DuodenumDuodenum

It is the shortest, widest and most fixed part of the It is the shortest, widest and most fixed part of the small intestine.small intestine.

Position and Shape:Position and Shape: Fixed to the posterior abdominal wall (retroperitoneal), Fixed to the posterior abdominal wall (retroperitoneal),

occupies the epigastric and umbilical regions.occupies the epigastric and umbilical regions. Follows a Follows a C-C- shaped course around the head of the shaped course around the head of the

pancreas.pancreas. Extends from the pylorus to the duodeno-jejunal flexure.Extends from the pylorus to the duodeno-jejunal flexure.

Parts of the duodenum:Parts of the duodenum: 1. First part:1. First part:

- 2 - 2 inches long, its 1st inch is mobile as it is inches long, its 1st inch is mobile as it is covered by peritoneum ant. and post. covered by peritoneum ant. and post.

-- It It begins begins at the pylorus, 1/2 an inch to the at the pylorus, 1/2 an inch to the right of the median plane at the level of right of the median plane at the level of L1 L1 (transpyloric plane).(transpyloric plane).

Relations of Relations of 11stst part: part:

AnteriorlyAnteriorly:: quadrate quadrate lobe of the lobe of the liver and liver and gallbladder.gallbladder.

PosteriorlyPosteriorly:: - Neck of the - Neck of the pancreas, pancreas,

- Portal vein, - Portal vein,

- bile duct- bile duct

InferiorlyInferiorly:: head of pancreas. head of pancreas. Superiorly:Superiorly: related to epiploic foramen. related to epiploic foramen.

2. Second part:2. Second part: -3 inches long and descends vertically from the level of L1 to L3. -3 inches long and descends vertically from the level of L1 to L3.

Covered by peritoneum anter.Covered by peritoneum anter. Relations:Relations:- - Anterior:Anterior: right lobe of the liver, gall bladder, transverse colon and right lobe of the liver, gall bladder, transverse colon and

coils of jejunum.coils of jejunum.- - Posterior:Posterior: hilum of the right kidney. hilum of the right kidney.- - Lateral:Lateral: hepatic flexure of the large intestine. hepatic flexure of the large intestine.- - Medial:Medial: head of pancreas, bile duct and pancreatico –duodenal head of pancreas, bile duct and pancreatico –duodenal

arteries.arteries.

3. Third part3. Third part:: 4 inch long, lies horizontally 4 inch long, lies horizontally

opposite to the level ofopposite to the level of L3. L3. RelationsRelations: : - - Anterior:Anterior: superior superior

mesenteric vessels and mesenteric vessels and coils of small intestine.coils of small intestine.

- - Posterior:Posterior: it is related to the it is related to the following structures from following structures from the right to the left side:the right to the left side: right ureter, right psoas right ureter, right psoas major, right. gonadal major, right. gonadal vessels, IVC, aorta and vessels, IVC, aorta and inferior mesenteric artery.inferior mesenteric artery.

- - SuperiorSuperior:: head of head of pancreas.pancreas.

- - InferiorInferior:: coils of small coils of small intestine.intestine.

4. Fourth part4. Fourth part: :

- It is one inch long. It ascends from the - It is one inch long. It ascends from the level of L3 to L2 one inch to the left of level of L3 to L2 one inch to the left of median plane at the dudeno-jejunal median plane at the dudeno-jejunal flexure.flexure.

Relations of the 4Relations of the 4thth part of the part of the duodenum: duodenum: Anterior:Anterior: transverse colon and transverse transverse colon and transverse

mesocolon.mesocolon.

Posterior:Posterior: left psoas major, left gonadal left psoas major, left gonadal and left renal vessels.and left renal vessels.

Medial:Medial: head of pancreas and aorta.head of pancreas and aorta. Lateral:Lateral: Lt Kidney. Lt Kidney.

Arterial supply of the duodenum:Arterial supply of the duodenum: 1. Supra-duodenal artery: from the hepatic artery proper 1. Supra-duodenal artery: from the hepatic artery proper

(coeliac trunk).(coeliac trunk). 2. Superior pancreatico-duodenal artery: from gastro-2. Superior pancreatico-duodenal artery: from gastro-

duodenal (coeliac).duodenal (coeliac). 3. Inferior pancreatico-duodenal artery: from superior 3. Inferior pancreatico-duodenal artery: from superior

mesenteric artery.mesenteric artery.

Peritoneal recesses of the duodenum:Peritoneal recesses of the duodenum:

- Superior duodenal recess. - Inferior recess.- Superior duodenal recess. - Inferior recess.

- Paraduodenal recess. - Retroduodenal recess.- Paraduodenal recess. - Retroduodenal recess.

1.1. COELIAC TRUNKCOELIAC TRUNK

Origin:Origin: front of abdominal

aorta ,upper border of L1.

Course:Course: short trunk passes

horizontally between two crura of diaphragm.

Regions Regions supplied by supplied by it:it:

it supplies the foregut.

Branches:Branches: Main branches

are:

1. Left gastric artery

2. Hepatic artery

3. Splenic artery

Branches of coeliac trunkBranches of coeliac trunk

I. Left gastric artery:

Course: upward, to left till

diaphragm ,curves down along lesser curvature ,between layers of lesser omentum ,then anastomoses with Rt gastric artery.

Branches:Branches:1. Oesophageal

branches.

2. Gastric branches.

22 - -Hepatic arteryHepatic artery Branches:Branches:1. Right gastric artery.

2. Supra-duodenal artery.

3. Gastroduodenal artery.i. Right gastroepiploic

artery.

ii. Superior pancreaticoduodenal artery.

4. Right hepatic artery (cystic a.)

5. Left hepatic artery.

33 - -Splenic arterySplenic artery it passes transversely to the left behind stomach.it passes transversely to the left behind stomach. Along upper border of pancreas. - It has a tortuous course.Along upper border of pancreas. - It has a tortuous course. It’s accompanied by splenic vein. It’s accompanied by splenic vein. It passes In front of left suprarenal gland and left kidney It passes In front of left suprarenal gland and left kidney

where it passes between two layers of lienorenal ligament to where it passes between two layers of lienorenal ligament to reach the hilum of spleen.reach the hilum of spleen.

BranchesBranches::1- 1- Pancreatic Pancreatic

branches:branches: su supply pply pancreas pancreas

2- 2- Short gastric Short gastric arteriesarteries: to upper : to upper part of greater part of greater curvature of the curvature of the stomach.stomach.

3- 3- Left gastroepiploic Left gastroepiploic artery:artery: it passes it passes between two layers between two layers of greater omentum of greater omentum along the greater along the greater curvature of curvature of stomach .stomach .

TerminationTermination::

It terminates by dividing into 5 or 6 splenic It terminates by dividing into 5 or 6 splenic arteries which enter the hilum of spleen .arteries which enter the hilum of spleen .

Prof.: Dr. Shawky Tayel