Page 91 - Clinical Anatomy

ECA2 7/18/06 6:42 PM Page 76

76 The abdomen and pelvis

Fig. 57◊The relations of the duodenum.

Fig. 58◊The duodenum and pancreas dissected to show the pancreatic ducts and
their orifices.

The fourth part (1in (2.5cm)) ascends upwards and to the left to end at
the duodenojejunal junction. It is surprisingly easy for the surgeon to
confuse this with the ileocaecal junction, a mistake which may be disas-
trous. He confirms the identity of the duodenal termination by the presence
of the suspensory ligament of Treitz, which is a well-marked peritoneal fold
descending from the right crus of the diaphragm to the duodenal termina-
tion, and by visualizing the inferior mesenteric vein which descends
from behind the pancreas immediately to the left of the duodenojejunal
junction.