The peritoneum

The abdomen (peritoneum) covers the walls of the abdominal cavity and internal organs; the total surface of about 2 m2. In General, the peritoneum consists of parietal (peritoneum parietale) and visceral (peritoneum viscerale). Parietal peritoneum lines the abdominal wall, visceral - inside (Fig. 275). Both sheets, touching each other, as if gliding about one another. This is facilitated by the muscles of the abdominal wall and a positive pressure in the intestinal tube. In the gaps between the sheets contains a thin layer of serous fluid, which moisturizes the surface of the peritoneum, facilitating the shift of internal organs. During the transition parietal peritoneum in visceral form of the mesentery, ligaments and folds.
Under the peritoneum almost everywhere there is a layer of podbroshennogo fiber (tela subserosa), consisting of loose and adipose tissue. Thickness podbroshennogo fiber in various areas of the abdomen expressed in varying degrees. On the anterior abdominal wall there is a significant layer, but is particularly well fiber developed around the bladder and below the navel of the hole. This is because when you stretch the bladder his top and body coming from behind the symphysis, penetrating between f. transversalis and parietal peritoneum. Podbroshennye fiber of small pelvis and back of the abdominal wall presents a thick layer, and the aperture of this layer is missing. Podbroshennye fiber well developed in the mesentery and the seal of the peritoneum. The visceral peritoneum often joined with the bodies and podbroshennye fiber is completely missing (liver, small intestine) or moderately developed (stomach, colon and other).
The peritoneum forms a closed bag, so part of the authorities is lying on the outside of the abdomen and covered it with only one hand.

the location of the visceral and parietal sheets peritoneal
275. Location visceral (green line) and parietal (red line) leaves peritoneal on the sagittal section of women.
1 - pulmo: 2 - phrenicus; 3 - lig. coronarium hepatis; 4 - recessus superior omentalis; 5 - lig. hepatogastricum; 6 - for. epiploicum; 7 - pancreas; 8 - radix mesenterii; 9-duadenum; 10 - jejunum; 11 - colon sigmoideum; 12 - corpus uteri; 13 - rectum; 14 - excavatio rectouterina; 15 - anus; 16 - vagina; 17 - urethra; 18 - vesica urinaria; 19 - excavatio vesicouterina; 20 - peritoneum parietalis; 21 - omentum transposed majus; 22 - colon transversum; 23 - mesocolon; 24 - bursa omentalis; 25 - ventriculus; 26 - hepar.

Such position of the authorities is called extraperitoneal. Extraperitoneal place duodenum, except for the initial part, pancreas, kidneys, urinary tract, prostate gland, the vagina, the lower part of the rectum. If the body is covered on three sides, it is called materialnym position. Such bodies are liver, upstream and downstream part of the colon, the middle part of the rectum, urinary bladder. Some of the bodies covered by the peritoneum from all sides, i.e. are administered intraperitoneally. This situation are the stomach, the skinny and the ileum, vermiform process, blind, transverse colon, sigmoid and the beginning of the rectum, the uterus and fallopian tubes, spleen.
Topography parietal and visceral peritoneum is clearly visible on the sagittal section of the trunk. Conditionally unified the peritoneal cavity is divided into three layers: top, average and bottom (Fig. 276).

topography peritoneal
276. Topography peritoneal upper, middle and lower floors of the abdomen.
1 - lobus hepatis sinister; 2 - ventriculus; 3 - pancreas; 4 - lien; 5 - bursa omentalis; 6 - mesocolon transversum; 7 - flexura duodenojejunalis; 8 - colon transversum; 9 - ren sinister; 10 - radix mesenteric 11 - aorta; 12 - colon descendens; 13 - mesocolon sigmoideum; 14 - colon sigmoideum; 15 - vesica urinaria; 16 - rectum; 17 - appendix vermiformis; 18 - cecum; 19 - colon ascendens; 20 - duodenum; 21 - flexura coli dextra; 22 - pylorus; 23 - for. epiploicum; 24 - lig. hepatoduodenale; 25 - lig. hepatogastricum.

