Transverse colon crossing duodenum — , / \ 
* 
THE DUODENUM. 1017 
and below it with the coils of the small intestine. Behind, it is connected by areolar 
tissue to the inner part of the right kidney, with its ureter and renal vessels: it 
is also related, as a rule, to the right psoas muscle below the kidney (Fig. 687). 
To its outer or right side lies the liver (here presenting the duodenal impres- 
sion) above, and often the ascending colon below. To its inner side are the inferior 
vena cava and the head of the pancreas, this latter overlapping it somewhat in front. 
The common bile duct, after passing down behind the first portion of the 
duodenum, descends between the head of the pancreas and the second portion, 
nearly as far as its middle; here it is joined by the pancreatic duct, and the two, 
Top of small sac 
Inferior vena cava Left lateral ligament of liver 
Lesser omentum (cut) \ | (Esophageal opening in diaphragm 
( / Gastro-phrenic¢ ligament 
Right lateral ligament | { Corresponds to ‘uncovered area’ of stomach 
of liver | / Gastro-spleni¢ omentum (cut) 
| Ido toon 
Phreno-colie ligauent 
Left end of transverse mesocolon 
Head of pancreas / / \ 
Great omentum (Cut) i \ | Splenic flexure of colon 
Part of small sac \ Lrausverse mesocolon (cut) 
Koot of mesentery (cut) 
Fic. 688.—THE PERITONEAL RELATIONS OF THE DUODENUM, PANCREAS, SPLEEN, KIDNEYS, ETC. 
From a body hardened by injections of formalin. In removing the liver, stomach, and intestines the lines of 
the peritoneal reflexions were carefully preserved. The peritoneum is coloured blue. 
piercing the wall of the duodenum obliquely, open by a common orifice on its 
inner aspect, about 34 to 4 inches (8-7 to 10 em.) beyond the pylorus. 
Peritoneal relations —There is no peritoneum on the posterior or deep surface 
of this part, whilst its superficial or anterior surface is covered, except where it is 
crossed by the colon (Fig. 688). 
When the beginning of the transverse colon is completely covered by peritoneum, and has a 
mesentery (a condition which often seems to be determined by a liver large in the vertical direc- 
tion), the whole of the anterior surface, with the exception of the insignificant area between the 
two layers of the transverse mesocolon, is covered by the peritoneum. 
On the other hand, when this part of the colon has no mesentery, it lifts the peritoneum off 
the front of the duodenum, and leaves a considerable “uncovered area,” which is united by 
areolar tissue to the back of the colon, 
