Peritoneal Ligaments of the Liver

Because the liver is developed in the ventral mesentery attaching the foregut to the anterior abdominal wall and the transverse septum, it is covered almost completely by the peritoneum derived from the ventral mesentery. The peritoneal reflections between the liver and the diaphragm, the anterior abdominal wall, and the stomach form peritoneal ligaments around the liver.2,3 Along the diaphragmatic surface, the liver is attached to the hemi-diaphragm by the coronary ligaments and triangular ligaments. The coronary ligaments are formed by two single layers of peritoneum, the anterior-superior and the posterior-inferior layer. The anterior-superior layer extends across the dome of the right hemidiaphragm from the midline to the right and fuses with the posterior-inferior layer that extends along the posterior surface of the right hemidiaphragm to form the right triangular ligament. These ligaments attach the right liver to the right hemidiaphragm. Similarly, the anterior-superior and posterior-inferior layers of the left coronary ligament extend across the undersurface of the left hemi-diaphragm and fuse to form the left triangular ligament laterally attaching the left liver to the left hemidia-phragm. The area of the liver between the anterior-superior and the posterior-inferior layers of the coronary ligament is closely applied to the diaphragm and is known as the bare area.

The anterior surface of the liver is attached to the anterior abdominal wall by the falciform ligament. The cranial portion of the falciform ligament is formed by the fusion of the right and left leaves of the anterior-superior layer of the coronary ligament. The falciform ligament extends caudally, and its free edge becomes the ligamentum teres (the round ligament). This ligament carries the obliterated umbilical vein from the umbilicus to the left portal vein via the umbilical fissure of the left liver.

Along the inferior and medial surface, the liver is attached to the lesser curvature of the stomach by the gastrohepatic ligament. The gastrohepatic ligament is formed by two peritoneal layers that cover the stomach.

It extends from the lesser curvature of the stomach and inserts into a horizontal fissure of the liver separating the left liver from the caudate sector. This ligament, also known as the lesser omentum, forms the anterior boundary of the lesser sac or the omental bursa. Cau-dally, the free edge of the gastrohepatic ligament is the hepatoduodenal ligament, which attaches to the duodenal bulb and inserts into the hilum of the liver (transverse fissure) carrying the hepatic artery, portal vein, and bile duct into the liver. The hepatoduodenal ligament forms the anterior boundary of the epiploic foramen (foramen of Winslow), which is where the lesser sac communicates with the peritoneal cavity.

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Essentials of Human Physiology

Essentials of Human Physiology

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