Anatomy of the peritoneum and peritoneal cavity

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Anatomy of the peritoneum and peritoneal cavity

USMLE® Step 1 questions

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Anatomy of the peritoneum and peritoneal cavity

Figure 1: Midsagittal view of the peritoneum and peritoneal cavity. 
Figure 2: Subdivisions of the peritoneal cavity. A. Midsagittal and B. Transverse sections showing the greater and lesser sacs. 
Figure 3: Lesser sac (Omental bursa). A. Midsagittal view. B. Anterior view with stomach reflected. C. Transverse section, inferior view.
Figure 4: Mesenteries of the intestines.
Figure 5: Greater and lesser omenta of the abdomen.
Figure 6: Development of the gut and mesenteries. A. Gut tube migrates from posterior abdominal wall, bringing the dorsal mesentery with it. B. Gut elongates and enlarges. C. Organs grow and rotate, resulting in twists in the mesenteries and peritoneal reflections (ligaments) that connect adjacent organs.

Figure 7: Schematic transverse sections showing the relationships of abdominal organs to the dorsal and ventral mesenteries during development.

A. Organs and mesenteries are in the midline during 5th week of development. B. The organs rotate to the right. C. and D. Fusion of a portion of the dorsal mesentery with the parietal peritoneum of posterior abdominal wall leaves the pancreas in a retroperitoneal position.

Figure 8: Embryological origin of the ventral mesentery. A. Ventral mesentery is derived from the septum transversum (mesoderm). B. Enlarging liver contacts the septum transversum, and portion of ventral mesentery covering the liver splits apart leaving a bare area of the liver, uncovered by visceral peritoneum.


USMLE® Step 1 style questions USMLE

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A partial liver resection is performed in a patient with an early stage hepatocellular carcinoma in the left lobe of the liver. During the procedure, a ligament is found that attaches the liver to the anterior abdominal wall. Which of the following structures are contained within this ligament?  


At first glance, the peritoneum and peritoneal cavity seem pretty simple, but some aspects, like the peritoneal ligaments, can be a bit confusing. In order to understand them, we need to go way back to their embryological formation. 
 Once upon a time, in an amniotic galaxy far far away, the embryonic body cavity is lined with mesoderm. As the fetus is developing, the embryonic body cavity becomes the primordial abdominal cavity and the mesoderm lining it becomes the parietal peritoneum which is a transparent, serous membrane that helps to form a closed sac, called the peritoneal cavity

As abdominal organs develop, they protrude into the peritoneum, like pushing your fist into a balloon. Your fist represents the developing abdominal viscera and the balloon represents the parietal peritoneum. As your fist pushes into the balloon it is lined closely by part of the balloon and this represents the visceral peritoneum. So, the visceral peritoneum covers the viscera, while parietal peritoneum lines the internal surface of the abdominopelvic wall; and these two layers are continuous with one another.  
The parietal peritoneum has the same blood and lymphatic supply and the same nerve supply as the region of the wall it lines, meaning it is sensitive to pressure, pain, heat and cold. The visceral peritoneum, on the other hand, has the same blood, lymphatic, and nerve supply as the viscera it covers, meaning it is sensitive to stretch and chemical irritation. 

Depending on their relationship with the peritoneum, abdominal and pelvic organs can be either intraperitoneal, retroperitoneal, or subperitoneal.  
Intraperitoneal organs are almost completely covered with visceral peritoneum, but remember they’re not inside the peritoneal cavity. These organs include the stomach, first part of the duodenum, jejunum, ileum, transverse colon, sigmoid colon, liver and spleen. 
 Now, the retroperitoneal organs, also known as primarily retroperitoneal, develop posterior to the peritoneal cavity, outside of the peritoneum, so they’re only partially covered with peritoneum. The retroperitoneal organs include the kidneys, ureters, suprarenal glands, and rectum. 

There are also secondarily retroperitoneal organs where they begin as intraperitoneal but later on in development become attached to the posterior abdominal wall. The secondarily retroperitoneal organs include the second to fourth parts of the duodenum, pancreas, and the ascending and descending colon. 
 Lastly, the subperitoneal organs, like the urinary bladder, are similar to the retroperitoneal organs, except they are located inferior to the peritoneal cavity, rather than posterior to it.  
The peritoneal cavity is a potential space between the parietal and visceral layers of the peritoneum. Keep in mind that the peritoneal cavity has no abdominal organs, it only contains a thin film of fluid that contains water, electrolytes and other substances derived from the interstitial fluid. The peritoneal fluid helps viscera move without friction, allowing for peristalsis, and it also has white blood cells and antibodies to resist infection.  
Quick quiz. Can you remember which organs are retroperitoneal and which organs are intraperitoneal?  
Now we are going to look at some of the peritoneal structures in adults. Let’s first start by looking at the omentum, which is a fold of peritoneum. There’s actually two of them: the greater omentum and the lesser omentum. 
The greater omentum is a four-layered peritoneal fold that hangs like an apron from the greater curvature of the stomach and the proximal part of the duodenum. After descending, it folds back and it attaches to the anterior surface of the transverse colon and its mesentery. These four layers fuse with one another.  
The lesser omentum is a double-layered peritoneal fold that connects the lesser curvature of the stomach and the proximal part of the duodenum to the liver. Posterior to the lesser omentum, there’s a space known as the lesser sac or omental bursa, and the rest of the peritoneal cavity is known as the greater sac. 


  1. "CARE OF THE NEW BORN REVISED 8ED (2017)" CBS Publishers & Distributors Private Limited (2014)
  2. "Knowledge is Power" Library and Archives Canada / Emergent Phenomenon Publishing (2019)
  3. "Grant's Dissector" Lippincott Williams & Wilkins (2012)
  4. "Peritoneal Physiology" Chronic Kidney Disease, Dialysis, and Transplantation (2019)
  5. "Surgical anatomy and anatomic surgery – Clinical and scientific mutualism" The Surgeon (2013)
  6. "Terminology and nomenclature in colonic surgery: universal application of a rule-based approach derived from updates on mesenteric anatomy" Techniques in Coloproctology (2014)
  7. "The subperitoneal space and peritoneal cavity: basic concepts" Abdominal Imaging (2015)
  8. "Chronic Kidney Disease, Dialysis, and Transplantation E-Book" Elsevier Health Sciences (2018)
  9. "The subperitoneal space and peritoneal cavity: basic concepts" Abdominal Imaging (2015)

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