Abdominal bags diagram. Canals, sinuses and pockets of the lower abdominal cavity

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TOPOGRAPHICAL ANATOMY OF THE LOWER ABDOMINAL CAVITY

TOPOGRAPHICAL ANATOMY OF THE LOWER FLOOR OF THE ABDOMINAL CAVITY. OPERATIONS ON THE SMALL AND COLON INTESTINES

Malformations of the duodenum

Features of the duodenum in newborns and children

The duodenum in newborns is more often ring-shaped and less often U-shaped. In children of the first years of life, the upper and lower bends of the duodenum are almost completely absent.

The upper horizontal part of the intestine in newborns is above the usual level, and only by the age of 7-9 falls to the body of the 1st lumbar vertebra. Ligaments between the duodenum and neighboring organs in young children are very tender, and almost complete absence fatty tissue in the retroperitoneal space creates the possibility of significant mobility of this section of the intestine and the formation of additional kinks.

Atresia- complete absence of a lumen (characterized by a strong expansion and thinning of the walls of those sections of the intestine that are above atresia).

stenoses– due to localized hypertrophy of the wall, the presence of a valve, a membrane in the lumen of the intestine, compression of the intestine by embryonic cords, an annular pancreas, superior mesenteric artery, and a highly located caecum.

In case of atresias and stenoses of the jejunum and ileum, the atrezated or narrowed intestine is resected along with a stretched, functionally incomplete section over 20-25 cm. In case of obstruction in the distal intestine, duodenojejunoanastomosis is used.

Diverticula.

Incorrect position of the duodenum -

mobile duodenum.

106

Lecture No. 7

Channels

Right side channel limited to the right by the lateral wall of the abdomen, to the left by the ascending colon. It communicates above with the subhepatic and right hepatic bags, below - with the right iliac fossa and the pelvic cavity.

Left side channel limited to the left by the lateral wall of the abdomen, to the right by the descending colon and sigmoid colon. It communicates below with the left iliac fossa and the pelvic cavity, at the top the canal is closed by the diaphragmatic-colic ligament.

sinuses

Right mesenteric sinus has a triangular shape

closed, limited to the right by the ascending colon, from above by the transverse colon, to the left by the root of the mesentery small intestine. The root of the mesentery of the small intestine runs from top to bottom and from left to right from the left side of the 2nd lumbar vertebra to the right sacroiliac joint. On its way, the root crosses the horizontal part of the duodenum, the abdominal aorta, the inferior vena cava and the right ureter.

Left mesenteric sinus limited to the left by the descending colon, to the right by the root of the mesentery of the small intestine, and from below by the sigmoid colon. Since the sigmoid colon only partially covers the lower border, this sinus freely communicates with the pelvic cavity.

Pockets

Superior duodenal pocket located above the superior duodenal fold.

lower duodenal pocket lies below the inferior duodenum

fold.

Superior ileocecal pouch It is located where the small intestine enters the large intestine, above the ileum.

Inferior ileocecal pouch It is located where the small intestine enters the large intestine, below the ileum.

Posterior intestinal pocket located behind the caecum.

intersigmoid pocket located at the site of attachment of the mesentery of the sigmoid colon along its left edge.

Topographic anatomy of the small intestine

duodenum- discussed above jejunum; ileum.

Holotopy: mesogastric and hypogastric regions.

Covering the peritoneum: from all sides. Between the sheets of the peritoneum along the mesenteric edge, the so-called extraperitoneal field (area nuda) is isolated, along which straight arteries enter the intestinal wall, and direct veins and extraorganic lymphatic vessels.

Skeletotopia: the root of the mesentery of the small intestine starts from the L2 vertebra and descends from left to right to the sacroiliac joint, crossing the horizontal part of the duodenum, aorta, inferior vena cava, right ureter.

Syntopy: in front - the greater omentum, on the right - the ascending colon, on the left - the descending and sigmoid colons, behind - the parietal peritoneum, below - bladder, rectum, uterus and its appendages.

