THE PERITONEUM. 



1745 



The falciform ligament (ligamentum falciforme hepatis) makes the fourth fold 

 which has been mentioned as leaving the umbiUcus. Seen from the side, it is a 

 sickle-shaped fold attached to the anterior wall above the umbilicus and later to the 

 diaphragm as far back as the top of the fissure of the ductus venosus on the pos- 

 terior surface of the liver (Fig. 1441 ). In its free inferior border runs the round 

 ligament, once the umbilical vein, from the umbilicus to the notch in the liver, and 

 thence in its own fissure on the under surface until it reaches the portal fissure, 

 where the falciform ligament ends. The latter divides the upper part of the dome 

 of the abdomen into two chambers, one on either side, of which the left one is the 

 larger. There is but little areolar tissue in the folds of the falciform ligament. 

 Small veins run along the round ligament, connecting the hepatic system with that 

 of the abdominal walls. Although in the embryo the fold starts from the navel, in 

 the adult it does not leave the abdominal wall for an inch or more above it. 



The superior surface of the liver is covered with peritoneum from either side of 

 the falciform ligament, which at the top of the posterior surface is reflected onto 

 the under side of the dia- 

 phragm. At the edge of ^^^- ^47o. 

 the right lobe, which has a 

 considerable posterior sur- 

 face uncovered by perito- 

 neum and attached to the 

 diaphragm, the layers cov- 

 ering the upper and lower 

 surfaces meet to form the 

 right triangular ligament, 

 which is attached for a 

 short distance beyond the 

 liver to the diaphragm and 

 has a sharp, free edge. 

 There is a similar arrange- 

 ment on the upper surface 

 of the left lobe, but the 

 left tria7igular ligament is 

 longer, and passes to the 

 diaphragm on the left of the 

 oesophageal opening and 

 above the spleen. Passing around the border of the right lobe of the liver, the peri- 

 toneum spreads over the inferior surface of that lobe as well as of the quadrate cov- 

 ering the gall-bladder which lies in a hollow between them. Exceptionally the gall*- 

 bladder is entirely surrounded, and is attached to the liver merely by a narrow fold. 

 The peritoneum is continued over the cystic duct to the edge of the lesser omentum, 

 to be presently described. The entire under surface of the left lobe is also covered 

 by peritoneum continuous with the preceding. The passage of the finger on this 

 surface to the right is interrupted at the front by the end of the falciform ligament 

 between it and the quadrate lobe. At the back farther progress to the right is 

 stopped by the lesser omentum in the fissure of the ductus venosus. All the peri- 

 toneal covering of the liver has thus been accounted for, e.xcepting that of the 

 caudate lobe and of the lobe of Spigelius. 



The gastro- hepatic or lesser omentum (ligamentum hepatogastrium, omentum 

 minus) is that part of the original anterior mesentery connecting the stomach and 

 the beginning of the duodenum with the liver. It must, theoretically, have been 

 originally a median antero-posterior fold, but it is now so twisted in consequence of 

 the change in position of the stomach as to be chiefly nearly transverse. Its line of 

 attachment to the stomach is along the lesser curvature from the gullet past the 

 pylorus, continued onto the first part of the duodenum, where it crosses from the 

 top to the left of the gut, until it passes the common bile-duct (by which the ducts 

 of the liver originally grew out of the gut) with its companions, the hepatic artery 

 and the portal vein. It is formed by the union of the peritoneal layers covering 

 respectively the front and back of the stomach and the sides of the duodenum con- 



IIO 



Diagram showing early arrangement of parietal and visceral perito- 

 neum. Blue, parietal ; yellow, right side, red, left side of visceral. Z, liver; 

 St, stomach ; Sp, spleen ; P, pancreas ; A', kidney. 



