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Peritoneal Ligaments
Peritoneal ligaments are double layers or folds of peritoneum that connect abdominal organs to one another or attach them to the abdominal wall. Many contain blood vessels, lymphatics, nerves, fat, and connective tissue and form important pathways between abdominal structures.
RegionAbdomen
SystemDigestive System
Peritoneal ligaments are folds of peritoneum that connect abdominal organs to other organs or to the abdominal wall. Most consist of two layers of peritoneum with a variable amount of connective tissue, fat, blood vessels, lymphatics, and nerves between the layers.
Despite their name, peritoneal ligaments are structurally different from the dense fibrous ligaments associated with joints. They are primarily reflections of the peritoneum created where the serous membrane passes from one surface to another.
Peritoneal ligaments help maintain anatomical relationships between abdominal viscera while also providing pathways through which vessels, nerves, and lymphatics reach organs. Major examples include the falciform ligament, coronary ligament, triangular ligaments, hepatogastric ligament, hepatoduodenal ligament, gastrosplenic ligament, and splenorenal ligament.
General Structure
A typical peritoneal ligament consists of two layers of serous peritoneum enclosing variable amounts of extraperitoneal connective tissue.
The space between these layers may contain important neurovascular structures traveling between abdominal organs.
Contents of Peritoneal Ligaments
Depending on the ligament, structures between the peritoneal layers may include:
- Arteries
- Veins
- Lymphatic vessels
- Lymph nodes
- Autonomic nerves
- Connective tissue
- Adipose tissue
- Embryological remnants
- Ducts
Functions of Peritoneal Ligaments
Peritoneal ligaments perform several anatomical functions:
- Connect abdominal organs to neighboring organs
- Connect organs to the abdominal wall
- Help maintain normal visceral relationships
- Provide pathways for vessels and nerves
- Transmit lymphatics between organs and regional lymph nodes
- Form boundaries of peritoneal spaces and recesses
- Permit controlled mobility of intraperitoneal organs
Peritoneal Ligaments and Mesenteries
Peritoneal ligaments and mesenteries are both formed by reflections of peritoneum. Their terminology is based largely on the structures they connect and their anatomical organization.
A mesentery generally suspends an intraperitoneal organ from the body wall and provides a route for its neurovascular supply. A peritoneal ligament usually connects an organ to another organ or to the abdominal wall.
Peritoneal Ligaments and Omenta
The greater and lesser omenta are specialized peritoneal folds associated with the stomach and proximal duodenum.
Individual portions of these folds are commonly named as ligaments according to the structures they connect.
Major Peritoneal Ligaments
| Ligament | Main Connection |
|---|---|
| Falciform ligament | Liver to anterior abdominal wall and diaphragm |
| Coronary ligament | Liver to diaphragm |
| Right triangular ligament | Right liver to diaphragm |
| Left triangular ligament | Left liver to diaphragm |
| Hepatogastric ligament | Liver to lesser curvature of stomach |
| Hepatoduodenal ligament | Liver to proximal duodenum |
| Gastrosplenic ligament | Stomach to spleen |
| Splenorenal ligament | Spleen to posterior abdominal wall near left kidney |
| Gastrocolic ligament | Stomach to transverse colon |
Falciform Ligament
The falciform ligament is a sickle-shaped double layer of peritoneum connecting the liver to the anterior abdominal wall and inferior surface of the diaphragm.
It extends from the umbilical region toward the superior surface of the liver.
Attachments of the Falciform Ligament
The falciform ligament attaches anteriorly to the internal surface of the anterior abdominal wall and superiorly to the diaphragm.
Its posterior attachment merges with the peritoneal reflections associated with the liver.
Free Border of the Falciform Ligament
The inferior free border of the falciform ligament extends from the umbilicus toward the inferior surface of the liver.
It contains the ligamentum teres hepatis.