Approximately in 1.5-2% of cases, at a distance of 1 m from the place where the ileum flows into the large intestine, on the edge opposite to the mesentery, a process is found - Meckel's diverticulum (the remnant of the embryonic vitelline duct), which can become inflamed and require surgical intervention.

blood supply It is carried out due to the superior mesenteric artery, from which 10-16 jejunal and ileo-intestinal arteries successively depart, located in the mesentery of the small intestine.

Features of the blood supply:

arcade type - the branches of the arteries dichotomously divide and form arterial arches (up to 5 orders);

segmental type - i.e. functionally insufficient intraorgan anastomoses between straight branches (depart from the marginal vessel formed by distally located arterial arches) entering the wall of the small intestine;

2 intestinal arteries account for 1 vein.

Direct veins emerge from the intestinal wall, which form

the jejunal and ileo-intestinal veins form the superior mesenteric vein. At the root of the mesentery, it is located to the right of the artery of the same name and goes behind the head of the pancreas, where it participates in the formation of the portal vein.

Lymph drainage carried out in the lymph nodes located in the mesentery in 3-4 rows. The central regional lymph nodes for the mesenteric part of the small intestine are the nodes that lie along the superior mesenteric vessels behind the head of the pancreas. The efferent lymphatic vessels form intestinal trunks that empty into the thoracic duct.

innervation The small intestine is provided with nerve conductors extending from the superior mesenteric plexus.

1. Upper floor of the peritoneal cavity splits into t ri bags: bursa hepatica, bursa pregastrica and bursa omentalis. Bursa hepatica covers the right lobe of the liver and separates from Bursa pregastrica through lig. falciforme hepatis; behind it is limited lig. coronarium hepatis. In depth bursa hepatica, under the liver, the upper end of the right kidney with the adrenal gland is palpated. Bursa pregastrica covers the left lobe of the liver, the anterior surface of the stomach and spleen; the left part of the coronary ligament passes along the posterior edge of the left lobe of the liver; the spleen is covered on all sides by the peritoneum, and only in the region of the gate its peritoneum passes from the spleen to the stomach, forming lig. gastrolienale, and on the diaphragm - lig. phrenicolienale.

Bursa omentalis, stuffing bag,

Cavity stuffing bag communicates with the common peritoneal cavity only through a relatively narrow foramen epipldicum. Foramen epiploicum bounded above by the caudate lobe of the liver, in front by the free edge of lig. hepatoduodenale, from below - by the upper part of the duodenum, from behind - by a sheet of peritoneum covering the inferior vena cava passing here, and more outwards - by a ligament passing from the posterior edge of the liver to the right kidney, lig. hepatorenale. Part of the stuffing bag, directly adjacent to the stuffing hole and located behind lig. hepatoduodenale, is called the vestibule - vestibulum bursae omentalis; it is bounded above by the caudate lobe of the liver, and below by the duodenum and head of the pancreas.

top wall stuffing bag the lower surface of the caudate lobe of the liver serves, and the processus papillaris hangs in the bag itself. The parietal sheet of the peritoneum, which forms the posterior wall of the omental bag, covers the aorta, inferior vena cava, pancreas, left kidney and adrenal gland located here. Along the anterior edge of the pancreas, the parietal sheet of the peritoneum departs from the pancreas and continues forward and downward as the anterior sheet of the mesocolon transversum or, more precisely, the posterior plate of the greater omentum, fused with the mesocolon transversum, forming the lower wall of the omental bag.

The left wall of the stuffing bag is made up of ligaments of the spleen: gastro-splenic, lig. gastrolienale, and diaphragmatic-splenic, lig. phrenicosplenicum.

Greater omentum, omentum majus,

The anterior plate of the greater omentum is served by two sheets of peritoneum extending downward from the greater curvature of the stomach and passing in front of the colon transversum, with which they fuse, and the transition of the peritoneum from the stomach to the colon transversum is called lig. gastrocolicum.

