Anatomy of the peritoneum and peritoneal cavity

Last updated: November 01, 2022

Anatomy of the peritoneum and peritoneal cavity

Surgery Rotation-PreReq

Surgery Rotation-PreReq

Abdominal quadrants, regions and planes
Anatomy of the abdominal viscera: Esophagus and stomach
Anatomy of the abdominal viscera: Innervation of the abdominal viscera
Anatomy of the abdominal viscera: Kidneys, ureters and suprarenal glands
Anatomy of the abdominal viscera: Large intestine
Anatomy of the abdominal viscera: Liver, biliary ducts and gallbladder
Anatomy of the abdominal viscera: Pancreas and spleen
Anatomy of the abdominal viscera: Small intestine
Anatomy of the female reproductive organs of the pelvis
Anatomy of the gastrointestinal organs of the pelvis and perineum
Anatomy of the male reproductive organs of the pelvis
Anatomy of the peritoneum and peritoneal cavity
Anatomy of the urinary organs of the pelvis
Anatomy of the vessels of the posterior abdominal wall
Anatomy clinical correlates: Female pelvis and perineum
Anatomy clinical correlates: Male pelvis and perineum
Anatomy clinical correlates: Other abdominal organs
Anatomy clinical correlates: Peritoneum and diaphragm
Anatomy clinical correlates: Viscera of the gastrointestinal tract
Bile secretion and enterohepatic circulation
Gastrointestinal system anatomy and physiology
Liver anatomy and physiology
Pancreatic secretion
Appendicitis: Pathology review
Diverticular disease: Pathology review
Gallbladder disorders: Pathology review
GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review
Pancreatitis: Pathology review
Anatomy of the anterolateral abdominal wall
Anatomy of the inguinal region
Anatomy of the muscles and nerves of the posterior abdominal wall
Anatomy clinical correlates: Anterior and posterior abdominal wall
Anatomy clinical correlates: Inguinal region
Buffering and Henderson-Hasselbalch equation
Physiologic pH and buffers
The role of the kidney in acid-base balance
Acid-base disturbances: Pathology review
Anatomy of the breast
Anatomy clinical correlates: Breast
Mammary gland histology
Estrogen and progesterone
Oxytocin and prolactin
Benign breast conditions: Pathology review
Breast cancer: Pathology review
Anatomy of the thyroid and parathyroid glands
Anatomy clinical correlates: Vessels, nerves and lymphatics of the neck
Anatomy clinical correlates: Viscera of the neck
Adrenal gland histology
Thyroid and parathyroid gland histology
Calcitonin
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Endocrine system anatomy and physiology
Parathyroid hormone
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Cushing syndrome and Cushing disease: Pathology review
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Multiple endocrine neoplasia: Pathology review
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Parathyroid disorders and calcium imbalance: Pathology review
Thyroid nodules and thyroid cancer: Pathology review
Introduction to the lymphatic system
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Osmoregulation
Potassium homeostasis
Renin-angiotensin-aldosterone system
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Cirrhosis: Pathology review
Deep vein thrombosis and pulmonary embolism: Pathology review
Diabetes insipidus and SIADH: Pathology review
Electrolyte disturbances: Pathology review
Heart failure: Pathology review
Nephrotic syndromes: Pathology review
Renal failure: Pathology review
Anatomy of the abdominal viscera: Blood supply of the foregut, midgut and hindgut
Enteric nervous system
Esophageal motility
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Viral hepatitis: Pathology review
Gallbladder histology
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Jaundice: Pathology review
Anatomy of the diaphragm
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Anatomy of the lungs and tracheobronchial tree
Anatomy of the pharynx and esophagus
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Respiratory system anatomy and physiology
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Fat-soluble vitamin deficiency and toxicity: Pathology review
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Water-soluble vitamin deficiency and toxicity: B9, B12 and vitamin C: Pathology review
Anatomy of the ascending spinal cord pathways
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Anatomy of the perineum
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Acetaminophen (Paracetamol)
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Blood pressure, blood flow, and resistance
Carbon dioxide transport in blood
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Frank-Starling relationship
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Law of Laplace
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Anatomy of the axilla
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Eye conditions: Inflammation, infections and trauma: Pathology review
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Colon histology
Small intestine histology
Stomach histology
Development of the digestive system and body cavities
Development of the gastrointestinal system
Colorectal polyps and cancer: Pathology review
How to deliver bad news
Empathetic listening for clinicians
Shared decision-making

Notes

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.
UNLABELLED
Illustrator: Patricia Nguyen, MScBMC
Editor: Kaitlin Marshall, MSc., BSc.
Editor: Leah Labranche, PhD, MSc, BSc(Hons)
Editor: David Clay, MSc., BSc.
Editor: Andrew Horne, MSc., BSc.

Transcript

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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. 

These two spaces communicate through the omental foramen, also called the epiploic foramen.

Anterior to the omental foramen, there’s the hepatoduodenal ligament, which is the free edge of the lesser omentum that contains the portal triad. Posterior to the omental foramen, is the inferior vena cava and the right crus of the diaphragm. Superior to the omental foramen is the liver, and inferior to the omental foramen is the first part of the duodenum. 

The peritoneal cavity as a whole is divided by the transverse mesocolon into a supracolic compartment and an infracolic compartment. 
 The supracolic compartment contains the stomach, liver and spleen. The infracolic compartment is located posterior to the greater omentum and contains the small intestine, as well as the ascending and descending colon. Communication between the supracolic and infracolic compartments happens through the paracolic gutters, which are grooves between the lateral aspect of the ascending or descending colon and the posterolateral abdominal wall

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