Page 81 - Clinical Anatomy

ECA2 7/18/06 6:42 PM Page 66

66 The abdomen and pelvis

Fig. 47◊The peritoneal cavity in longitudinal section (female).

departure is the parietal peritoneum of the anterior abdominal wall below
the umbilicus. At this level the membrane is smooth apart from the shallow
ridges formed by the median umbilical fold (the obliterated fetal urachus
passing from the bladder to the umbilicus), the medial umbilical folds (the
obliterated umbilical arteries passing to the umbilicus from the internal
iliac arteries) and the lateral umbilical folds (the peritoneum covering the
inferior epigastric vessels).
A cicatrix can usually be felt and seen at the posterior aspect of the
umbilicus, and from this the falciform ligament sweeps upwards and slightly
to the right of the midline to the liver. In the free border of this ligament lies
the ligamentum teres (the obliterated fetal left umbilical vein) which passes
into the groove between the quadrate lobe and left lobe of the liver.
Elsewhere, the peritoneum sweeps over the inferior aspect of the
diaphragm, to be reflected on to the liver (leaving a bare area demarcated
by the upper and lower coronary ligaments of the liver) and on to the right
margin of the abdominal oesophagus. After enclosing the liver (for further
details, see page 95), the peritoneum descends from the porta hepatis as a
double sheet, the lesser omentum, to the lesser curve of the stomach. Here it
again splits to enclose this organ, reforms at its greater curve, then loops
downwards, then up again to attach to the length of the transverse colon,
forming the apron-like greater omentum.
The transverse colon, in turn, is enclosed within this peritoneum which
then passes upwards and backwards as the transverse mesocolon to the
posterior abdominal wall, where it is attached along the anterior aspect of
the pancreas.