmoid mesocolon. It is attached to the sigmoid colon. And this is the third one. It is a meso appendix. Okay. It is a mesentery or of the appendix. Okay. So we have three parts of the colon have mesocolon transverse colon, sigmoid colon and appendix. So these parts are mobile. The transverse colon is mobile. The sigmoid colon is mobile and the appendix is also mobile. Okay. This is a cross section of the abdomen. This is the liver. This is the stomach, spleen and kidney. Okay. So of course, okay. Between the liver and the anterior abdominal wall, this ligament is the falciform
8:57 ligament. Okay, between the stomach and the spleen, this is the gastro-splenic ligament or gastro-splenic omentum. This between the spleen and the kidney, it is the lino-renal ligament. Okay, and this is the falci-form ligament between the liver and the anterior abdominal wall. And this is the lesser omentum. Okay. What are the functions of the peritoneum? Okay. The first function is protection of the abdominal organs. It maintains their position by suspending them by ligaments. So protection and maintaining
9:46 their position, the position of the abdominal organs. Second one, it secretes fluid, peritoneal fluid or serous fluid. Labrication, it lubricates the surface of the organs by secreting serious fluid to prevent the friction between the organs. The greater momentum, this one, the greater momentum is called the placement of the abdomen. It fights intra-abdominal infection. And it provides passages for blood vessels, lymphatics and nerves to the viscera. So protection maintains a position of the organs lubrication of the surface of the
10:33 organs to prevent the friction placement of the abdomen is a greater momentum and provide passages for blood vessels, lymphatics and the nerves to the viscera. Regarding the blood supply and the nervous supply of the peritoneum, parietal layer and visceral layer, parietal layer is similar to the abdominal wall visceral layer is similar to the visceral so the parietal layer yes parietal layer is similar to the body wall in blood supply and the nervous supply visceral layer is similar to the visceral in blood supply and the nervous supply so the nervous supply of the parietal layer is from the nervous supply of the abdominal wall lower six thoracic nervous
11:21 Okay, and then L1, it you hypogastric and the L you inguinal nervous and also the phrenic nerve to the roof of the peritoneum or of the peritoneal cavity. Regarding the visceral layer, it is supplied by autonomic nervous of the related visceral regarding the blood supply. Okay, because the parietal layer is supplied by somatic nervous, it is painful. It is sensitive to pain and the visceral layer is sensitive only to stretch. It is not sensitive to pain but to stretch. Regarding the blood supply, the parietal layer is supplied by the arteries of the body
12:08 wall. The visceral layer is supplied by the arteries of the related viscera. Regarding the lymph drainage, same lymph drainage, the parietal layer drains into the lymphatics of the body wall. The visceral layer drains into the lymphatics of the related visceral. Then we'll talk about the peritoneal cavity. The peritoneal cavity is the cavity between or is the potential space between the parietal layer
12:55 and the visceral layer of the peritoneum. This peritoneal cavity in the male is completely closed sac. So it is completely. closed sac in the males. How about the females? In the females, it is not completely closed because the uterine tubes open into the peritoneal cavity. So the peritoneal cavity is the space between the parietal layer, potential space between parietal layer and the visceral layer. It is completely closed sac in the males. It is not completely closed in the females because the uterine tubes open into the peritoneal cavity. Regarding the contents
13:43 of the peritoneal cavity, the peritoneal cavity normally contains thin film of serous fluid. This ferous serous fluid is formed of water, electrolytes, leukocytes, and antibodies. the peritoneal cavity may contain abnormal collection of fluid so abnormal collection of what abnormal collection excessive serious fluid which is called ascites okay so excessive serious fluid ascites or pass in case of peritonitis inflammation or blood in case of internal hemorrhage. So the contents of the peritoneal cavity normally it contains only thin film of serous fluid for
14:30 lubrication of the organs, but abnormal collection like ascites, like in ascites, okay, excessive serous fluid or pus in case of peritonitis or blood in case of internal hemorrhage. Regarding the divisions of the peritoneal cavity, liver, stomach, transverse colon, and this is the pancreas. Okay? The peritoneal cavity is divided into two sacs. The first one is called lesser sac or omental bursa, and the lesser sac is located behind the stomach. This is the lesser sac. Okay? Lesser sac. mental
15:17 bursa and the second sac is the greater sac which is the main part okay it is anterior to the stomach between the stomach and the anterior abdominal wall so lesser sac behind the stomach greater sac in front of the stomach the two sacs are completely separated from each other except at the epiploic foramen where the two sacs communicate Okay, this is the epiploic foramen. So the divisions of the peritoneal cavity, it is divided into greater sac, which is the main part and lesser sac behind the stomach and the two sacs communicate by epiploic foramen.
