1014 THE ORGANS OF DIGESTION. 



of the duodenum, the remaining parts would be covered anteriorly by the left 

 leaf of mesentery until the intestine is called jejunum, when it is wholly invested 

 by mesentery. 



The different layers of mesocolon cannot be regarded as forming any covering 

 in the above list, because their attachments are all secondary. 



A persistence of the mesoduodenum is normal in many animals, abnormal 

 in man. 



Ligaments of the Duodenum. 



These are peritoneal folds connecting it to neighboring viscera or to the poste- 

 rior abdominal wall. 



1. Lig. suspensorium duodeni or lig. hepato-duodenale is the right edge of the 

 lesser omentum, and passes from the hilus of the liver to invest by two layers the 

 first portion of the duodenum, except a part of its posterior surface. 



2. Lig. cystico-duodenale, from the neck of the gall-bladder to the superior 

 curve of the duodenum. 



3. Lig. duodeno-renale, triangular in form, from the right surface of the supe- 

 rior curve of the duodenum to the summit of the right kidney. The lig. hepato- 

 renale is posterior to this one. 



4. On the left of the ascending duodenum, where the left layer of the mesen- 

 tery runs into the lower layer of the transverse mesocolon or into prerenal peri- 

 toneum, one or two ligaments may limit certain fossae : they are lig. duodeno- 

 mesocolica. 



For duodenal fossae, see p. 994. 



Eelations of Duodenum. 



The duodenum, occupying a fixed position against the posterior abdominal 

 wall, comes into relation with all the abdominal organs except the spleen, which 

 is fixed in the left cupola of the diaphragm. We may describe the relations with 

 (1) Movable organs of the abdominal cavity, (2) Fixed organs of the posterior 

 abdominal wall, (3) Lumbar skeleton. 



(1) The relation with movable organs can be determined at once on opening 

 the cavity. The stomach, in its empty state, touches by its antrum pylori the 

 duodeno-jejunal angle (Braune), (Fig. 634). This occurs behind the posterior 

 wall of the stomach, and the two are separated by the transverse mesocolon. If 

 the stomach be distended the pylorus is deflected farther to the right, and the 

 above relation is lost. 



The hepatic flexure of the colon passes over the lower part of the anterior 

 surface of the right kidney, and the beginning of the transverse colon over the 

 middle part of the descending duodenum, as we have seen. The movable small 

 intestines, being included in the ring of the colon, cover the duodenum as 

 it lies in the lower chamber, and so render it almost inaccessible. 



(2) The relations with fixed organs are with liver, the two kidneys, and the 

 pancreas. The first and second portions are related to the liver and neck of gall- 

 bladder. An impressio duodenalis is not always made on the quadrate lobe, 

 although the first part of the duodenum passes under it. The initial curve is 

 fixed at the inferior vena, cava and neck of gall-bladder where the peritoneum is 

 broken and the investment is incomplete. The impressio duodenalis is on the 

 inferior surface of the right lobe to the right of the gall-bladder, to the left of 

 the renal impression, and behind the colic impression. 



In respect to the kidneys, not all authors speak of the left as being related. 

 Luschka has always found the ascending duodenum related to the left kidney, as 

 well as the descending duodenum to the right kidney, but the two duodenal 

 parts always behave differently to their respective kidneys. 



The descending duodenum is thrown strongly backward on the right of the 

 lumbar column, and immediately meets the right kidney and suprarenal capsule as 

 they all leave the liver. It then rests on the inner margin of the anterior surface 



