Fascia Van Treitz

Stephen R. Baker, M.D. Professor and Chairman Department of Radiology University Hospital C320 UMD New Jersey Medical School 150 Bergen Street Newark, NJ USA

Alfred S. Berne, M.D. Professor of Radiology SUNY Health Science Center 750 East Adams Street Syracuse, NY USA

Chusilp Charnsangavej, M.D.

Professor of Radiology

Department of Diagnostic Radiology

The University of Texas M.D. Anderson Cancer Center

1515 Holcombe Boulevard

Houston, TX

Kyunghee C. Cho, M.D. Professor of Radiology Department of Radiology University Hospital C320 UMD New Jersey Medical School 150 Bergen Street Newark, NJ USA

Michiel A.M. Feldberg, M.D., Ph.D. Professor of Radiology Department of Radiology University Hospital Utrecht Heidelberglaan 100 Utrecht 3584 CX Netherlands

Bruce Javors, M.D.

Chief of G. I. Radiology

Vice-Chairman

Department of Radiology

St. Vincents Hospital and Medical Center

New York, NY

Hiromu Mori, M.D.

Professor and Chairman

Department of Radiology

Oita Medical University

Hasama-Machi

Oita 879-55

Japan

Michael Oliphant, M.D.

Chief of Radiology and Medical Director

Department of Medical Imaging

Crouse Hospital

736 Irving Avenue

Syracuse, NY

Clinical Professor of Radiology SUNY Health Science Center Syracuse, NY USA

Catherine Roy, M.D. Professor of Radiology Chef de Service Service de Radiologie B

Les Hopitaux Universitaires de Strasbourg—BP426

F-67091 Strasbourg Cedex

France

Maarten S. van Leeuwen, M.D., Ph.D. Department of Radiology University Hospital Utrecht Heidelberglaan 100 Utrecht 3584 CX Netherlands

Ronald Wachsberg, M.D. Associate Professor of Radiology Department of Radiology University Hospital C320 UMD New Jersey Medical School 150 Bergen Street Newark, NJ USA

Sobotta Peritoneal Cavity
Fig. 1—2. Abdominal viscera.

The stomach has been removed from the cardia to the pylorus, revealing the lesser sac (omental bursa) and structures on the posterior wall.

(From Sobotta, Courtesy of Urban & Schwarzenberg.)

Sobotta Retroperitoneum

Fig. 1—3. Retroperitoneum of an adult female.

(From Sobotta, Courtesy of Urban and Schwarzenberg.)

Fig. 1—3. Retroperitoneum of an adult female.

(From Sobotta, Courtesy of Urban and Schwarzenberg.)

Peritoneal Folds The Stomach

Fig. 3—16. The phrenicocolic ligament as seen at surgery in two different cases.

(a) The phrenicocolic ligament (PCL) is the elevated peritoneal fold inferolateral to the spleen (SP). LL = left lobe of liver.

(b) After retracting the stomach and greater omentum (GO), the phrenicocolic ligament is apparent as an elevated ridge (arrows) extending from the anatomic splenic flexure of the colon (SF) posteriorly to the diaphragm. The ligament is seen inferolateral to the spleen (SP).

(Courtesy of Yong Ho Auh, M.D., Asan Medical Center, Seoul, Korea)

Fig. 3—16. The phrenicocolic ligament as seen at surgery in two different cases.

(a) The phrenicocolic ligament (PCL) is the elevated peritoneal fold inferolateral to the spleen (SP). LL = left lobe of liver.

(b) After retracting the stomach and greater omentum (GO), the phrenicocolic ligament is apparent as an elevated ridge (arrows) extending from the anatomic splenic flexure of the colon (SF) posteriorly to the diaphragm. The ligament is seen inferolateral to the spleen (SP).

(Courtesy of Yong Ho Auh, M.D., Asan Medical Center, Seoul, Korea)

Fig. 3—31. Anatomy of the lesser sac and the gastropancreatic plica.