Ligamentum Teres Hepatis
The ligamentum teres hepatis, or round ligament of the liver, is the fibrous remnant of the left umbilical vein.
It lies within the free inferior margin of the falciform ligament and travels toward the inferior surface of the liver.
Falciform Ligament as a Surface Landmark
The falciform ligament provides a visible surface division between the anatomical right and left lobes on the diaphragmatic surface of the liver.
This external division does not correspond to the functional division of the liver based on vascular and biliary anatomy.
Coronary Ligament
The coronary ligament consists of peritoneal reflections connecting the superior and posterior surfaces of the liver to the diaphragm.
It is formed by superior and inferior layers that surround the nonperitoneal region known as the bare area of the liver.
Superior Layer of the Coronary Ligament
The superior layer is formed where peritoneum covering the superior surface of the liver reflects onto the inferior surface of the diaphragm.
Inferior Layer of the Coronary Ligament
The inferior layer forms another reflection between the posterior liver and diaphragm.
Together with the superior layer, it defines much of the boundary of the bare area.
Bare Area of the Liver
The bare area is a region on the posterior aspect of the liver that lacks a peritoneal covering and lies directly against the diaphragm through connective tissue.
The coronary ligament surrounds much of this region.
Right Triangular Ligament
The right triangular ligament is formed where the superior and inferior layers of the coronary ligament meet at the right lateral aspect of the liver.
It helps attach the right lobe of the liver to the diaphragm.
Left Triangular Ligament
The left triangular ligament is formed by the union of peritoneal layers near the left lateral aspect of the liver.
It anchors the left lobe of the liver to the diaphragm.
Liver-Related Peritoneal Ligaments
| Ligament | Important Feature |
|---|---|
| Falciform | Connects liver with anterior abdominal wall and diaphragm |
| Coronary | Surrounds much of the bare area |
| Right triangular | Lateral fusion of coronary layers on right |
| Left triangular | Peritoneal attachment of left liver to diaphragm |
| Hepatogastric | Connects liver and stomach |
| Hepatoduodenal | Connects liver and duodenum and contains portal triad |
Lesser Omentum
The lesser omentum is a double-layered peritoneal fold extending from the liver to the lesser curvature of the stomach and the proximal duodenum.
It is conventionally divided into the hepatogastric and hepatoduodenal ligaments.
Hepatogastric Ligament
The hepatogastric ligament is the broad, thin portion of the lesser omentum extending between the liver and the lesser curvature of the stomach.
It forms an important part of the anterior boundary of the lesser sac.
Contents of the Hepatogastric Ligament
The hepatogastric ligament contains small vessels, lymphatics, autonomic nerves, and connective tissue.
Gastric vessels are associated with its attachment along the lesser curvature.
Hepatoduodenal Ligament
The hepatoduodenal ligament is the thickened right free edge of the lesser omentum extending between the liver and proximal duodenum.
It is particularly important because it contains the principal structures entering and leaving the liver through the porta hepatis.
Portal Triad
The hepatoduodenal ligament contains the major components of the portal triad:
- Proper hepatic artery
- Hepatic portal vein
- Common bile duct
It also contains lymphatic vessels, lymph nodes, autonomic nerves, and connective tissue.
Arrangement of the Portal Triad
Within the hepatoduodenal ligament, the hepatic portal vein lies posteriorly.
The proper hepatic artery and common bile duct lie anterior to the portal vein, with the bile duct generally positioned to the right of the artery.
Portal Triad Arrangement Summary
| Structure | Typical Position |
|---|---|
| Common bile duct | Anterior and right |
| Proper hepatic artery | Anterior and left |
| Hepatic portal vein | Posterior |
Free Edge of the Lesser Omentum
The hepatoduodenal ligament forms the right free border of the lesser omentum.
Immediately posterior to this free edge is the opening connecting the greater and lesser sacs.
Epiploic Foramen
The epiploic foramen, or omental foramen, is the natural communication between the greater sac and lesser sac.