These two sheets of the omentum can descend in front of the loops of the small intestine almost to the level of the pubic bones, then they are bent into the posterior plate of the omentum, so that the entire thickness of the greater omentum consists of four sheets; with loops of small intestines, the leaves of the omentum do not normally grow together. Between the sheets of the anterior plate of the omentum and the leaves of the posterior there is a slit-like cavity, which communicates with the cavity of the omental bag at the top, but in an adult the leaves usually fuse with each other, so that the cavity of the greater omentum is obliterated over a large extent.

By greater curvature stomach cavity sometimes in an adult for a greater or lesser extent continues between the leaves of the greater omentum.

In the thickness of the greater omentum are located The lymph nodes, nodi lymphatici omentales, draining lymph from the greater omentum and transverse colon.

Educational video anatomy of floors, canals, bursae, peritoneal pockets and omentum

Peritoneum, peritoneum, represents a closed serous sac, which only in women communicates with the outside world through a very small abdominal opening of the fallopian tubes. Like any serous sac, the peritoneum consists of two sheets: parietal, parietal, peritoneum parietale, and visceral, peritoneum viscerale. The first lines the abdominal walls, the second covers the insides, forming their serous cover over a greater or lesser extent. Both sheets are in close contact with each other, between them, with an unopened abdominal cavity, there is only a narrow gap called the peritoneal cavity, cavitas peritonei, which contains a small amount of serous fluid that moistens the surface of the organs and thus facilitates their movement around each other. When air enters during an operation, or an autopsy, or when pathological fluids accumulate, both sheets diverge and then the peritoneal cavity takes the form of a real, more or less voluminous cavity.

Parietal peritoneum lines the anterior and lateral walls of the abdomen with a continuous layer from the inside and then continues to the diaphragm and the posterior abdominal wall. Here it meets the viscera and, wrapping itself on the latter, directly passes into the visceral peritoneum covering them. Between the peritoneum and the walls of the abdomen there is a connective tissue layer, usually with a greater or lesser content of adipose tissue, tela subserosa, - subperitoneal fiber, which is not equally expressed everywhere. In the region of the diaphragm, for example, it is absent; on the back wall of the abdomen, it is most developed, covering the kidneys, ureters, adrenal glands, abdominal aorta and inferior vena cava with their branches.

Along the anterior abdominal wall, for a large extent, the subperitoneal tissue is weakly expressed, but below, in the regio pubica, the amount of fat in it increases, the peritoneum here connects to the abdominal wall more loosely, due to which the bladder, when stretched, pushes the peritoneum away from the anterior abdominal wall and its anterior surface, at a distance of about 5 cm above the pubis, comes into contact with the abdominal wall without the mediation of the peritoneum. The peritoneum in the lower part of the anterior abdominal wall forms five folds converging to the navel, umbilicus; one median unpaired, plica umbilicalis mediana, and two paired, plicae umbilicales mediales and plicae umbilicales laterales. These folds delimit on each side above the inguinal ligament two fossae inguinales related to the inguinal canal. Immediately below the medial part of the inguinal ligament is the fossa femoralis, which corresponds to the position of the inner ring of the femoral canal.

Up from the navel, the peritoneum passes from the anterior abdominal wall and diaphragm to the diaphragmatic surface of the liver in the form of a falciform ligament, lig. falciforme hepatis, between the two leaves of which in its free edge is laid a round ligament of the liver, lig. teres hepatis (overgrown umbilical vein). The peritoneum behind the falciform ligament from the lower surface of the diaphragm wraps onto the diaphragmatic surface of the liver, forming the coronary ligament of the liver, lig. coronarium hepatis, which at the edges looks like triangular plates, called triangular ligaments, lig. triangulare dextrum et sinistrum.

