U ao J

Fig. 3—13. Sagittal section through the left lobe of the liver.

The smaller left lobe (LL) of the liver lies anterior to the stomach (S), including both its upper fundic and distal body portions. Ao = aorta.

Paracolic Ligament

Fig. 3—14. Peritoneal attachments and recesses of the left upper quadrant.

(a) Diagram of horizontal section. The intraperitoneal spaces around the left lobe of the liver and the spleen are freely continuous (gray area). The perisplenic space is bounded by the splenorenal and gastrosplenic ligaments. LK = left kidney; P = tail of pancreas.

(b) Frontal drawing (spleen removed). The phrenicocolic ligament partially bridges the junction between the perisplenic space and the left paracolic gutter. The lesser sac resides above the transverse mesocolon and medial to the splenorenal ligament.

Fig. 3—14. Peritoneal attachments and recesses of the left upper quadrant.

(a) Diagram of horizontal section. The intraperitoneal spaces around the left lobe of the liver and the spleen are freely continuous (gray area). The perisplenic space is bounded by the splenorenal and gastrosplenic ligaments. LK = left kidney; P = tail of pancreas.

(b) Frontal drawing (spleen removed). The phrenicocolic ligament partially bridges the junction between the perisplenic space and the left paracolic gutter. The lesser sac resides above the transverse mesocolon and medial to the splenorenal ligament.

angular form with the apex cephalad22 (Fig. 3-21) and varies in size, but generally will admit one (an approximately 4.5 cm circumference) or most commonly two fingers (9 cm circumference).24 In normal circumstances, it is a potential opening, with mesothelial surfaces gliding over each other.

The lesser sac (Figs. 3-14a, 3-22 to 3-24) lies behind the lesser omentum, the stomach and duodenal bulb, and the gastrocolic ligament. It is bounded inferiorly by the transverse colon and the mesocolon (Fig. 3-25), although a well-defined inferior recess persists in a few individuals between the anterior and posterior reflections of the greater omentum (Figs. 3-26 and 3-27). The lesser sac is defined posteriorly chiefly by most of the pancreas; to the right, the caudate lobe of the liver projects into the upper recess of the sac (Figs. 3-28 to 3-30).25,26

A prominent oblique fold of peritoneum, the gastro-pancreatic plica, is raised from the posterior abdominal wall by the left gastric artery. The plica is a fatty triangular structure measuring 2-3 cm in cross section at its base and is inclined toward the posterior wall of the stomach27 (Fig. 3-31). This fold often divides the lesser sac into two compartments:

1. A smaller medial compartment to the right composed of the vestibule to the lesser sac, where the anatomic landmark is the caudate lobe of the liver (Figs. 323 and 3-30), and a superior recess dorsal to the medial segment of the left hepatic lobe.

2. A larger lateral compartment to the left inferiorly (Fig. 3-23).

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Phrenicocolic Ligament Radiology

Fig. 3—15. The phrenicocolic ligament as seen in vivo by peritoneoscopy.

Phrenicocolic Ligament

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) (These figures also appear in the color insert.)

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) (These figures also appear in the color insert.)

Phrenicocolic Ligament Radiology

Fig. 3—17. The phrenicocolic ligament (arrows).

On this plain film, this ligament is seen as a striplike density subtending the splenic angle at the level of the anatomic splenic flexure of the colon.

(Reproduced from Meyers.18)

(Reproduced from Meyers. )

Fig. 3—18. The phrenicocolic ligament is seen (arrow) partially subtending the left subphrenic (perisplenic) space in a case of free intraperitoneal air. Decubitus projection. The liver and spleen have fallen to the right.

(Reproduced from Meyers.18)

Fig. 3—18. The phrenicocolic ligament is seen (arrow) partially subtending the left subphrenic (perisplenic) space in a case of free intraperitoneal air. Decubitus projection. The liver and spleen have fallen to the right.

(Reproduced from Meyers.18)

Fig. 3—19. Prone peritoneography outlines the phrenicocolic ligament (arrows).

This structure supports the spleen (Sp) as it extends from the splenic flexure of the colon (C) to the left diaphragm and is in continuity with the gastrosplenic ligament (arrowheads) seen on end. The close relationship of the posterior margin of the spleen to the left kidney (LK) is shown.

(Reproduced from Meyers. )

Paracolic Ligament

Fig. 3-20. The phrenicocolic ligament.

(a) CT demonstrates the phrenicocolic ligament (curved arrows) as a triangular fat-containing structure extending from the splenic flexure of the colon to the diaphragm at the level of the 10th or 11th rib.

(b) Coronal sonogram of the left flank shows a bandlike echogenic structure (arrows) extending from the colon to the abdominal wall, just inferior to the tip of the spleen (SP). Left paracolic ascites is separated from the perisplenic ascites by the phrenicocolic ligament.

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

Fig. 3-20. The phrenicocolic ligament.

(a) CT demonstrates the phrenicocolic ligament (curved arrows) as a triangular fat-containing structure extending from the splenic flexure of the colon to the diaphragm at the level of the 10th or 11th rib.

(b) Coronal sonogram of the left flank shows a bandlike echogenic structure (arrows) extending from the colon to the abdominal wall, just inferior to the tip of the spleen (SP). Left paracolic ascites is separated from the perisplenic ascites by the phrenicocolic ligament.

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

Essentials of Human Physiology

Essentials of Human Physiology

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