The hepatoduodenal ligament forms its anterior boundary.
Boundaries of the Epiploic Foramen
| Boundary | Structure |
|---|---|
| Anterior | Hepatoduodenal ligament containing portal triad |
| Posterior | Inferior vena cava covered by peritoneum |
| Superior | Caudate lobe of liver |
| Inferior | First part of duodenum |
Pringle Maneuver
The anatomical arrangement of the hepatoduodenal ligament allows temporary compression of the structures within it during the Pringle maneuver.
Compression reduces blood inflow to the liver through the hepatic artery and portal vein and can help determine whether hepatic bleeding originates from vessels entering through the portal triad.
Gastrosplenic Ligament
The gastrosplenic ligament is a double layer of peritoneum extending between the greater curvature of the stomach and the hilum of the spleen.
It is one of the major peritoneal attachments of the spleen.
Contents of the Gastrosplenic Ligament
The gastrosplenic ligament contains important vessels traveling between the splenic vascular system and stomach.
Its principal vascular contents include:
- Short gastric vessels
- Left gastro-omental vessels
Short Gastric Vessels
The short gastric arteries and veins pass through the gastrosplenic ligament between the splenic region and the fundus of the stomach.
Left Gastro-Omental Vessels
The left gastro-omental vessels, also called left gastroepiploic vessels, arise near the splenic region and travel toward the greater curvature of the stomach.
They are associated with the gastrosplenic ligament before continuing along the greater curvature.
Splenorenal Ligament
The splenorenal ligament, also called the lienorenal ligament, extends between the spleen and the posterior abdominal wall in the region of the left kidney.
It forms an important pathway between the retroperitoneum and the splenic hilum.
Contents of the Splenorenal Ligament
Important structures associated with the splenorenal ligament include:
- Splenic artery
- Splenic vein
- Tail of the pancreas
- Lymphatic vessels
- Autonomic nerve fibers
Pancreatic Tail and Splenorenal Ligament
The tail of the pancreas extends within the splenorenal ligament toward the splenic hilum.
This relationship is clinically important because the pancreatic tail can be injured during splenic surgery.
Peritoneal Attachments of the Spleen
The two major vascular peritoneal ligaments associated with the spleen are the gastrosplenic and splenorenal ligaments.
Together they connect the spleen with the stomach and posterior abdominal wall while transmitting important vessels.
Gastrosplenic Versus Splenorenal Ligament
| Feature | Gastrosplenic Ligament | Splenorenal Ligament |
|---|---|---|
| Connection | Stomach to spleen | Spleen to posterior abdominal wall near left kidney |
| Major vessels | Short gastric and left gastro-omental vessels | Splenic vessels |
| Pancreatic tail | Not a principal content | Closely associated and extends within ligament |
Greater Omentum
The greater omentum develops from the dorsal mesogastrium and hangs inferiorly from the greater curvature of the stomach.
Several named peritoneal ligaments are associated with its attachments, including the gastrocolic ligament.
Gastrocolic Ligament
The gastrocolic ligament extends between the greater curvature of the stomach and the transverse colon.
It forms an important portion of the greater omentum.
Gastrocolic Ligament and Lesser Sac
The gastrocolic ligament lies anterior to the lesser sac region.
Surgical division of the gastrocolic ligament can provide access to the lesser sac and anterior surface of the pancreas.
Gastrocolic Vascular Relationships
The right and left gastro-omental vessels run along the greater curvature of the stomach in close association with the greater omental attachments.
These vessels form an arterial arcade along the greater curvature.
Gastrophrenic Ligament
The gastrophrenic ligament is a peritoneal fold connecting the upper stomach, particularly the fundic region, with the diaphragm.
It represents another derivative of the dorsal mesogastrium.
Phrenicocolic Ligament
The phrenicocolic ligament is a peritoneal fold extending between the left colic flexure and the diaphragm.
It helps support the left colic flexure and lies inferior to the spleen.