The upper floor is limited from above by a diaphragm and bottom mesentery transverse colon. There are liver, stomach, spleen, duodenum, pancreas. Parietal peritoneum with front and rear walls continues on the diaphragm, where changes in the liver as ligaments - ligg. coronarium hepatis, falciforme hepatis, triangulare dextrum et sinistrum (see Ligament of the liver). The liver, with the exception of the rear edge covered by the visceral peritoneum; its rear and front pieces are found at the gates of the liver, which between them are ductus choledochus, v. portae, a. hepatica propria. Double sheet peritoneal connects the liver and kidney, stomach and duodenum as ligaments - ligg. phrenicogastricum, hepatogastricum, hepatoduodenale, hepatorenale. The first three chords form a small gland (omentum transposed minus). Sheets peritoneal small gland in the area of the lesser curvature of the stomach diverge, covering her front and back panels. In the greater curvature of the stomach again they are connected in a double-layer plate hanging freely in the abdominal cavity in the form of folds at a distance of 20-25 cm from the greater curvature in adults. This two-layer plate peritoneal turns up and reaches the back of the abdominal wall, where and grows at level II of the lumbar vertebrae.
Four-fold peritoneum, hanging ahead of the small intestine, called the great seal (omentum transposed majus). In children sheets peritoneal greater omentum is well expressed.
Two-layer peritoneum at level II of the lumbar vertebrae splits into two directions: one sheet lines the back of the abdominal wall above II lumbar vertebra, covering the pancreas, and a portion of the duodenum, and is parietal sheet stuffing bags. The second piece of peritoneal from the back of the abdominal wall falls down to the transverse colon, surrounding it on all sides, and again returned to the back of the abdominal wall at level II of the lumbar vertebrae. In the merger of 4 sheets peritoneum (two - greater omentum and two transverse colon) formed a mesentery transverse colon (mesocolon), which is the lower boundary of the upper floor of the abdomen.
In the top floor of the abdomen between the authorities are limited space and bags. Right subphrenic space is called hepatic bag (bursa hepatica dextra) and represents a narrow crack between the right degree of liver and diaphragm. Below it is reported with the right side channel, which was formed ascending colon and the abdominal wall. At the top of the bag is limited coronary and broad ligaments.
Left subphrenic bag (bursa hepatica sinistra) is less than the right.
Packing bag (bursa omentalis) volume is a cavity containing 3-4 years, and largely isolated from the abdomen. Bag limited front small gland and stomach, gastrocolic ligament, bottom - mesentery transverse colon, rear - parietal peritoneum, top - abdominal-gastric ligament. Packing bag reported with the peritoneal cavity Salnikov hole (for. epiploicum), limited front lig. hepatoduodenale, top - liver, rear - lig. hepatorenale, bottom - lig. duodenorenale.
The middle floor the abdomen is located between the mesentery transverse colon and the entrance to the pelvis. It hosts the small intestine and part of the colon.
Below mesenteric transverse colon sheet peritoneal from the small intestine passes on the back of the abdominal wall and hang loop jejunum and ileum, forming a mesentery (mesenterium). The root of the mesentery has a length of 18-22 cm, attached to the posterior abdominal wall at level II lumbar vertebra on the left. Following from left to right and top to bottom, consistently across the aorta, the inferior Vena cava right ureter, it ends right at the level of the iliac bone joints. In the mesentery penetrate the blood vessels and nerves. The root of the mesentery divides the middle floor of the abdomen on the right and left mesenteric sinuses.
Right mesenteric sinus (sinus mesentericus dexter) is located to the right of the root of the mesentery, the medial and bottom limited by the small intestine mesentery, top - mesentery transverse colon, right - ascending colon rectum. Parietal peritoneum, the lining the bosom, grows to the back of the abdominal wall; behind him are the right kidney, ureter, blood vessels for the blind and the ascending part of the colon.
Left mesenteric sinus (sinus mesentericus sinister) somewhat longer right. Its limits: upper - mesentery transverse colon (level II lumbar vertebra), lateral - the descending part of the large intestine and the mesentery of the sigmoid colon, medial - the small intestine mesentery. The bottom border-left bosom does not have and continues into the cavity and small pelvis. Under the parietal peritoneum are the aorta, the veins and arteries to direct, sigmoid and a descending part of the colon; and there they are left ureter and lower pole of the kidney.
On the middle floor of the abdomen distinguish between right and left side channels.
The right side channel (canalis lateralis dexter) is a narrow slit, which is limited lateral wall of the belly, and the ascending part of the colon. Top channel continues in hepatic bag (bursa hepatica), and from the bottom through the iliac fossa reported to the lower floor of the abdominal cavity (cavity and small pelvis).
The left side channel (canalis lateralis sinister) is located between the side wall and the downstream division of the colon. At the top of his limits abdominal-colon-intestinal ligament (lig. phrenicocolicum dextrum), bottom channel is opened in the iliac fossa.
On the middle floor of the abdomen there are numerous hollows formed by the folds of the peritoneum and bodies. The deepest of them are located around the beginning of the jejunum, the final part of the ileum, the caecum and in the mesentery of the sigmoid colon. Here we describe only those pockets that occur constantly and clearly expressed.
Dvenadtsatiperstnoi poor, deepening (recessus duodenojejunalis) limited abdominal fold root of the mesentery of the colon and flexura duodenojejunalis. The depth of deepening ranges from 1 to 4 Characteristic is that in the crease of the peritoneum, limiting this deepening, provides smooth muscle bundles.
Top ileocecal deepening (recessus ileocecalis superior) is located in the upper right corner formed by the blind gut and the final Department of the jejunum. This deepening visibly expressed in 75% of cases.
Lower ileocecal deepening (recessus ileocecalis inferior) is located in the lower right corner between skinny and blind gut. From the lateral side of it also limits the vermiform process together with his mesentery. The depth of deepening 3-8 see
Posidoniaceae deepening (recessus retrocecalis) fickle, is formed by folds in the transition parietal peritoneum in visceral and is located behind the cecum. The depth of deepening ranges from 1 to 11 cm, which depends on the length of the cecum.
Miniholiday deepening (recessus intersigmoideus) is located in the mesentery of the sigmoid colon the left (Fig. 277, 278).

