THE PERITONEUM. 



pelvis. The attachment of the mesentery for the lower end of the ileum is placed so much nearer 

 the pelvic cavity that this portion of the bowel, even with a shorter mesentery, occupies the pelvis 

 and is often found in an inguinal or femoral hernia. ED.] After partly surrounding the pelvic 

 viscera (see page 147 for detailed description), the peritoneum passes from the upper surface 

 of the bladder to the inner surface of the anterior abdominal wall and upward to the umbilicus. 



Upon the right side the peritoneum passes from the porta hepatis to the superior portion 

 of the duodenum and forms the anterior layer of the ligamentum hepatoduodenale. There is no 

 sharp line of demarcation between this ligament and the ligamentum hepatogastricum, but the 

 ligamentum hepatoduodenale is thicker and contains the ductus choledochus in its right free bor- 

 der. Further to the left the hepatic artery is enclosed between the layers of the same ligament, 

 while the portal vein passes to the liver between and somewhat behind the artery and duct. We 

 will now trace the peritoneum through the foramen of Winslow into the bursa omentalis. This 

 posterior layer of the peritoneum is indicated in the diagrammatic drawing (Fig. 60) by a red 

 line. It first forms the posterior layer of the gastrohepatic omentum, then covers the posterior 

 surface of the stomach, and passes from the greater curvature to the transverse colon as the pos- 

 terior layer of the narrow ligamentum gastrocolicum. As a rule, the bursa omentalis does not 

 extend into the great omentum in adult life; this portion of the peritoneum is consequently 

 represented in Fig. 60 by a red dotted line. After the disappearance of the lumen of the bursa 

 omentalis the anterior and posterior layers of the great omentum become adherent and the pos- 

 terior layer also adheres to the anterior surface of the transverse colon ; in this manner the liga- 

 mentum gastrocolicum is formed (compare Fig. 59 with Fig. 60). At the bottom of the bursa 

 omentalis the peritoneum forms the upper layer of the transverse mesocolon; it then passes to 

 the vertebral column, covers the anterior surface of the pancreas, forms the inferior layer of the 

 ligamentum coronarium hepatis, and is finally reflected over the caudate lobe of the liver. If the 

 liver is displaced upward, the caudate lobe may therefore be seen lying in the bursa omentalis, 

 beneath the gastrohepatic omentum; it is also easy to see the pancreas through the same omentum 

 in the posterior portion of the bursa omentalis by displacing the stomach somewhat downward. 

 The upper portion of the duodenum also receives a peritoneal covering from the bursa omentalis 

 which extends toward the left as far as the kidney and the spleen, where it forms the posterior 

 layer of the ligamentum gastrolienale* which connects the stomach with the spleen (see page 

 133). In Fig. 60 it is clearly shown that, in addition to the foramen of Winslow, the lesser peri- 

 toneal cavity may be opened from the front in three places: (i) Through the lesser omentum; 

 (2) through the ligamentum gastrocolicum; and (3) through the transverse mesocolon. Upon 

 the right side the peritoneum passes from the inferior surface of the liver to the anterior surface 

 of the right kidney; it then runs to the hepatic flexure of the colon and the flexura duodeni supe- 

 rior and is reflected over the anterior surface and sides of the ascending colon, so that this portion 

 of the intestine has a comparatively broad attachment to the posterior abdominal wall. In the 

 right iliac fossa the cecum with the processus vermiformis, which possesses its own mesenteriolum, 

 is usually completely surrounded by peritoneum. 



Upon the left side the parietal peritoneum is reflected from the inferior surface of the duo- 

 denum to the stomach, from which it passes to the spleen, forming the ligamentum phrenico- 



*Gastrosplenic omentum. 