Phrenicocolic Ligament and the Spleen
The phrenicocolic ligament can provide a degree of inferior support to the spleen.
Its position beneath the spleen has led to its description as part of a supporting shelf for the organ.
Peritoneal Ligaments of the Colon
Several named peritoneal folds may be associated with the colon and its attachments.
Their development and prominence vary considerably between individuals.
Hepatocolic Ligament
The term hepatocolic ligament may be used for a peritoneal fold extending between the liver or gallbladder region and the colon.
Its size and configuration are variable and it is less constant than the major hepatic and gastric peritoneal ligaments.
Duodenocolic and Other Accessory Folds
Accessory peritoneal folds may occur between portions of the duodenum, colon, liver, stomach, and neighboring structures.
These folds show considerable anatomical variation and are generally less consistent than the principal named ligaments.
Embryological Basis
Many peritoneal ligaments develop from the ventral and dorsal mesenteries of the embryonic gastrointestinal tract.
Growth and rotation of the stomach, liver, spleen, and surrounding organs transform these primitive mesenteries into the adult peritoneal folds.
Ventral Mesentery
The ventral mesentery persists primarily in the region of the foregut.
It contributes to formation of the lesser omentum and falciform ligament.
Derivatives of the Ventral Mesentery
Important derivatives include:
- Falciform ligament
- Hepatogastric ligament
- Hepatoduodenal ligament
Dorsal Mesogastrium
The dorsal mesogastrium is the dorsal mesentery associated with the embryonic stomach.
Rotation and growth of the stomach greatly alter its configuration and contribute to formation of the lesser sac and several adult peritoneal ligaments.
Derivatives Associated With the Dorsal Mesogastrium
Structures derived from or associated with remodeling of the dorsal mesogastrium include:
- Greater omentum
- Gastrosplenic ligament
- Splenorenal ligament
- Gastrophrenic ligament
Development of the Lesser Omentum
The lesser omentum develops from the ventral mesentery between the developing liver and the stomach and proximal duodenum.
Its adult subdivisions are the hepatogastric and hepatoduodenal ligaments.
Development of the Falciform Ligament
The falciform ligament develops from the ventral mesentery between the developing liver and anterior abdominal wall.
The umbilical vein travels within this region during fetal life.
Development of the Splenic Ligaments
The spleen develops within the dorsal mesogastrium.
Remodeling of this mesentery creates the gastrosplenic ligament between the stomach and spleen and the splenorenal ligament between the spleen and posterior abdominal wall.
Peritoneal Ligaments as Neurovascular Pathways
One of the most important functions of peritoneal ligaments is providing protected routes for neurovascular structures traveling to and from abdominal organs.
The hepatoduodenal ligament and splenic ligaments are particularly important examples.
Clinical Importance of the Hepatoduodenal Ligament
The hepatoduodenal ligament is a critical surgical landmark because it contains the portal triad.
Its structures are encountered during hepatobiliary surgery, liver transplantation, pancreatic procedures, and operations involving the proximal duodenum.
Clinical Importance of the Splenorenal Ligament
The splenorenal ligament must be considered during mobilization of the spleen because it contains the splenic vessels and is closely associated with the pancreatic tail.
Excessive or poorly controlled dissection near the splenic hilum can injure these structures.
Clinical Importance of the Gastrosplenic Ligament
Division of the gastrosplenic ligament may be required during splenic or gastric surgery.
The short gastric and left gastro-omental vessels within the ligament must be identified and controlled appropriately.
Access to the Lesser Sac
The lesser sac can be approached surgically through several routes.
One common route involves division of the gastrocolic ligament between the stomach and transverse colon, exposing the anterior surface of the pancreas.
Spread of Fluid and Disease
Peritoneal ligaments can influence the spread of fluid, inflammation, blood, and malignant disease within the abdomen.
Their vascular and lymphatic contents also provide potential pathways for dissemination between connected regions.