(a) Anatomic specimen with spaces injected. The gastropancreatic plica (white arrowheads), within which courses the left gastric artery (black arrowhead), is a structure of some dimension. It separates the vestibule (Vb) in relationship to the caudate lobe (CL) from the larger lateral recess of the lesser sac (LS). The latter is separated by the gastrosplenic ligament (open arrow) from the gastrosplenic recess (GSR) and by the splenorenal ligament (white arrow) from the splenorenal recess (SRR). The vestibule is separated by the gastrohepatic ligament (curved arrow) from the gastrohepatic recess (GHR). Ao = aorta; C = inferior vena cava; Sp = spleen. (Reproduced from Kumpan.27)

Perisplenic RecessGastropancreatic Ligament

Fig. 3—110. Abscess localization in postoperative neocompartment following transection of gastrohepatic ligament.

(a) Axial anatomic section with injection to simulate abscess formation within the vestibule (Vb) of the lesser sac clearly separated by an intact gastrohepatic ligament (between the clamps) from abscess within the gastrohepatic recess (GHR) of the greater peritoneal cavity. CL = caudate lobe; Ao = aorta; C = inferior vena cava; PV = portal vein.

(b) After resection of the gastrohepatic ligament, a neocompartment (asterisk) is formed by communication of the gastrohepatic recess and vestibule. X = gastropancreatic plica; ST = stomach; LS = lesser sac; Sp = spleen.

(Reproduced from Kumpan27)

Gastropancreatic Plica

Fig. 3—112. Abscess localization in postoperative neocompartment.

Following splenectomy with resection of the gastrosplenic and splenorenal ligaments, communication is established between the left subphrenic (perisplenic) space and the lesser sac. (b) Axial anatomic section with injection after removal of spleen to simulate abscess (A). Arrow = gastropancreatic plica. (Reproduced from Kumpan27)

Fig. 3—112. Abscess localization in postoperative neocompartment.

Following splenectomy with resection of the gastrosplenic and splenorenal ligaments, communication is established between the left subphrenic (perisplenic) space and the lesser sac. (b) Axial anatomic section with injection after removal of spleen to simulate abscess (A). Arrow = gastropancreatic plica. (Reproduced from Kumpan27)

Subxiphoid

Subxiphoid

Lymphatic Drainage Liver

Fig. 6—1. Superficial pathways of lymphatic drainage of the liver.

Note that the anterior diaphragmatic nodes consist of two groups: the lateral anterior diaphragmatic group and the medial group, which includes the pericardiac nodes and the subxiphoid nodes behind the xiphoid cartilage. The nodes in the falciform ligament drain into the anterior abdominal wall along the superficial epigastric and deep epigastric lymph nodes. The epigastric and the subxiphoid nodes drain into the internal mammary nodes.

Fig. 6—1. Superficial pathways of lymphatic drainage of the liver.

Note that the anterior diaphragmatic nodes consist of two groups: the lateral anterior diaphragmatic group and the medial group, which includes the pericardiac nodes and the subxiphoid nodes behind the xiphoid cartilage. The nodes in the falciform ligament drain into the anterior abdominal wall along the superficial epigastric and deep epigastric lymph nodes. The epigastric and the subxiphoid nodes drain into the internal mammary nodes.

Gastrohepatic Ligament Lymph Nodes

Fig. 6—2. Deep pathways of lymphatic drainage of the liver.

The deep pathways follow the hepatic veins to the inferior vena cava nodes and the juxtaphrenic nodes that follow along the phrenic nerve. These nodal groups are considered as the middle diaphragmatic nodes. The pathways that follow the portal vein drain to the hepatic hilar nodes and the nodes in the hepatoduodenal ligament. They drain into the celiac node and the cisterna chyli.

Fig. 6—2. Deep pathways of lymphatic drainage of the liver.

The deep pathways follow the hepatic veins to the inferior vena cava nodes and the juxtaphrenic nodes that follow along the phrenic nerve. These nodal groups are considered as the middle diaphragmatic nodes. The pathways that follow the portal vein drain to the hepatic hilar nodes and the nodes in the hepatoduodenal ligament. They drain into the celiac node and the cisterna chyli.

Gastrosplenic Lymph Node

nodes

Fig. 6—7. Pathways of lymphatic drainage of the stomach.

Fascia Treitz
Fig. 6—13. Pathways of lymphatic drainage of the colon.
Lymphatic Drainage Descending Colon

Fig. 8—17. Transverse anatomic cross-sections.

Connective tissues of spaces as well as mesenteries and fasciae are stained by dye permeation.

(a) Level of uncinate process of pancreas and renal arteries.

