FASCIA OF THE
ABDOMEN
Chris van Zyl
KHC
Outline

Peritoneum
 Embryology
 Anatomy

Quick word on
 Fascia
of the anterior abdominal wall
 Fascia around kidneys
Peritoneam




Serous membrane
Divided into parietal and
visceral
Parietal peritoneum lines
anterior, lateral and
posterior walls peritoneal
cavity
Visceral peritoneum lines
all the organs
that are intraperitoneal.
Embryology


Mesentries divide coelomic cavity into R + L halves
Upper abdomen
 Stomach
+ gut suspended in the middle
 Liver in the ventral mesentery
 Spleen in dorsal mesentery
Embryology

Organs migrate in anticlockwise fashion
 Liver
lies on the right
 Spleen on the left

Drags mesenteries into position they occupy in
muturity
Peritoneal cavity
Two main regions


Greater sac (general abdominal cavity)
Lesser sac (or omental bursa)

Communicate via foramen of Vinslow (epiploic foramen)
Course


Covers the
inferior aspect of
diaphragm and is
reflected onto the
liver and the abdominal
part of the esophagus
After the liver is enclosed,
it extends from the porta
hepatis as a double layer
(lesser omentum) to the
lesser curvature of the
stomach
Course


It encloses the stomach,
reaches the greater
curvature of stomach and
extends as a double layer
(greater omentum) down
into the abdominal
cavity,loops back up to the
transverse colon.
From there the transverse
mesocolon is formed, which
joins the post abdominal
wall on the anterior aspect
of the pancreas
Course

Double layer devides into
single layers



one which runs superiorly over
the post abdominal wall and
reflected onto the bare area
of liver
The other runs inferiorly over
the post abdominal wall to
cover the pelvic organs and join
the peritoneum of the anterior
abdominal wall.
The post peritoneal layer of the
post abdo wall is interrupted as
it’s reflected from the
duodenojejenal to ileocaecal
junction to form the mesentery
of the jejenum and ileum
Blood supply of the peritoneum
To the parietal peritoneum
 Lumbar vessels
 Branches of the inferior and superior epigastric
arteries
 Musculophrenic arteries
 Deep circumflex arteries
To the visceral peritoneum
 From the arteries supplying the appropriate viscera
Innervation of the peritoneum
To the parietal peritoneum
 From the nerves supplying the diaphragm and
adjacent body wall - e.g. phrenic (C3-C5) and
intercostal and subcostal nerves (T7-L1)
To the visceral peritoneum
 Sympathetic nerves innervating the appropriate
viscera.
Peritoneam
Anatomy devided into:




Peritoneal spaces
Peritoneal reflections including ligaments
Mesentry
Omenta
Peritoneal Spaces:

Peritoneal cavity devided
by transverse colon and
mesocolon into:
 Supramesocolic
compartment
 Right
and Left
supramesocolic spaces
 Inframesocolic
compartment
 Devided
by root of
smallbowel mesentery

Right and Left inframesocolic
spaces
Right supramesocolic space
Devided into:
 Right subphrenic space


Diaphragmatic surface of R
liver from falciform ligament
medially to coronary ligament
postero-infer
Right subhepatic space
Subdevided into ant + post
spaces (Morrison’s pouch)
 Communicates with R
paracolic gutter + R infracolic
space


Lesser sac
Left supramesocolic space
Devided into:
 Ant left perihepatic
space
 Post left perihepatic
space (gastrohepatic
recess)
 Anterior left
subphrenic spaces
 Posterior left suphrenic
spaces
Imaging
RSP: R subphric S
LSP: L subphrenic S
LPC: L paracolic S
LSs: Sup recess LS
Lsi: Inf recess LS
Lesser Sac

Posterior Wall


Anterior Wall


Peritoneum over post. stomach,
lesser omentum
Lateral Wall


Peritoneum over pancreas, left
adrenal, upper pole of left
kidney
Spleen, gastrosplenic,
splenorenal ligaments
Communicates via epiploic
foramen (of Winslow)
Lesser sac

Devided by
gastropancreatic fold
(left gastric artery)
 Superior
 Encloses
 Inferior
 Lies
recess
caudate lobe
recess
between stomach
and pancreas
Left Gastric artery: Arrow
GHL: Gastro hepatic lig
SHS: Subhepatic S
LSs: Sup recess LS
Lsi: Inf recess LS
Foramen of Winslow



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Post: IVC
Ant: free edge of lesser omentum containing
portal vein, hepatic artery, CBD
Sup: Caudate lobe
Inf: 1st part of duodenum
Right inframesocolic compartment
Bounded by:
 Transverse mesocolon
sup and to the R
 Root of small bowel
mesentery
Left inframesocolic space



Larger than right
In free communication with pelvis right to midline
Sigmoid colon and mesentery forms partial barier
left of midline
Paracolic gutters




Peritoneal recesses lat to ascending + descending
colon
Right continuous with right subhepatic/phrenic spaces
Left seperated by phrenicocolic ligament
Both communicates with pelvis
Imaging: Inframesocolic compart.
Pelvic peritoneal spaces/pouches
The rectouterine pouch/ Pouch of Douglas (in
females) separating rectum from bladder
 The rectovesical pouch (in males) separating
the rectum from the bladder
 The vesicouterine pouch (in females) separating
bladder from uterus

