1. Fascia of the Abdomen
Chris van Zyl
KHC

2. Outline Peritoneum Quick word on Embryology Anatomy
Fascia of the anterior abdominal wall
Fascia around kidneys

3. Peritoneam Serous membrane Divided into parietal and visceral
Parietal peritoneum lines anterior, lateral and posterior walls peritoneal cavity
Visceral peritoneum lines all the organs that are intraperitoneal.

4. Embryology Mesentries divide coelomic cavity into R + L halves
Upper abdomen
Stomach + gut suspended in the middle
Liver in the ventral mesentery
Spleen in dorsal mesentery

5. Embryology Organs migrate in anticlockwise fashion
Liver lies on the right
Spleen on the left
Drags mesenteries into position they occupy in muturity

6. Peritoneal cavity Two main regions
Greater sac (general abdominal cavity)
Lesser sac (or omental bursa)
Communicate via foramen of Vinslow (epiploic foramen)

7. Course
Covers the inferior aspect of diaphragm and is reflected onto the liver and the abdominal part of the esophagus
After the liver is enclosed, it extends from the porta hepatis as a double layer (lesser omentum) to the lesser curvature of the stomach

8. Course
It encloses the stomach, reaches the greater curvature of stomach and extends as a double layer (greater omentum) down into the abdominal cavity,loops back up to the transverse colon.
From there the transverse mesocolon is formed, which joins the post abdominal wall on the anterior aspect of the pancreas

9. Course Double layer devides into single layers
one which runs superiorly over the post abdominal wall and reflected onto the bare area of liver
The other runs inferiorly over the post abdominal wall to cover the pelvic organs and join the peritoneum of the anterior abdominal wall.
The post peritoneal layer of the post abdo wall is interrupted as it’s reflected from the duodenojejenal to ileocaecal junction to form the mesentery of the jejenum and ileum

10. Blood supply of the peritoneum
To the parietal peritoneum
Lumbar vessels
Branches of the inferior and superior epigastric arteries
Musculophrenic arteries
Deep circumflex arteries
To the visceral peritoneum
From the arteries supplying the appropriate viscera

11. Innervation of the peritoneum
To the parietal peritoneum
From the nerves supplying the diaphragm and adjacent body wall - e.g. phrenic (C3-C5) and intercostal and subcostal nerves (T7-L1)
To the visceral peritoneum
Sympathetic nerves innervating the appropriate viscera.

12. Peritoneam Anatomy devided into: Peritoneal spaces
Peritoneal reflections including ligaments
Mesentry
Omenta

13. Peritoneal Spaces:
Peritoneal cavity devided by transverse colon and mesocolon into:
Supramesocolic compartment
Right and Left supramesocolic spaces
Inframesocolic compartment
Devided by root of smallbowel mesentery
Right and Left inframesocolic spaces

14. Right supramesocolic space
Devided into:
Right subphrenic space
Diaphragmatic surface of R liver from falciform ligament medially to coronary ligament postero-infer
Right subhepatic space
Subdevided into ant + post spaces (Morrison’s pouch)
Communicates with R paracolic gutter + R infracolic space
Lesser sac

15. Left supramesocolic space
Devided into:
Ant left perihepatic space
Post left perihepatic space (gastrohepatic recess)
Anterior left subphrenic spaces
Posterior left suphrenic spaces

16. Imaging RSP: R subphric S LSP: L subphrenic S LPC: L paracolic S
LSs: Sup recess LS
Lsi: Inf recess LS

17. Lesser Sac Posterior Wall Anterior Wall Lateral Wall
Peritoneum over pancreas, left adrenal, upper pole of left kidney
Anterior Wall
Peritoneum over post. stomach, lesser omentum
Lateral Wall
Spleen, gastrosplenic, splenorenal ligaments
Communicates via epiploic foramen (of Winslow)

18. Lesser sac Devided by gastropancreatic fold (left gastric artery)
Superior recess
Encloses caudate lobe
Inferior recess
Lies between stomach and pancreas
Left Gastric artery: Arrow
GHL: Gastro hepatic lig
SHS: Subhepatic S
LSs: Sup recess LS
Lsi: Inf recess LS

19. Foramen of Winslow Post: IVC
Ant: free edge of lesser omentum containing portal vein, hepatic artery, CBD
Sup: Caudate lobe
Inf: 1st part of duodenum

20. Right inframesocolic compartment
Bounded by:
Transverse mesocolon sup and to the R
Root of small bowel mesentery

21. Left inframesocolic space
Larger than right
In free communication with pelvis right to midline
Sigmoid colon and mesentery forms partial barier left of midline

22. Paracolic gutters
Peritoneal recesses lat to ascending + descending colon
Right continuous with right subhepatic/phrenic spaces
Left seperated by phrenicocolic ligament
Both communicates with pelvis

23. Imaging: Inframesocolic compart.

24. Pelvic peritoneal spaces/pouches
The rectouterine pouch/ Pouch of Douglas (in females) separating rectum from bladder
The rectovesical pouch (in males) separating the rectum from the bladder
The vesicouterine pouch (in females) separating bladder from uterus