(b) Level of third portion of duodenum and the infrarenal abdominal aorta. These stained sections demonstrate particularly relevant features:

1. Anatomically, the anterior pararenal space is potentially continuous across the midline.

2. The perirenal spaces at these levels share no bilateral continuity; there is midline termination of the anterior renal fascia.

3. The anterior pararenal space ventrally is anatomically continuous with the roots of the small bowel mesentery and similarly of the transverse mesocolon. Lesions of the perirenal contents, including the kidneys and adrenals, are provided anatomic continuity along their major vessels to the aorta and inferior vena cava and thereby to the small bowel mesentery and transverse mesocolon. Extraperitoneal and intraperitoneal structures constitute the continuum designated as the subperitoneal space. This is fully discussed in Chapter 13.

4. Rupture of an abdominal aortic aneurysm can be anticipated as likely occurring into the perirenal space or dissecting into the posterior pararenal space or psoas muscle on the left. Anatomic considerations include the point of rupture both on the circumference of the aorta and on the cephalocaudal level. Other factors include the acuity, force, and volume of the rupture and preexisting adhesions.

(Reprinted with permission from Han M-C, Kim C-W: Sectional Human Anatomy, 2nd ed. Ilchokak, Seoul, Korea, 1989.)

Abdominal Fascia Pararenal

AC = Ascending colon APS = Anterior pararenal space ARF = Anterior renal fascia Ao = Aorta Ca = Cartilage Co = Colon

D2 = Second portion of duodenum D3 = Third portion of duodenum D4 = Fourth portion of duodenum DC = Descending colon EO = External oblique muscle IO = Internal oblique muscle IVC = Inferior vena cava IE = Ileum

IlC = Iliocostalis muscle Je = Jejunum

L1-2 = L1-2 intervertebral disc

L2 = L2 vertebral body L3 = L3 vertebral body LC = Left diaphragmatic crus LCoF = Lateroconal fascia LK = Left kidney LRA = Left renal artery LRV = Left renal vein LgD = Longissimus dorsi muscle LtD = Latissimus dorsi muscle MeF = Mesenteric fat Mf = Multifidus muscle PF = Perirenal fat PP = Parietal peritoneum PPE = Posterior pararenal fat PRE = Posterior renal fascia PeC = Peritoneal cavity Ps = Psoas muscle

OL = Quadratus lumborum muscle

RC = Right diaphragmatic crus

RCx = Renal cortex

RK = Right kidney

RL = Right lobe of liver

RP = Renal pelvis

RRA = Right renal artery

RRV = Right renal vein

ReA = Rectus abdominis muscle

SMA = Superior mesenteric vein

TA = Transversus abdominis muscle

TC = Transverse colon

UnP = Uncinate process of pancreas, head

Ur = Ureter

Fascia Anterior Uncinate Process

Fig. 8—108. Anatomic sections of fusion fasciae.

(a) Section at the level of the pancreatic tail, with slight anterior traction on the left colonic fat. The mesenteric fat medial to the splenic flexure (SF) of the colon portrays the continuity between transverse mesocolon mediocranially and left colonic compartment laterocaudally. Note the loose areolar tissue (arrows) between this mesenteric fat and the pancreatic tail, representing the fusion fascia posterior to the transverse mesocolon medially and the cranial extension of the left retromesenteric plane, also called left fascia of Toldt, laterally. A space, also bridged by loose areolar tissue (arrowheads), appears between the pancreatic tail and perirenal space, representing the fusion fascia between the left pancreaticoduodenal compartment and primitive retroperitoneum. SP = spleen.

(b) Section at the level ofpancreatic head (P) and neck, with traction on the left colonic compartment. The left colonic compartment is demarcated from the primitive retroperitoneum by loose areolar tissue representing the left retromesenteric plane (black arrows). Anteriorly, the transverse mesocolon (black asterisks) attaches to the pancreatic neck, posterior to the stomach, and anterior to the duodenojejunal junction (white asterisk) in the left paraduodenal fossa. White arrow = inferior mesenteric vein; DC = descending colon; TC = transverse colon.

Fig. 8—108. Anatomic sections of fusion fasciae.