Internal Herniation
Abnormal openings or spaces associated with peritoneal folds can occasionally contribute to internal hernias.
The epiploic foramen is a natural peritoneal opening through which abdominal viscera can rarely herniate.
Peritoneal Ligaments on CT
Many peritoneal ligaments are difficult to visualize directly on routine CT when they contain little fat or fluid.
They can often be inferred from the course of vessels, distribution of fat, organ relationships, and patterns of disease spread.
Peritoneal Ligaments on MRI
MRI can demonstrate peritoneal folds and their contents when sufficient tissue contrast, fat, fluid, or pathological thickening outlines them.
Understanding normal ligament anatomy helps localize abnormalities within the peritoneal cavity.
Importance in Cancer Spread
Peritoneal ligaments may provide routes along which malignant disease extends between abdominal organs.
Tumor spread can follow vascular, lymphatic, connective tissue, and peritoneal pathways contained within these folds.
Importance in Abdominal Surgery
Surgeons frequently divide, retract, or preserve peritoneal ligaments to gain access to abdominal organs.
Safe dissection requires knowledge of the vessels, ducts, nerves, and other structures that may lie between their layers.
Important Ligaments and Their Contents
| Ligament | Important Contents or Relationships |
|---|---|
| Falciform | Ligamentum teres in free inferior margin |
| Hepatoduodenal | Portal vein, proper hepatic artery, common bile duct, lymphatics and nerves |
| Hepatogastric | Small vessels, nerves and lymphatics associated with lesser curvature |
| Gastrosplenic | Short gastric and left gastro-omental vessels |
| Splenorenal | Splenic vessels and pancreatic tail |
| Gastrocolic | Part of greater omental complex between stomach and transverse colon |
Key Anatomical Relationships
| Region | Principal Peritoneal Ligaments |
|---|---|
| Liver | Falciform, coronary, triangular, hepatogastric and hepatoduodenal ligaments |
| Stomach | Hepatogastric, gastrosplenic, gastrocolic and gastrophrenic ligaments |
| Spleen | Gastrosplenic and splenorenal ligaments |
| Transverse colon | Gastrocolic ligament and associated greater omental attachments |
Key Features of Peritoneal Ligaments
| Feature | Key Point |
|---|---|
| Basic structure | Usually double layers of peritoneum |
| Primary role | Connect organs to organs or abdominal wall |
| Possible contents | Vessels, nerves, lymphatics, fat, ducts and connective tissue |
| Ventral mesentery derivatives | Falciform ligament and lesser omentum |
| Dorsal mesogastrium derivatives | Gastrosplenic and splenorenal ligaments and greater omental structures |
| Portal triad location | Hepatoduodenal ligament |
| Pancreatic tail relationship | Splenorenal ligament |
| Short gastric vessels | Gastrosplenic ligament |
| Liver bare area boundary | Coronary ligament |
Anatomical and Clinical Importance
Peritoneal ligaments are important structural components of the abdominal cavity. They arise from reflections and developmental modifications of the peritoneum and connect abdominal organs with one another or with the abdominal wall.
Many of these ligaments serve as essential neurovascular pathways. The hepatoduodenal ligament contains the portal triad, the gastrosplenic ligament transmits the short gastric and left gastro-omental vessels, and the splenorenal ligament is closely associated with the splenic vessels and pancreatic tail. Other ligaments, including the falciform, coronary, and triangular ligaments, contribute to the peritoneal attachments of the liver.
Understanding these folds is essential for interpreting the arrangement of the peritoneal cavity, lesser sac, abdominal viscera, and vascular pathways. Their anatomy is also important during hepatobiliary, gastric, pancreatic, splenic, and colorectal surgery and in understanding the spread of fluid, inflammation, hemorrhage, and malignant disease through the abdomen.
Published on September 29, 2026
Last updated on September 29, 2026
Last updated on September 29, 2026