The Anatomy of the Human Peritoneum and Abdominal Cavity: Considered from the Standpoint of Development and Comparative AnatomyHuntington, George S. (George Sumner)
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The Anatomy of the Human Peritoneum and Abdominal Cavity: Considered from the Standpoint of Development and Comparative Anatomy
Huntington, George S. (George Sumner)
Abdomen; Peritoneum
In Fig. 286 finally the hardened abdominal viscera of an adult human
subject are shown in the ventral view with the lesser omentum incised.
The cut through the lesser omentum exposes the hepatic recess of the
lesser peritoneal cavity immediately to the left of the foramen of
Winslow. Toward the right free margin of the omentum the divided portal
vein, hepatic artery and duct are seen between the layers of the omentum
imbedded in the pancreas and coursing behind the first portion of the
duodenum on their way to the transverse fissure.
To the left of these structures the omental tuberosity of the pancreas
projects above the level of the lesser curvature under cover of the
secondary parietal peritoneum forming the dorsal wall of the lesser sac,
while the lower edge of the Spigelian lobe appears in the upper angle of
the incision.
If we remember that the liver is itself welded to the diaphragm between
the layers of the coronary ligament (Fig. 280), it will become
apparent that the serous surface of the Spigelian lobe forms part of the
ventral wall of a peritoneal recess situated behind the lesser omentum,
between this membrane and the diaphragm. Access to this recess, without
the division of peritoneal layers, can only be obtained by passing from
right to left, along the caudate lobe, between the vena cava behind,
covered by parietal peritoneum, and the free right edge of the lesser
omentum in front. (In the reverse direction of the arrow shown in Fig.
284.) This hepatic or Spigelian recess of the lesser peritoneal cavity
has categorically the following boundaries (Figs. 282 and 283):
Dorsal: Parietal peritoneum, reflected along the line CD, from the
caudal layer of the coronary ligament to the diaphragm.
Ventral: Visceral peritoneum investing the Spigelian lobe and the
gastro-hepatic omentum.
Right: Reflection of peritoneum along the line DE (caval fissure) to
become the parietal peritoneum covering the diaphragm.
Left: Right layer of lesser omentum, reflected along the fissure for the
ductus venosus (CB) to the cardiac portion of the lesser curvature,
continuous with the dorsal layer of the lesser omentum reflected from
the transverse fissure to the pyloric segment of the lesser curvature
(AB).
We will presently see that certain relations of the vessels connected
with the liver at the transverse fissure and of the duodenum prevent the
finger, when passed from right to left behind the free right edge of the
lesser omentum and along the caudate lobe of the liver, from proceeding
downward at this point. A narrow channel of communication is thus formed
between the Spigelian recess and rest of the lesser sac on the one hand,
and the general greater peritoneal cavity on the other. This channel is
the so-called foramen of Winslow.
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