25. Peritoneal reflections
8 Legaments
4 Mesentries
2 Omenta

26. Peritoneal ligaments Right coronary ligament Left coronary ligament
Reflection of peritoneum from diaphragm to post surface of R liver lobe
Bare area between two layers of this ligament
Left coronary ligament
Continuation of this peritoneal reflection to the left

27. Peritoneal ligaments Gastrosplenic ligament Falciform ligament
Continuous with greater omentum
From greater curve of stomach to spleen.
Contains gastroepiploic vessels + short gastric vessels
Falciform ligament
From anterosup surface of liver to diaphragm + ant abdominal wall
Carries lig Teres (obliterated umbilical vein) in free edge
Continues with fissure for lig venosum

28. Peritoneal ligaments Phrenicocolic ligament Splenorenal ligament
From splenic flexure to diaphragm
Continuous with transverse mesocolon + splenorenal lig
Splenorenal ligament
From pancreatic tail to splenic hilus
Transmits splenic vessels

29. Peritoneal ligaments Hepatoduodenal ligaments Duodenocolic ligament
From flexure between 1st + 2nd part of duodenum to porta hepatis
Transports portal triad
Duodenocolic ligament
From R colic flexure to descending duodenum
Continuous with transverse mesocolon

30. Imaging

31. Imaging

32. Broad ligament of the uterus
Wide fold of peritoneum that connects the sides of the uterus to the walls and floor of the pelvis

33. Broad ligament of the uterus
Subcomponents:
Mesometrium- the mesentery of the uterus; the largest portion of the broad ligament
Mesosalpinx- the part that surrounds the Fallopian tube
Mesovarium- the part that connects the anterior surface of the ovary to the remainder of the broad ligament.

34. Mesentries Small bowel mesentry Broad fan shaped fold
Conects jejunum + ileum to post abdominal wall
Extends from duodenojejunal flexure (Left of L2) to upper part of R SI joint
Root continuous with L + R ant pararenal spaces
Contains jejunal, ileal branches of SMA and accompanying veins, nerves, lymphatics

35. Mesentries Transverse mesocolon
Connects transvers colon to post abdominal wall
Pass from ant head and body of pancreas to post colon
Upper layer adherent to greater omentum
Contains middle colic vessels, nerves + lymphatics

36. Mesentries Sigmoid mesocolon Mesoappendix
Attaches sigmoid colon to pelvic wall
Line of attachment inverted V with apex near devision of L common iliac artery
Leftlimb descends to L psoas, R into pelvis
Contains sup rectal vessels
Mesoappendix
Attached to lower end of small bowel mesentry

37. Omenta
Greater and Lesser

38. Greater Omentum Continuous with:
Hangs from the greater curve of the stomach and loops down in front of the intestines before curving back upwards to attach to the transverse colon, thus 4 layers of peritoneum 
Continuous with:
Gastrocolic ligament: largest component
Gastrosplenic ligament: to splenic hilus
Gastrophrenic ligament

39. Lesser Omentum
Attached to the lesser curvature of the stomach, prox duodenum and the liver
Subdivided into: 
Gastrohepatic ligament
connects the left lobe of the liver to the lesser curvature of the stomach
Hepatoduodenal ligament
free edge of the omentum, extends to porta hepatis and ligamentum venosum
Contains gastric artery, coronary vein, left gastric nodal chain

40. Fascia of anterior abdominal wall
Superficial fascia
Superficial layer
Deep layer
Transversalis fascia
2: Superficial layer
3: Deep layer
8: Transversalis fascia

41. Superficial fascia
Single layer superiorly containing variable ammounts of fat
Inferiorly devides into superficial and deep layers
Superficial layer (Fascia of Camper):
Passes over inguinal ligament
Continuous with superficial fascia of the thigh
Continues in the scrotum as the fascia of Dartos

42. Superficial fascia Deepy layer (Fascia of Scarpa):
Connected to aponeurosis of external oblique laterally + linea alba/ symphisis pubis medially
Passes over inguinal ligamnet inferolaterally to fuse with fascia of the thigh
Forms superfiscial perineal fascia inferomedially (Fascia of Colles)

43. Transversalis fascia
Lies between transverse abdominis and extraperitoneal fat
Continuous with inferior diaphragmatic fascia
Fuses with thoracolumbar fascia posteriorly
Spermatic cord/Round ligament passes through transversalis fascia at deep inguinal ring
becomes internal spermatic fascia

44. Fascia around kidneys Renal fascia situated around the perirenal fat
Devided into:
Anterior fascia (Gerota’s)
Continuous with R inf coronary ligament
Posterior fascia (Zuckerkandl’s)
Continous with diaphragmatic fascia and iliacus fascia
Fused laterally as conal fascia
Continuous with transversalis fascia
Fused medially with sheeths of aorta + IVC

45. Fascia around kidneys

46. References: Applied Radiological Anatomy
Paul Butler, Adam W. M. Mitchell, Harold Ellis
Anatomy for Diagnostic Imaging
Stephanie Ryan, Michelle McNicholas, Stephen Eustace
Third Edition