The Sectional Anatomy And Imaging Research Of The Omental Bursa

[Objective] To observe and measure the courser rule of the peritoneal plica that surrounded each recess of the lesser sac, and measure the diameters of each recess in the transection to clarify the boundary of each recess and the size of lesser sac, so that we can improve the location and quailtation diagnosis of the diseases that was in lesser sac or generated at the nearby organs, and it will be helpful to the clinical therapy.[Method] 15 the cadaver specimens with none structural diseases were selected. The courser rule of the ligaments that surrounded each recess of the lesser sac and the length of the cohering edge of the main ligaments to the corresponding strcutures was observed and measured, the main arteries in the peritoneal plica that composed the boundary of the inferior omental recess and the splenic omental recess was dissected. The communication of the superior and inferior recesses was observed, and the data of foramen bursae omenti majoris, the anteroposterior dimension, the mediolateral dimension of each recess in the six continual transection from the Gastric cardia section to downward was measured. Signs that multitude diseases involved in the recesses of lesser sac in the image of computed tomography was observed and a statistics was made.[Result] The boundary of the inferior omental recess: its downward boundary was the lentored edge of the second and third layer of the lesser sac. Its upward boundary was the above margin of the pancreas that was accompanied by the splenic artery. Its anterior boundary was the peritoneum that covers posterior surface of stomach and the anterior two layers of the greater omentum. Its posterior boundary was the posterior two layers of the greater omentum, the transverse colon, the transverse mesocolon and the peritoneum that covers the frontal of the pancreas. The left boundary was composed of the splenorenal ligament, gastrosplenic ligament and the splenocolic ligament. Theright boundary was composed of the coherence of the right fringe of the gastrocolic ligament and the transverse mesocolon, the turning curve of the peritoneum that turned from the borderline of Cervicum pancreatis and Caput pancreatis to the below of the beginning of the duodenum. Toward superior the inferior omental recess was always connected to the superior omental recess by foramen bursae omenti majoris. The boundary of the splenic omental recess: its downward boundary was the above margin of the pancreas. Its left boundary was the gastrosplenic ligament and the hilus of spleen. The cohering edge of the gastrosplenic ligament to the posterior of the fundus stomach went to right upper and overshooted the gastric surface of spleen and changed to the left layer of gastrophrenic ligament, the left layer of gastrophrenic ligament went continually to right down and it consisted of the upward, right boundary of the splenic omental recess simultaneously. Its anterior boundary was the peritoneum that covered the posterior surface of stomach. Its posterior boundary was the upper part of the splenorenal ligament, the peritoneum that covered the diaphragm and Left kindney and Left suprarenal gland. The gastropancreatic fold and the hepatopancreatic fold consisted of foramen bursae omenti majoris that was the boundary sign of the superior and inferior recesses. The height of foramen bursae omenti majoris(the prominent degree of the gastropancreatic fold and the hepatopancreatic fold) was 0.85±0.38 cm,its range that was 0.55-1.77cm fluctuates largely. In the transverse section, the superior and splenic recesses were located on Gastric cardia section, Angular part of left hepatic portal vein section, Sagittal part of left hepatic portal vein section; the inferior recess was located on Hepatic portal vein, Body of gallbladder section, Left renal vein accessing to Inferior vena caver vein section. In this paper, signs that ascites involved in the superior recess in the image of computed tomography was analysed, and we found out the probability that inferior recess was involved in simultaneously was 28.6%. Signs that Acute Pancreatitis involved in the inferiorrecess in the image of computed tomography was analysed, and we found out the probability that the splenic and superior recess was involved in simultaneously was 27.3%,9.1%.[Conclusion]1.The communicating types of the superior and inferior omental recesses can be divided into two parts, one is the superior omental recess connection to the inferior omental recess directly, another is the superior omental recess not connection to the inferior omental recess, according to the prominent degree of the gastropancreatic fold and the hepatopancreatic fold, it will precipitate the clinics to make a correct evaluation weather the process generated at the superior or inferior recess would involved in one another.2. The upward, posterior, left, right boundary of inferior omental recess are always defined by Splenic artery, Middle colic artery, the beginning part of the branches of Splenic artery at the hilus of spleen(Left gastroepiploic artery, Short gastric arteries) and Gastroduodenal artery. The downward, left, right boundary of splenic omental recess are always defined by Splenic artery, Short gastric arteries and Posterior gastric artery. In the image diagnosis, we can observe and speculate the original position of the diseases in the subphrenic space and its processing, so that we can improve the location and qualitation diagnosis of the diseases in this region.3.The definition of the boundary of recesses of lesser sac will make a correct location of ascites that generated at lesser sac or/and the nearby spaces in Acute Pancreatitis, it will make us finish the CT evaluation of Acute Pancreatitis more confidently, it will be helpful to the clinic therapy.