Posterior Abdominal Wall: Pancreas and Bile Ducts

Posterior abdominal wall with pancreas and extrahepatic bile ducts in situ (anterior

aspect). The gastrocolic ligament has been divided, the transverse colon and the stomach

replaced to display the pancreas and superior mesenteric vessels. 1 Stomach (pyloric part) and pylorus

2 Right gastro-omental (gastro-epiploic) artery

3 Fundus of gallbladder

4 Liver (right lobe)

5 Head of pancreas

6 Superior mesenteric artery and vein

7 Duodenum

8 Middle colic artery

9 Transverse colon

10 Greater curvature of stomach

(remnants of gastrocolic ligament)

11 Body of stomach

12 Body of pancreas

13 Left gastro-omental (gastro-epiploic) artery

14 Splenic artery

15 Spleen

16 Tail of pancreas

17 Left colic flexure

18 Jejunum

19 Cystic artery

20 Hepatic artery proper

21 Celiac trunk

22 Right gastric artery

23 Common hepatic artery

24 Gastroduodenal artery

25 Superior mesenteric artery

26 Superior posterior pancreaticoduodenal artery

27 Superior anterior pancreaticoduodenal artery

28 Short gastric arteries

29 Left gastric artery

30 Posterior pancreatic branch of splenic artery

31 Inferior pancreaticoduodenal artery

32 Jejunal arteries

Blood supply of upper abdominal organs (branches of the celiac trunk and

superior mesenteric artery). (Schematic drawing.)

Posterior Abdominal Wall: Duodenum, Pancreas, and Spleen 317

Posterior abdominal wall with duodenum, pancreas, and spleen (anterior aspect). Dissection of pancreatic and common bile duct.

The stomach has been removed, the liver raised, and the duodenum anteriorly opened.

1 Ligamentum teres

2 Gallbladder and cystic artery

3 Common hepatic duct and portal vein

4 Cystic duct

5 Right gastric artery (pylorus with superior part of duodenum,

cut and reflected)

6 Gastroduodenal artery

7 Common bile duct

8 Probe within the minor duodenal papilla

9 Accessory pancreatic duct

10 Probe within the major duodenal papilla

11 Descending part of duodenum (opened)

12 Middle colic artery and inferior pancreaticoduodenal artery

13 Horizontal part of duodenum (distended)

14 Superior mesenteric artery

15 Liver (left lobe)

16 Caudate lobe of liver and hepatic artery proper

17 Abdominal part of esophagus (cut)

18 Probe in epiploic foramen and lymph node

19 Left gastric artery

20 Spleen

21 Splenic vein and branches of splenic artery

22 Main pancreatic duct and head of pancreas

23 Left colic flexure and tail of pancreas

24 Duodenojejunal flexure

318 Posterior Abdominal Wall: Root of the Mesentery and Peritoneal Recesses

1 Liver

2 Falciform ligament

3 Hepatoduodenal ligament

4 Pylorus (divided)

5 Gallbladder

6 Probe within the epiploic foramen

7 Duodenojejunal flexure (divided)

8 Greater omentum

9 Root of mesentery

10 Ascending colon

11 Free colic taenia

12 End of ileum (divided)

13 Vermiform appendix with meso-appendix

14 Cecum

15 Pancreas and site of lesser sac

16 Diaphragm

17 Spleen

18 Cardia (part of stomach, divided)

19 Head of pancreas

20 Body and tail of pancreas

21 Transverse mesocolon

22 Transverse colon (divided)

23 Descending colon

24 Cut edge of mesentery

25 Sigmoid colon

26 Rectum

27 Attachment of bare area of liver

28 Inferior vena cava

29 Kidney

30 Attachment of right colic flexure

31 Root of transverse mesocolon

32 Junction between descending and horizontal

parts of duodenum

33 Bare surface for ascending colon

34 Ileocecal recess

35 Retrocecal recess

36 Root of meso-appendix

37 Superior recess of lesser sac 38 Isthmus (opening) (omental bursa) 39 Splenic recess

40 Superior duodenal recess

41 Inferior duodenal recess

42 Bare surface for descending colon

43 Paracolic recesses

44 Root of mesentery

45 Root of mesosigmoid

46 Intersigmoid recess

47 Hepatic veins

48 Duodenojejunal flexure

49 Attachment of left colic flexure

50 Esophagus

51 Entrance to lesser sac through the epiploic

foramen

Abdominal cavity after removal of stomach, jejunum, ileum, and

part of the transverse colon. Liver has been slightly raised.

Peritoneal reflections from organs and the

position of root of mesentery and peritoneal

recesses on the posterior abdominal wall

(schematic drawing).

1

Posterior Abdominal Wall: Root of the Mesentery and Peritoneal Recesses 319

Peritoneal recesses on the posterior abdominal wall. The liver, stomach, jejunum, ileum, and colon have been removed. The duodenum,

pancreas, and spleen have been left in place.

320 Horizontal Sections through the Abdominal Cavity

1 Rectus abdominis muscle

2 Falciform ligament

3 Liver (right lobe)

4 Inferior vena cava

5 Diaphragm

6 Intervertebral disc

7 Liver (left lobe)

8 Rib

9 Liver (caudate lobe)

10 Abdominal (descending) aorta

11 Stomach

12 Spleen

13 Spinal cord

14 Longissimus and iliocostalis muscles

15 Body of vertebra

16 Rectus abdominis muscle

17 External abdominal oblique muscle

18 Transverse colon

19 Head of pancreas

20 Greater duodenal papilla

21 Duodenum

22 Suprarenal gland and ureter

23 Kidney

24 Round ligament of liver

25 Superior mesenteric artery and vein

26 Psoas major muscle

27 Descending colon

28 Quadratus lumborum muscle

29 Cauda equina

30 Right renal vein

31 Small intestine

32 Iliacus muscle

33 Ilium

34 Ileocecal valve

35 Cecum

36 Common iliac artery and vein

37 Gluteus medius muscle

38 Vertebral canal and dura mater

Horizontal section through

the abdominal cavity

at level 1 (from below).

Horizontal section through

the abdominal cavity (MRI scan,

corresponding to level 1).

Arrow: stomach.

Levels of sections.

321

16

17

18

19

20

21

3

22

23

15

14

29

28

23

27

26

4

10

31

25

31

24

34

35

36

37

38

14

33

32

26

27

31

Horizontal Sections through the Abdominal Cavity

Horizontal section through

the abdominal cavity at the level

of greater duodenal papilla

(from below).

Horizontal section through

the abdominal cavity (CT scan,

corresponding to level 2).

Horizontal section through

the abdominal cavity

at level 3 (from below).