(a) Section at the level of the pancreatic tail, with slight anterior traction on the left colonic fat. The mesenteric fat medial to the splenic flexure (SF) of the colon portrays the continuity between transverse mesocolon mediocranially and left colonic compartment laterocaudally. Note the loose areolar tissue (arrows) between this mesenteric fat and the pancreatic tail, representing the fusion fascia posterior to the transverse mesocolon medially and the cranial extension of the left retromesenteric plane, also called left fascia of Toldt, laterally. A space, also bridged by loose areolar tissue (arrowheads), appears between the pancreatic tail and perirenal space, representing the fusion fascia between the left pancreaticoduodenal compartment and primitive retroperitoneum. SP = spleen.

(b) Section at the level ofpancreatic head (P) and neck, with traction on the left colonic compartment. The left colonic compartment is demarcated from the primitive retroperitoneum by loose areolar tissue representing the left retromesenteric plane (black arrows). Anteriorly, the transverse mesocolon (black asterisks) attaches to the pancreatic neck, posterior to the stomach, and anterior to the duodenojejunal junction (white asterisk) in the left paraduodenal fossa. White arrow = inferior mesenteric vein; DC = descending colon; TC = transverse colon.

Paraduodenal Fossa

Fig. 8-108. (Continued) (c) Section at the level of the pancreatic head (P). The right pancreaticoduodenal compartment is demarcated posteriorly by the loose areolar tissue of the retropancreaticoduodenal fusion fascia (arrowheads), also called fascia of Treitz, and anteriorly by the loose areolar tissue of the cranial extension of the right retromesenteric plane, also called right fascia of Toldt (arrows). Note the continuity of the transverse mesocolon (asterisks) with the right colonic compartment, located anterior to the right perirenal space. White arrow = inferior mesenteric vein; HF = hepatic flexure.

(d) Section below the level of the pancreatic head, demonstrating the slender right and left colonic compartments at this level (black arrows). Note how the right colonic compartment covers the right side of the pancreaticoduodenal compartment (white asterisk), while the medial extension of the left colonic compartment (black-and-white arrow) lies posterior to the left extension of the horizontal part of the duodenum (D). The retropancreaticoduodenal fusion fascia is located posterior to the duodenum and anterior to the primitive retroperitoneum, aorta, and inferior caval vein. AC = ascending colon; DC = descending colon.

Fig. 8-108. (Continued) (c) Section at the level of the pancreatic head (P). The right pancreaticoduodenal compartment is demarcated posteriorly by the loose areolar tissue of the retropancreaticoduodenal fusion fascia (arrowheads), also called fascia of Treitz, and anteriorly by the loose areolar tissue of the cranial extension of the right retromesenteric plane, also called right fascia of Toldt (arrows). Note the continuity of the transverse mesocolon (asterisks) with the right colonic compartment, located anterior to the right perirenal space. White arrow = inferior mesenteric vein; HF = hepatic flexure.

(d) Section below the level of the pancreatic head, demonstrating the slender right and left colonic compartments at this level (black arrows). Note how the right colonic compartment covers the right side of the pancreaticoduodenal compartment (white asterisk), while the medial extension of the left colonic compartment (black-and-white arrow) lies posterior to the left extension of the horizontal part of the duodenum (D). The retropancreaticoduodenal fusion fascia is located posterior to the duodenum and anterior to the primitive retroperitoneum, aorta, and inferior caval vein. AC = ascending colon; DC = descending colon.

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Responses

  • katharina kuester
    Where is the spleen located in the female body?
    6 years ago
  • carla
    Where are 6 major lymph nodes.?
    6 years ago
  • joann
    What is the difference between omentum and peritoneum?
    6 years ago
  • EDEN
    Where is the peritoneal cavity located?
    6 years ago
  • Stuart Christie
    Where is the pylorus in an adult female?
    6 years ago
  • muhammed
    Where are gastrohepatic lymph nodes?
    5 years ago
  • Anniina
    Where are the level 7 lymph nodes?
    5 years ago
  • sofia
    Where is the omentum and the pelvic?
    5 years ago
  • findlay
    What is the viscera of the abdominal cavity?
    4 years ago
  • Robinia
    Where is the pylorus of the stomach and terminal ileum?
    4 years ago
  • asmait
    What is the lymphatic drainage of liver use and images?
    4 years ago
  • prima
    Where is upper abdominal and gastrohepatic ligament lymph node?
    3 years ago
  • Aili
    Where is the hepatoduodenal lymph node in the body?
    2 years ago
  • daniel woods
    Where are the liver lymph glands?
    2 years ago

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