16:02 Regarding the lesser sac, this is the liver, stomach, transverse colon and the pancreas. Regarding the lesser sac, it is located behind the stomach. So this is the lesser sac. So what are the boundaries? Okay. Anterior wall of the lesser sac. This is the anterior wall of the lesser sac. Four structures. The first structure is this one. Lesser omentum. So anterior wall. Lesser omentum. And then the stomach. And then the anterior two layers. Okay. Lesser omentum. Okay, could it look of the liver first or the lobe of the liver, lesser momentum,
16:48 stomach and then the anterior two layers. Okay, stomach and then anterior two layers of the greater momentum. So anterior layer and the role of the lesser sac for structures could it look of the liver lesser momentum, posterior surface of the stomach and anterior two layers of the greater momentum. The posterior wall also for structures. Okay, posterior wall, this is the posterior wall. Okay, so number one, posterior two layers of the greater momentum. Then the transverse colon. Then the transverse mesocolon. And then the structures in front, the structures forming the stomach bed. Okay? Or peritoneum covering
17:36 the stomach bed. Regarding the roof, this is the roof. It is the reflection of the peritoneum. Okay. Okay. So it is a peritoneum lining the diaphragm regarding the floor. The floor, it is the space between the anterior two layers and the posterior two layers of the greater momentum. Again, boundaries of the lesser sac. Liver, stomach, transverse colon, peritoneum. Anterior rule for structures. Okay. This is the lesser sac. So anterior rule. Four structures. This is the first one. Okay. It is the codeate loop of the liver. This is the lesser momentum. Posterior surface of the stomach. Anterior two layers of the
18:24 greater momentum. Then the posterior role. Four structures. Posterior two layers of the greater momentum. Transverse colon. Transverse mesocolon. And then peritoneum covering the stomach bit. Okay, in front of the body of the pancreas. The transverse mesocolon connects the transverse colon with the body of the pancreas. Then the roof. It is the peritoneum lining the diaphragm. Then the floor. Okay, it is the inferior recess. It is the peritoneum. It is the space between anterior two layers and the posterior two layers of the greater omentum.
19:11 Again, boundaries of the lesser sac. Left side and right side. Right border. This is the right border of the lesser sac. It is the right border of the greater momentum. This is the right border of the greater momentum in the lower part. And in the upper part, it is the epipeloid for a human. It is the opening to the lesser sac. Regarding the left border. left border lower part is the left border of the greater momentum. This is the left border of the greater momentum. Okay. And the upper part is the angle between two ligaments angle between gastro splenic ligament and the line or renal
19:56 ligament. So this is the splenic recess of the lesser sec splenic recess. Regarding the epiploic foramen, this is the epiploic foramen. Okay. anterior wall of the epipleic foramen is the free margin of the lesser momentum and the free margin of the lesser momentum contains three structures. So free margin of the lesser momentum containing three structures. The first one is the bile duct anterior and to the right. Second one is the hepatic artery anterior and to the left. And third one is the portal vein behind the duct and the artery.