From the diaphragmatic surface of the liver, the peritoneum through the lower sharp edge of the liver bends to the visceral surface; from here it departs from the right lobe to the upper end of the right kidney, forming lig. hepatorenale, and from the gate - to the lesser curvature of the stomach in the form of a thin lig. hepatogastricum and on the part of the duodeni closest to the stomach in the form of lig. hepatoduodenale. Both of these ligaments are duplications of the peritoneum, since two layers of the peritoneum meet in the region of the gate of the liver: one is going to the gate from the front of the visceral surface of the liver, and the second is from its back. Lig. hepatoduodenale and lig. hepatogastricum, being a continuation of one another, together make up the lesser omentum, omentum minus. On the lesser curvature of the stomach, both sheets of the lesser omentum diverge: one sheet covers the anterior surface of the stomach, the other - the back. On the greater curvature, both sheets converge again and descend down in front of the transverse colon and loops of the small intestine, forming the anterior plate of the greater omentum, omentum majus. Going down, the sheets of the greater or lesser height are wrapped back up, forming its back plate (the greater omentum thus consists of four sheets). Having reached the transverse colon, the two sheets that make up the posterior plate of the greater omentum fuse with the colon transversum and with its mesentery and, together with the latter, then go back to the margo anterior of the pancreas; from here the leaves diverge; one is up, the other is down. One, covering the anterior surface of the pancreas, goes up to the diaphragm, and the other, covering the lower surface of the gland, passes into the mesentery of the colon transversum. In an adult, with complete fusion of the anterior and posterior plates of the greater omentum with the colon transversum on the tenia mesocolica, 5 sheets of the peritoneum are thus fused: four sheets of the omentum and the visceral peritoneum of the intestine. Let us now trace the course of the peritoneum from the same sheet of the anterior abdominal wall, but not in the upward direction to the diaphragm, but in the transverse direction.

From the anterior abdominal wall, the peritoneum, lining the lateral walls of the abdominal cavity and passing to the posterior wall on the right, surrounds the caecum with its appendix on all sides; the latter receives the mesentery - mesoappendix. The peritoneum covers the colon ascendens in front and from the sides, then the lower part of the anterior surface of the right kidney, passes in the medial direction through m. psoas and ureter and at the root of the mesentery of the small intestine, radix mesenterii, folds into the right leaf of this mesentery. Having supplied the small intestine with a complete serous cover, the peritoneum passes into the left leaf of the mesentery; at the root of the mesentery, the left sheet of the latter passes into the parietal sheet of the posterior abdominal wall, the peritoneum further covers the lower part of the left kidney to the left and approaches the colon descendens, which belongs to the peritoneum, as well as the colon ascendens; further, the peritoneum on the lateral wall of the abdomen is again wrapped on the anterior abdominal wall. The entire peritoneal cavity, in order to facilitate the assimilation of complex relationships, can be divided into three areas, or floors:

1. the upper floor is bounded from above by the diaphragm, from below by the mesentery of the transverse colon, mesocolon transversum;
2. the middle floor extends from the mesocolon transversum down to the entrance to the small pelvis;
3. the lower floor starts from the line of entry into the small pelvis and corresponds to the cavity of the small pelvis, which ends downward with the abdominal cavity.

Upper floor of the peritoneal cavity breaks up into three bags: bursa hepatica, bursa pregastrica and bursa omentalis. Bursa hepatica covers the right lobe of the liver and is separated from bursa pregastrica by means of lig. falciforme hepatis; behind it is limited lig. coronarium hepatis.

In the depths of the bursa hepatica, iodine by the liver, the upper end of the right kidney with the adrenal gland is palpated. Bursa pregastrica covers the left lobe of the liver, the anterior surface of the stomach and spleen; the left part of the coronary ligament passes along the posterior edge of the left lobe of the liver; the spleen is covered on all sides by the peritoneum, and only in the region of the gate does its peritoneum pass from the spleen to the stomach, forming lig. gastrolienale, and on the diaphragm - lig. phrenicolienale.

