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Anatomy

Abdomen

Question 110 of 180

The mesentery connects which of the following structures to the posterior abdominal wall:

Answer:

The mesentery is a large, fan-shaped, double-layered fold of peritoneum that connects the jejunum and ileum to the posterior abdominal wall. Its superior attachment is at the duodenojejunal junction, just to the left of the upper lumbar part of the vertebral column. It passes obliquely downwards and to the right, ending at the ileocaecal junction near the upper border of the right sacroiliac joint.

Peritoneal Mesenteries

Table: Anatomical Overview of the Abdominal Cavity

Structure Key anatomy
Peritoneal cavity Divided into greater and lesser sacs
Greater sac Divided into supracolic and infracolic compartments by transverse mesocolon, compartments connected by paracolic gutters
Supracolic compartment Contains stomach, liver and spleen, lies under cover of costal limits of thoracic cage
Infracolic compartment Divided into left and right parts by oblique attachment of mesentery, contains small intestine and ascending/descending colon, continuous with pelvic cavity
Lesser sac (omental bursa Lies posterior to stomach and liver and anterior to pancreas, continuous with greater sac through epiploic foramen
Greater omentum Descends from greater curvature of stomach and first part of duodenum, drapes inferiorly over transverse colon, jejunum and ileum, folds back up and ascends to adhere to transverse colon/mesocolon before arriving at posterior abdominal wall
Lesser omentum Extends from lesser curvature of stomach and first part of duodenum to inferior surface of liver
Mesentery Connects jejunum and ileus to posterior abdominal wall, attaches superiorly to duodenojejunal junction and passes oblique downwards and to the right to end at ileocecal junction
Transverse mesocolon Connects transverse colon to posterior abdominal wall, leaves posterior abdominal wall across anterior surface of head and body of pancreas and passes outwards to surround transverse colon
Sigmoid mesocolon Connects sigmoid colon to abdominal wall, V-shaped fold with apex near division of left common iliac artery, left limb descending along medial border of left psoas major muscle and right limb descending into pelvis to end at vertebral level S3

Mesenteries are peritoneal folds that attach viscera to the posterior abdominal wall. They allow some movement and provide a conduit for vessels, nerves and lymphatics to reach the viscera and include:

  • the mesentery - associated with parts of the small intestine
  • the transverse mesocolon - associated with transverse colon
  • the sigmoid mesocolon - associated with the sigmoid colon.

Mesentery

The mesentery is a large, fan-shaped, double-layered fold of peritoneum that connects the jejunum and ileum to the posterior abdominal wall. Its superior attachment is at the duodenojejunal junction, just to the left of the upper lumbar part of the vertebral column. It passes obliquely downwards and to the right, ending at the ileocaecal junction near the upper border of the right sacroiliac joint.

Transverse Mesocolon

The transverse mesocolon is a fold of peritoneum that connects the transverse colon to the posterior abdominal wall. It leaves the posterior abdominal wall across the anterior surface of the head and body of the pancreas and passes outwards to surround the transverse colon. Its anterior layer is adherent to the posterior layer of the greater omentum.

Sigmoid Mesocolon

The sigmoid mesocolon is an inverted V-shaped peritoneal fold that attaches the sigmoid colon to the abdominal wall. The apex of the V is near the division of the left common iliac artery, with the left limb of the descending V along the medial border of the left psoas major muscle, and the right limb descending into the pelvis to end at the level of vertebra S3.

Modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons

Peritoneal Cavity. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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