20:42 So the anterior wall of the epiploic foramen, if you put your finger in the epiploic foramen, the structures in front of your finger are three. Bile duct anterior and to the right, hepatic artery anterior and to the left, and the portal vein behind the two. Posteriorly, it is the inferior vena cava. Superiorly, it is the quodate porosis of the quodate lobe of the liver. and inferiorly it is the first part of the deugenium. So this is the epiploic foramen. Again, epiploic foramen. This is the lesser omentum. Okay. This is the lesser sac. This is the splenic recess of the
21:28 lesser sac. And this is the epiploic foramen. So anterior. This is the gastrosplenic ligament. And this is the line or renal ligament. Okay, splenic recess. So anteriorly, it is the free margin of the lesser momentum. This free margin of the lesser momentum contains the three structures. Bile duct anterior and to the right. Hepatic artery anterior and to the left. And the portal vein behind the two. Posteriorly, it is the inferior vena cava. And this is the splenic recess of the lesser sac. Regarding the greater sac, greater sac,
22:14 the blue, the green structure, greater sac, it is divided into, it is divided by the lesser momentum, the stomach, the greater momentum, transverse colon, And the transverse with the colon is divided by these structures into anterior compartment and the posterior compartment. This is the anterior compartment. And this is the posterior compartment. Anterior compartment in front of the lesser omentum, in front of the stomach, and in front of the greater omentum. This is the anterior compartment of the
23:03 greater sex. Posterior compartment. Okay. Anterior compartment behind the anterior abdominal wall posterior to the anterior abdominal. Posterior compartment. This is a posterior compartment. Anterior to the posterior abdominal wall. Yes. And the posterior to the greater omentum transversy colon and the transversy mesocolon. Subdivisions of the greater sec. The greater sec is divided by the transversy mesocolon. Okay. transverse mesocolon attached to this transverse colon into supra-colic compartment and the infracolic compartment. This supra-colic compartment contains the
23:48 stomach, the liver, the gallbladder, the spleen, okay, and the deuterium. The infracolic compartment, this is the infracolic compartment. The infracolic compartment below the transverse mesocolon, it contains a small intestine and ascending and descending colon. So the greater sec is divided into anterior compartment and the posterior compartment. Okay, anterior compartment in front of the stomach. posterior compartment behind the greater momentum transverse colon and the transverse mesocolon it is subdivided into supra colic compartment and the infracolic compartment by the transverse mesocolon the supra colic compartment contains stomach and discipline
24:37 liver and gallbladder the infracolic compartment contains a small intestine okay and ascending colon and descending colon Regarding the peritoneal recesses, peritoneal spaces, we have five spaces. The five spaces are lesser sac, omental persa, and the lesser sac is the largest peritoneal recess. And then four paracolic gutters. Two on the right side and two on the left side. Two related to the ascending colon and two related to the descending colon.
25:25 duodenal fossi three and the three seqal recesses related to the seql and the subpharenic spaces four subpharenic spaces two in front of the liver and two behind the liver okay so we finished with the lesser sac regarding the paracolic gutters paracolic gutters one Okay, on each side of the ascending column and the descending column. So paracolic gutters, okay, two right, two right related to the ascending column, one medial and one lateral to the ascending column. So paracolic gutters, medial
26:12 and lateral to the ascending column, and also two on the left side, okay, one medial and one lateral to the descending column. So paracolic gutters, this is a sentence colon. So this is lateral and this is medial. This is a descendant colon. This is lateral and this is medial. So for paracolic gutters. Then duodenal fussy. The duodenal fussy are three. This is the fourth part of the duodenum. Okay, fourth part of the deuterium, and this is the geogenome, and this is the deuterium geogenome flexure. The deuterium fosses are related to
26:58 the fourth part of the deuterium. Okay, so three. This is the first one, superior deuterium fosses. This is the second one, inferior deuterium fosses. Okay, and this is the third one, para deuterium fosses on the left side. Okay, paradiudanal fossa or left paradiudanal fossa. It is related to the inferior mesentric vein. What is the clinical importance of the duodenal fossa? Small intestine may enter this fossa and it gets strangulated. Okay, so coils of small intestine may enter aneurysis. Okay, and form internal hernia.
27:46 which can lead to strangulation. So these are the sites of internal herniation. Regarding the seqal recesses, this is the seql. The seql is related to three recesses. This is the first one, superior iliosecal recess. Second one, inferior iliosecal recess. Okay, between the appendix and the ilium. And this is the third one, illio retrocecal recess this retrocecal recess usually contains the appendix and also the clinical importance is it is is they are sites of internal herniation okay which can lead to internal which can lead to strangulation
28:37 okay regarding the subphrenic spaces suffering spaces between the liver and the diaphragm the subpharynx spaces are potential spaces between the diaphragm and the liver we have two anterior and two posterior the two anterior subpharynx spaces are separated by the falciform ligament this falciform ligament of the liver separates the two anterior subpharynx spaces left anterior subpharynx space and the right sub anterior subpharenic space. The two posterior subpharenic spaces, the two posterior subpharenic spaces, one on the left side and one on the right
29:24 side. The one on the left side is the lesser sac. The one on the right side between the liver and the kidney, it is the hepatorenal space. Hepatorenal space. The left posterior subpharenic space is the lesser sac. Okay, subpharenic abscess. Subphrenic abscess is accumulation of pass in the left or right subphrenic space. Due to increase the frequency of appendicitis or ruptured duodenal ulcer. Pass ascends to the subphrenic space via the right paracolic gutter. So the subphrenic abscess is usually on the right side. It's usually on the right side.
30:11 subphrenic space. Okay, due to the increased frequency of appendicitis and ruptured or perforated due to an ulcer. And thank you very much. Best wishes and good luck.