Bursa omentalis, stuffing bag, is a part of the common cavity of the peritoneum, lying behind the stomach and lesser omentum. The composition of the lesser omentum, omentum minus, includes, as indicated, two ligaments of the peritoneum: lig. hepatogastricum, running from the visceral surface and the gate of the liver to the lesser curvature of the stomach, and lig. hepatoduodenale, connecting the gates of the liver with the pars superior duodeni. Between leaves lig. hepatoduodenale pass the common bile duct (right), common hepatic artery (left) and portal vein (posteriorly and between these formations), as well as lymphatic vessels, nodes and nerves. The cavity of the omental bag communicates with the common cavity of the peritoneum only through a relatively narrow foramen epiploicum. Foramen epiploicum is bounded above by the caudate lobe of the liver, in front by the free edge of lig. hepatoduodenale, from below - by the upper part of the duodenum, from behind - by a sheet of peritoneum covering the inferior vena cava passing here, and more outwards - by a ligament passing from the posterior edge of the liver to the right kidney, lig. hepatorenale. Part of the stuffing bag, directly adjacent to the stuffing hole and located behind lig. hepatoduodenale, is called the vestibule - vestibulum bursae omentalis; it is bounded above by the caudate lobe of the liver, and below by the duodenum and head of the pancreas. The lower surface of the caudate lobe of the liver serves as the upper wall of the stuffing bag, and the processus papillaris hangs in the bag itself.

The parietal sheet of the peritoneum, which forms the posterior wall of the omental bag, covers the aorta, inferior vena cava, pancreas, left kidney and adrenal gland located here. Along the anterior edge of the pancreas, the parietal sheet of the peritoneum departs from the pancreas and continues forward and downward as the anterior sheet of the mesocolon transversum or, more precisely, the posterior plate of the greater omentum, fused with the mesocolon transversum, forming the lower wall of the omental bag. The left wall of the stuffing bag is made up of ligaments of the spleen: gastro-splenic, lig. gastrolienale, and diaphragmatic-splenic, lig. phrenicosplenicum. The greater omentum, omentum majus, hangs down from the colon transversum in the form of an apron, covering the loops of the small intestine for a greater or lesser extent; It got its name from the presence of fat in it. It consists of 4 sheets of peritoneum, fused in the form of plates. The anterior plate of the greater omentum is served by two sheets of peritoneum extending downward from the greater curvature of the stomach and passing in front of the colon transversum, with which they fuse, and the transition of the peritoneum from the stomach to the colon transversum is called lig. gastrocolicum. These two sheets of the omentum can descend in front of the loops of the small intestine almost to the level of the pubic bones, then they are bent into the posterior plate of the omentum, so that the entire thickness of the greater omentum consists of four sheets; with loops of small intestines, the leaves of the omentum do not normally grow together. Between the sheets of the anterior plate of the omentum and the leaves of the posterior there is a slit-like cavity, which communicates with the cavity of the omental bag at the top, but in an adult the leaves usually fuse with each other, so that the cavity of the greater omentum is obliterated over a large extent. Along the greater curvature of the stomach, the cavity sometimes continues in an adult for a greater or lesser extent between the leaves of the greater omentum. In the thickness of the greater omentum, there are lymph nodes, nodi lymphatici omentales, which drain lymph from the greater omentum and the transverse colon.

Middle floor of the peritoneal cavity becomes available for review if the greater omentum and transverse colon are raised upwards.

Using the ascending and descending colons on the sides and the mesentery of the small intestines in the middle as boundaries, it can be divided into four sections: between the lateral walls of the abdomen and the colon ascendens and descendens are the right and left lateral canals, canales laterales dexter et sinister; the space covered by the colon is divided by the mesentery of the small intestine, going obliquely from top to bottom and from left to right, into two mesenteric sinuses, sinus mesentericus dexter and sinus mesentericus sinister. On the posterior parietal sheet of the peritoneum, a number of peritoneal pits are noted, which are of practical importance, since they can serve as a site for the formation of retroperitoneal hernias. At the point of transition of the duodenum into the jejunum, small pits are formed - depressions, recessus duodenalis superior et inferior. These pits are limited on the right by the bend of the intestinal tube, flexura duodenojejunalis, on the left by the fold of the peritoneum, plica duodenojejunalis, which goes from the top of the bend to the posterior abdominal wall of the abdomen immediately below the body of the pancreas and contains v. mesenterica inferior.

