局部解剖学-结肠上区.ppt

Section 4 Peritoneum and Peritoneal Cavity Ⅱ) Divisions of peritoneal cavity Peritoneal cavity is divided into supracolic and infracolic compartments by transverse colon and its mesocolon. 1.Supracolic compartments (subphrenic space )lies between diaphragm and transverse colon and its mesocolon. It includes some spaces, for example, Suprahepatic and Infrahepatic recess. 2. Infracolic compartments lies below transverse colon and its mesocolon. It has four spaces: right and left paracolic sulci (gutters), right and left mesenterial sinuses (infracolic spaces). (1) Right paracolic sulcus (gutter) lies lateral to ascending colon. It communicates with hepatorenal recess and pelvic cavity. It provides a route for spread of infection between pelvic and upper abdominal region. (2) Left paracolic sulcus (gutter) lies along lateral side of descending colon and opens freely into the pelvis at its lower end. It is separated above from supracolic compartment by phrenicocolic ligament. (3) Right mesenteric sinus (right infracolic space －triangular space) lies between root of mesentery, ascending colon, right 2/3 of transverse colon and its mesocolon. This sinus is almost closed by surrounding structures and loop of small intestine. (4) Left mesenteric sinus (left infracolic space) lies between root of mesentery, descending colon, right 1/3 of transverse colon and its mesocolon. It opens downwards and communicates with pelvis, so the infection of sinus may directly spread to pelvis cavity. ★ Clinical Notes Clinically the spaces, sulci, sinuses and recesses are important factors in spreading infection in peritonitis. 1. In perforation of posterior wall of stomach, contains from stomach may pass upwards to hepatorenal recess through omental bursa and omental foramen and pass downwards to rectovesical pouch ( male ) or rectouterine pouch ( female ) along right paracolic sulcus. 2. In supine position, infected fluid t