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1 Anat Chir 8-04-2004 16:16 Pagina 21

TRANSVERSE MESOCOLON INSERTION OF THE TRANSVERSE MESOCOLON

This goes from the right hypochondrium to the left


one, moving somewhat obliquely from the bottom
upwards and from right to left, to form a back-
wards curve (colon arch).
Above it subsequently corresponds to the under-
side of the liver, to the greater curvature of the
stomach and finally the lower part of the spleen.

The peritoneum surrounds the transverse colon,


forming a long mesentery, the transverse meso-
colon, which joins it to the rear wall of the
abdomen along a line extending from the right
kidney to the left one and divides the abdominal
cavity into two compartments, the supramesocolic
space and the submesocolic space.
TRANSVERSE MESOCOLON, STOMACH, SPLEEN,
PANCREAS
The insertion line first crosses the front face of the
right kidney, the descending portion of the duode-
num, the head of the pancreas, the superior
mesenteric vessels; it then passes over the duode-
nojejunal angle and terminates in correspondence
with the upper third of the left kidney after fol-
lowing the lower margin of the pancreas.

Like the mesentery and the ascending mesocolon,


the transverse mesocolon forms part of the primary
common mesentery and, with respect to the
ascending mesocolon, it is identified on the right
hand side by the coalescence line extending from
the SMA to the right bend of the colon.
SECONDARY ROOT OF THE TRANSVERSE Similarly, the left side of the transverse mesocolon
MESOCOLON is attached to the rear coelomatic peritoneum fol-

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Laparoscopic Colorectal Surgery - Hüscher
Surgical Anatomy - F. Ruotolo, G. Sgarzini, M. Ipri, A. Mereu and C. G. S. Hüscher
1 Anat Chir 8-04-2004 16:16 Pagina 22

Fredet’s fascia

Fredet’s fascia

FREDET’S FASCIA FREDET’S FASCIA

lowing an ascending oblique line from the SMA to


the left colon bend.
In this manner the secondary root of the trans-
verse mesocolon is formed.

The transverse mesocolon, under the right part of


its root, comes into contact with the preduodenal
peritoneum to form, in front of the duodenum, the
pancreas and the origin of the SMA, a coalescence
extending from the top downward: the preduo-
denopancreatic submesancolic fascia or Fredet's
right transverse mesocolon fascia, which some
authors improperly identify as Toldt's fascia.

Also to the right of the body's sagittal midline,


but in correspondence with the supermesancolic
plane, the omentum attaches to the front face of
the second duodenal portion and the head of the
pancreas, creating the omental prepancreatic
supermesocolic fascia.
The latter corresponds to Fredet's fascia in the
submesocolic area.

To the side of the duodenum it joins Treitz's


retropancreatic fascia, which continues into
Treitz’s fascia Toldt's fascia at the bottom.

The right portion of the transverse mesocolon is


extremely short, whereas the left portion is always
of considerable length.
TREITZ’S FASCIA

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Laparoscopic Colorectal Surgery - Hüscher
Surgical Anatomy - F. Ruotolo, G. Sgarzini, M. Ipri, A. Mereu and C. G. S. Hüscher
1 Anat Chir 8-04-2004 16:16 Pagina 23

GASTROCOLIC OMENTUM - BOUCHET'S AREA

Because of this arrangement the left portion of


GASTROCOLIC OMENTUM the colon is subject to excessive mobility, which
is partially corrected by the gastrocolic ligament.

The latter, which is formed by the front sheet of


the gastrocolic omentum, has a thin and trans-
parent area on the distal side of Winslow's gas-
troepiploic vascular arch (Bouchet's circular
translucent zone), which represents the tradition-
al access route to the epiploon retrocavity, in
alternative to access by colo-epiploic detachment
and to submesocolic access through Riolano's
avascular area.

Kidney

Left Colic

Treitz

KIDNEY, TREITZ, LEFT COLIC TRIETZ

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Laparoscopic Colorectal Surgery - Hüscher
Surgical Anatomy - F. Ruotolo, G. Sgarzini, M. Ipri, A. Mereu and C. G. S. Hüscher