The greater omentum: |
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A double apron like fold peritoneum which hangs from:
- Greater curvature of the stomach
- Lower part of the first part of the duodenum.
Contains:
- Extraperitoneal fat
- Gastroepiploic vessels and their nerve plexuses
- Lymph vessels and nodes
Parts
- Gastrosplenic ligament containing:
- Short gastric vessels and their nerve plexus
- Lymph vessels and nodes
- Fat.
- Gastrophrenic ligament
- Gastrocolic ligament containing mainly fat, lymphatics and lymph nodes
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Functions:
- Fat depot
- Mechanical cushion
- Protective “policeman” of the abdominal cavity – tends to adhere to any areas of inflamed peritoneum, with which it may come into contact, and thus often prevents the escape of the contents of a hollow viscus which may have perforated.
- It contains defence cells such as macrophages and lymphocytes
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Divisions of the peritoneal cavity
- Two peritoneal sacs:
- Greater sac
- Lesser sac.
- The peritoneal sac entered through the anterior body wall is the greater sac.
- The lesser sac lies behind the stomach,lesser omentum and liver
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Subdivisions
The greater omentum, transverse colon and transverse mesocolon form a shelf dividing the greater sac into supracolic and infracolic compartments.
Supra colic compartment
Sub divided into smaller spaces:
- The right and left subphrenic recesses separated by the falciform ligament.They lie between the lower surface of the diaphragm and the upper surfaces of the right and left lobes of the liver.
- The hepatorenal recess lies between the inferior surface of the right lobe and the right kidney.
Infra colic compartment
- Is subdivided by the obliquely lying mesentry into right and left infra colic spaces.
- Because of the obliquity of the partition, the right infra colic space is above to the right and the left infra colic space is below and to the left.
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Smaller peritoneal recesses
- They are of practical importance because a viscus may intrude into such a recess, producing an internal hernia which may become impacted.
- The surgeon must recognize the danger of cutting such a vascular fold in his attempt to free the impacted viscus.
Smaller recesses occur in three regions:
Near the duodenal flexure
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Near the ileocecal junction
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At the sigmoid mesocolon |
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- Inferior duodenal recess
- Superior duodenal recess (sometimes under a vascular fold)
- Paraduodenal recess (behind a vascular paraduodenal fold)
- Retroduodenal recess
- Mesocolic recess
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- Superior ileocecal recess
- Inferior ileocecal recess
- Retrocecal recess
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Lesser sac |
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- The lesser sac is also called the omental bursa.
- It lies behind the stomach and facilitates its movement
Epiploic / Omental foramen
Forms the entrance into omental bursa
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Subdivisions
Vestibule – lies behind stomach and lesser omentum
Superior recess- behind the liver
Inferior recess- behind the stomach
Splenic recess- anterior to spleen. |
Superior |
Anterior |
Posterior |
Inferior |
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Caudate lobe of liver |
Free edge of lesser omentum containing:
- Common bile duct
- Hepatic artery proper
- Portal vein
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Inferior vena cava |
First part of duodenum |
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