In the area of ​​transition of the small intestine to the large intestine, there are two pits: recessus ileocaecalis inferior et superior, below and above the plica ileocaecalis, passing from the ileum to the medial surface of the caecum. The deepening of the parietal sheet of the peritoneum, in which the caecum lies, is called the fossa of the caecum and is noticeable when the caecum and the nearest section of the ileum are pulled upwards. The resulting fold of the peritoneum between the surface of m. iliacus and the lateral surface of the caecum is called plica caecalis. Behind the caecum, in the fossa of the caecum, there is sometimes a small opening leading to the recessus retrocaecalis, extending upward between the posterior abdominal wall and the colon ascendens. On the left side there is a recessus intersigmoideus; this fossa is noticeable on the lower (left) surface of the mesentery of the sigmoid colon, if you pull it up. Lateral to the descending colon, sometimes there are peritoneal pockets - sulci paracolici. Above, between the diaphragm and flexura coli sinistra, there is a fold of the peritoneum, lig. phrenicocolicum; it is located just under the lower end of the spleen and is also called the splenic sac.

Lower floor. Descending into the cavity of the small pelvis, the peritoneum covers its walls and the organs lying in it, including the genitourinary ones, so the relationship of the peritoneum here depends on gender. The pelvic section of the sigmoid colon and the beginning of the rectum are covered with peritoneum on all sides and have a mesentery (located intraperitoneally). middle department the rectum is covered by the peritoneum only from the anterior and lateral surfaces (mesoperitoneally), and the lower one is not covered by it (extraperitoneally). Passing in men from the anterior surface of the rectum to the posterior surface of the bladder, the peritoneum forms a recess located behind the bladder, excavatio rectovesicale. With an unfilled bladder, on its upper posterior surface, the peritoneum forms a transverse fold, plica vesicalis transversa, which is smoothed out when the bladder is filled.

In women, the course of the peritoneum in the pelvis is different due to the fact that between bladder and rectum is the uterus, which is also covered by the peritoneum. As a result, in the pelvic cavity in women there are two peritoneal pockets: excavdtio rectouterina - between the rectum and the uterus and excavatio vesicouterina - between the uterus and the bladder. In both sexes, there is a prevesical space, spatium prevesicale, formed in front of the fascia transversalis, which covers the transverse abdominal muscles behind, and the bladder and peritoneum behind. When the bladder is filled, the peritoneum moves upward, and the bladder is adjacent to the anterior abdominal wall, which allows it to penetrate into the bladder through its anterior wall during surgery without damaging the peritoneum. The parietal peritoneum receives vascularization and innervation from parietal vessels and nerves, and the visceral peritoneum receives blood vessels and nerves branching in the organs covered by the peritoneum.

The abdominal cavity is bounded in front and laterally by the walls of the abdomen, behind by the lumbar region, and from above by the diaphragm; from below, it passes into the cavity of the small pelvis. It contains within itself the abdominal cavity and the organs of the retroperitoneal space.

Abdomen (cavum peritoneale) is represented by a space surrounded by a serous membrane - the peritoneum (peritoneum). It includes all organs covered by the peritoneum (Fig. 133). The serous sheet covering the walls of the abdomen from the inside is called parietal, or parietal, and adjacent to the organs, visceral, or visceral. Both sheets are one whole, they directly pass one into the other. Between the sheets of the peritoneum contains a small amount of serous fluid - up to 30 ml.

Rice. 133. Sinuses and channels of the abdominal cavity.
I - liver bag; II - pregastric bag; III - right mesenteric sinus; IV - left mesenteric sinus; V - right channel; VI - left channel, 1 - diaphragm; 2 - coronary ligament of the liver; 3 - liver; 4 - stomach; 5 - spleen; 6 - transverse colon: 7 - duodenal inflection; 8 - descending section of the large intestine: 9 - sigmoid colon; 10 - bladder; 11 - the final section of the ileum; 12 - cecum with appendix; 13 - root of the mesentery small intestine; 14 - ascending section of the large intestine; 15 - duodenum; 16 - gallbladder.

