Peritoneum

The abdominal cavity (the space bounded by the vertebrae, abdominal muscles, diaphragm, and pelvic floor) is different from the intraperitoneal space (located within the abdominal cavity but wrapped in peritoneum). The structures within the intraperitoneal space are called "intraperitoneal" (e.g., the stomach and intestines), the structures in the abdominal cavity that are located behind the intraperitoneal space are called "retroperitoneal" (e.g., the kidneys), and those structures below the intraperitoneal space are called "subperitoneal" or "infraperitoneal" (e.g., the bladder).

Structure

Layers

The peritoneum is one continuous sheet, forming two layers and a potential space between them: the peritoneal cavity.

The outer layer, the parietal peritoneum, is attached to the abdominal wall and the pelvic walls. The tunica vaginalis, the serous membrane covering the male testis, is derived from the vaginal process, an outpouching of the parietal peritoneum.

The inner layer, the visceral peritoneum, is wrapped around the visceral organs, located inside the intraperitoneal space for protection. It is thinner than the parietal peritoneum. The mesentery is a double layer of visceral peritoneum that attaches to the gastrointestinal tract. There are often blood vessels, nerves, and other structures between these layers. The space between these two layers is technically outside of the peritoneal sac, and thus not in the peritoneal cavity.

The potential space between the parietal and visceral peritoneum is the peritoneal cavity, filled with a small amount (about 50 mL) of slippery serous fluid that allows the two layers to slide freely over each other.

The right paracolic gutter is continuous with the right and left subhepatic spaces. The epiploic foramen allows communication between the greater sac and the lesser sac. The peritoneal space in males is closed, while the peritoneal space in females is continuous with the extraperitoneal pelvis through openings of the fallopian tubes, the uterus, and the vagina.

Subdivisions

Peritoneal folds are omentums, mesenteries and ligaments; they connect organs to each other or to the abdominal wall. There are two main regions of the peritoneal cavity, connected by the omental foramen.

• The greater sac, represented in red in the diagrams above.
• The lesser sac, represented in blue. The lesser sac is divided into two "omenta":
  • The lesser omentum (or hepatogastric) is attached to the lesser curvature of the stomach and the liver.
  • The greater omentum (or gastrocolic) hangs from the greater curvature of the stomach and loops down in front of the intestines before curving back upwards to attach to the transverse colon. In effect it is draped in front of the intestines like an apron and may serve as an insulating or protective layer.

The mesentery is the part of the peritoneum through which most abdominal organs are attached to the abdominal wall and supplied with blood and lymph vessels and nerves.

Omenta

Mesenteries

Other ligaments and folds

In addition, in the pelvic cavity there are several structures that are usually named not for the peritoneum, but for the areas defined by the peritoneal folds:

Classification of abdominal and pelvic structures

The structures in the abdomen are classified as intraperitoneal, mesoperitoneal, retroperitoneal or infraperitoneal depending on whether they are covered with visceral peritoneum and whether they are attached by mesenteries (mensentery, mesocolon).

Structures that are intraperitoneal are generally mobile, while those that are retroperitoneal are relatively fixed in their location.

Some structures, such as the kidneys, are "primarily retroperitoneal", while others such as the majority of the duodenum, are "secondarily retroperitoneal", meaning that structure developed intraperitoneally but lost its mesentery and thus became retroperitoneal.