pockets peritoneal
277. Pockets peritoneum (by E. I. Zaitsev). 1 - flexura duodenojejunalis.
pockets mesenteric sigmoid colon
278. Pockets of the mesentery of the sigmoid colon (by E. I. Zaitsev).

The lower floor of the abdomen is located in the pelvis, where the folds and hollows of the peritoneum. The visceral peritoneum, covering the sigmoid colon, continues on the rectum and covers the upper part IPR, Central part - mesopedinella, and then shifted to women on the rear of the vault of the vagina and the posterior wall of the uterus. In men the peritoneum with rectal goes to the seminal vesicles and the rear wall of the bladder. Thus, the lower part of the rectum length 6-8 cm is beyond abdominal bag.
Men between the rectum and bladder formed a deep depression (excavatio rectovesicalis) (Fig. 279). In women, due to the fact that among these bodies wedged uterus with pipes, formed two hollows: premonicion-uterine (excavatio rectouterina) - the deeper, the sides limited premonicion-Royal fold (plica rectouterina), and gallbladder-uterine (excavatio vesicouterina), located between the bladder and the uterus (Fig. 280). The peritoneum the front and back surfaces of the walls of the uterus from its sides connected in a wide uterine ligament (ligg. lata uteri), which on the side of the small pelvis continue in the parietal peritoneum. The upper edge of each broad uterine ligaments lies fallopian tube; it is attached to the ovary and between her sheets goes round ligament of the uterus.

the ratio of the pelvic peritoneum on the sagittal cut the man
279. The ratio of the pelvic peritoneum on the sagittal cut the man's (scheme).
1 - excavatio rectovesicalis; 2 - rectum; 3 - vesica urinaria; 4 - prostata; 5 - m. sphincter ani externus; 6 - urethra.

the ratio of the pelvic peritoneum on sagittal sawing a woman
280. The ratio of the pelvic peritoneum on sagittal sawing a woman (scheme).
1 - peritoneum parietale; 2 - rectum; 3 - the uterus; 4 - excavatio rectouterina; 5 - vesica urinaria; 6 - vagina; 7 - urethra; 8 - excavatio vesicouterina; 9 - tuba uterina; 10 - ovarium; 11 - lig. suspensorium ovarii.

The peritoneum side wall of the pelvis are directly connected with the peritoneum the rear and front walls. In the inguinal region and the belly covers a number of entities forming ridges and pits. On the middle line on the front wall of the abdomen has a median umbilical fold (plica umbilicalis mediana)covering the same bunch of the bladder. On the sides of the bladder are the umbilical artery (AA. umbilicales), covered with a medial umbilical folds (plicae umbilicales mediales). Between the median and the medial folds are nadpisywanie fossa (fossae supravesicales)which is better expressed in bladder emptied. Lies lateral 1 cm from plica umbilicalis medialis side umbilical fold (plica umbilicalis lateralis, which arose as a result of passage A. I. v. epigastricae inferiores. Lies lateral plica umbilicalis lateralis is formed lateral inguinal hole (fossa inguinalis lateralis), which corresponds to the inner hole of the inguinal canal. The peritoneum plica between umbilicalis medialis and plica umbilicalis lateralis covers medial groin hole (fossa inguinalis medialis).