Most organs (stomach, small intestine, cecum, transverse colon, and sigmoid colon, spleen) are shrouded in peritoneum from all sides, that is, they lie intraperitoneally, or intraperitoneally. They are held on the mesentery or ligaments formed by the sheets of the peritoneum. Other organs (liver, gallbladder, ascending and descending colon, part of the duodenum, pancreas, rectum) are closed by the peritoneum on three sides, with the exception of the posterior, i.e., located mesoperitoneally. A small number of organs (duodenum, pancreas, kidneys, ureters, large blood vessels) lie behind the peritoneum - occupy a retroperitoneal position.

Using the position of the transverse colon with its mesentery, the abdominal cavity is divided into upper and lower floors, which approximately corresponds to the plane passing through the ends of the X ribs. In the upper floor, three bags (or bags) are distinguished: hepatic, pregastric and omental. The hepatic bag (bursa hepatica) is located between the diaphragm, the anterior wall of the abdomen and the right lobe of the liver. The pregastric bag (bursa pregastrica) is localized in front of the stomach with its ligaments and adjoins the left lobe of the liver and spleen. These bags are separated from each other by the falciform ligament of the liver. The omental bag (bursa omentalis) is represented by a slit-like space bounded in front by the stomach with its ligaments, below - by the left side of the transverse colon with its mesentery, on the left - by the spleen with its ligaments and behind - by the peritoneum of the posterior abdominal wall covering the pancreas, the left kidney with the adrenal glands, aorta and inferior vena cava; from above, the stuffing bag adjoins the caudate lobe of the liver (Fig. 134). This bag communicates with the common cavity through the omental opening of Winslovia (for. epiploicum Winslowi), limited by covered peritoneum right kidney with the adjoining inferior vena cava behind, the initial part of the duodenum below, the caudate lobe of the liver above and the hepatoduodenal ligament in front.

Rice. 134. The course of the peritoneum on the sagittal section of the abdomen (semi-schematically). The abdominal aorta is slightly displaced to the right and left undissected. 1 - diaphragm; 2 - small gland; 3 - gland hole; 4 - truncus coeliacus; 5-a. mesenterica superior; 6 - pancreas; 7-a. renalis; 8 - cisterna chyli and a. testicularis; 9 - duodenum; 10-a. mesenterica inf.; 11 - latero- and retro-aortic lymph nodes; 12 - mesenterium; 13 - vasa iliaca communia; 14 - greater omentum: 15 - colon transversum; 16 - mesocolon transversum; 17 - stomach; 18 - liver.

In the lower floor of the abdominal cavity, the right and left mesenteric sinuses and lateral canals are isolated. The right sinus (sinus mesentericus dexter) is bounded above by the mesentery of the transverse colon, on the right by the ascending colon, on the left and below by the mesentery of the small intestine and in front by the greater omentum. flowing here inflammatory processes to a certain extent closed by the boundaries of the sinus. The left mesenteric sinus (sinus mesentericus sinister) is bounded above by the mesentery of the transverse colon, on the right by the mesentery of the small intestines, on the left by the descending colon and in front by the greater omentum. At the bottom, the sinus is open into the pelvic cavity, which makes it possible for pus or blood to spread here. Both mesenteric sinuses communicate through a gap bounded by the initial part of the small intestine and the mesentery of the transverse colon. The right lateral canal (canalis lateralis dexter) is bounded by the lateral wall of the abdomen and the ascending colon, the left (canalis lateralis dexter) by the lateral wall of the abdomen and the descending colon. Both channels above communicate with the upper floor of the abdominal cavity, but on the left this communication is limited due to the existence of lig. phrenicocolicum. Inflammatory processes can spread through these channels.