Peritoneal reflections



8 Legaments
4 Mesentries
2 Omenta
Peritoneal ligaments

Right coronary ligament
 Reflection
of peritoneum
from diaphragm to post
surface of R liver lobe
 Bare area between two
layers of this ligament

Left coronary ligament
 Continuation
of this
peritoneal reflection to
the left
Peritoneal ligaments

Gastrosplenic ligament
 Continuous
with greater omentum
 From greater curve of stomach to spleen.
 Contains gastroepiploic vessels + short gastric vessels

Falciform ligament
 From
anterosup surface of liver to diaphragm + ant
abdominal wall
 Carries lig Teres (obliterated umbilical vein) in free
edge
 Continues with fissure for lig venosum
Peritoneal ligaments

Phrenicocolic ligament
 From
splenic flexure to diaphragm
 Continuous with transverse mesocolon + splenorenal lig

Splenorenal ligament
 From
pancreatic tail to splenic hilus
 Transmits splenic vessels
Peritoneal ligaments

Hepatoduodenal ligaments
flexure between 1st + 2nd part of duodenum to
porta hepatis
 Transports portal triad
 From

Duodenocolic ligament
 From
R colic flexure to descending duodenum
 Continuous with transverse mesocolon
Imaging
Imaging
Broad ligament of the uterus

Wide fold of peritoneum that connects the sides of the uterus
to the walls and floor of the pelvis
Broad ligament of the uterus

Subcomponents:
 Mesometrium- the mesentery of the uterus; the
largest portion of the broad ligament
 Mesosalpinx- the part that surrounds the
Fallopian tube
 Mesovarium- the part that connects the anterior
surface of the ovary to the remainder of the
broad ligament.
Mesentries

Small bowel mesentry
 Broad
fan shaped fold
 Conects jejunum + ileum to post abdominal wall
 Extends from duodenojejunal flexure (Left of L2) to
upper part of R SI joint
 Root continuous with L + R ant pararenal spaces
 Contains jejunal, ileal branches of SMA and
accompanying veins, nerves, lymphatics
Mesentries

Transverse mesocolon
 Connects
transvers colon to post abdominal wall
 Pass from ant head and body of pancreas to post colon
 Upper layer adherent to greater omentum
 Contains middle colic vessels, nerves + lymphatics
Mesentries

Sigmoid mesocolon





Attaches sigmoid colon to
pelvic wall
Line of attachment inverted
V with apex near devision
of L common iliac artery
Leftlimb descends to L
psoas, R into pelvis
Contains sup rectal vessels
Mesoappendix

Attached to lower end of
small bowel mesentry
Omenta

Greater and Lesser
Greater Omentum
Hangs from the greater curve of the stomach and loops
down in front of the intestines before curving back
upwards to attach to the transverse colon, thus 4 layers
of peritoneum
Continuous with:



Gastrocolic ligament: largest component
Gastrosplenic ligament: to splenic hilus
Gastrophrenic ligament
Lesser Omentum
Attached to the lesser curvature of the stomach, prox
duodenum and the liver
Subdivided into:
 Gastrohepatic ligament
 connects
the left lobe of the liver to the lesser curvature
of the stomach

Hepatoduodenal ligament
 free
edge of the omentum, extends to porta hepatis
and ligamentum venosum

Contains gastric artery, coronary vein, left gastric
nodal chain
Fascia of anterior abdominal wall

Superficial fascia
 Superficial
 Deep

layer
layer
Transversalis fascia
2: Superficial layer
3: Deep layer
8: Transversalis fascia
Superficial fascia


Single layer superiorly containing variable
ammounts of fat
Inferiorly devides into superficial and deep layers
 Superficial
 Passes
layer (Fascia of Camper):
over inguinal ligament
 Continuous with superficial fascia of the thigh
 Continues in the scrotum as the fascia of Dartos
Superficial fascia
 Deepy
layer (Fascia of Scarpa):
 Connected
to aponeurosis of external oblique laterally +
linea alba/ symphisis pubis medially
 Passes over inguinal ligamnet inferolaterally to fuse with
fascia of the thigh
 Forms superfiscial perineal fascia inferomedially (Fascia of
Colles)
Transversalis fascia




Lies between transverse abdominis and
extraperitoneal fat
Continuous with inferior diaphragmatic fascia
Fuses with thoracolumbar fascia posteriorly
Spermatic cord/Round ligament passes through
transversalis fascia at deep inguinal ring

becomes internal spermatic fascia
Fascia around kidneys


Renal fascia situated around the perirenal fat
Devided into:
 Anterior
fascia (Gerota’s)
 Continuous
 Posterior
fascia (Zuckerkandl’s)
 Continous
 Fused
with diaphragmatic fascia and iliacus fascia
laterally as conal fascia
 Continuous
 Fused
with R inf coronary ligament
with transversalis fascia
medially with sheeths of aorta + IVC
Fascia around kidneys
References:

Applied Radiological Anatomy


Paul Butler, Adam W. M. Mitchell, Harold Ellis
Anatomy for Diagnostic Imaging


Stephanie Ryan, Michelle McNicholas, Stephen Eustace
Third Edition