Trusted medical expertise in seconds.

Access 1,000+ clinical and preclinical articles. Find answers fast with the high-powered search feature and clinical tools.

Try free for 5 days
Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer.

Abdominal cavity

Last updated: September 2, 2021

Summarytoggle arrow icon

The abdominal cavity is located between the thoracic cavity and pelvic cavity. It is lined by the parietal and visceral peritoneum, and the space between these two layers forms the peritoneal cavity. The peritoneal cavity develops from the intraembryonic coelom, which arises within the lateral plate mesoderm. The abdominal organs (e.g., spleen, kidneys) and structures of the gastrointestinal tract are covered by the peritoneum. The visceral peritoneum folds upon itself to form peritoneal folds, which suspend organs and divide the peritoneal cavity into various compartments (e.g., the greater sac, lesser sac, and subphrenic space). Organs that are completely covered by the visceral peritoneum are referred to as intraperitoneal organs and those that are only partially covered are called retroperitoneal organs. The retroperitoneal space lies between the peritoneal cavity and the posterior abdominal wall. It contains the following structures: abdominal aorta, inferior vena cava, portal vein, abdominal prevertebral plexus, lymph node clusters, lymphatic trunks, and cisterna chyli.

Overview of peritoneum

Peritoneum is a serous mesothelial membrane that lines the abdominopelvic cavity and encloses most intraabdominal and pelvic organs. It consists of two layers, the parietal peritoneum and visceral peritoneum.

Parietal peritoneum

Visceral peritoneum

Omentum

Omentum is a double layer of visceral peritoneum arising from the stomach and proximal part of duodenum to various abdominal organs.

Peritoneal ligament

Definition: a collection of folds of visceral peritoneum connecting certain gastrointestinal organs to one another and/or to the abdominal wall

Overview of peritoneal ligaments
Ligaments Attachments Content(s) Clinical significance
Stomach and duodenal attachments
Greater omentum Gastrocolic ligament
Gastrosplenic ligament
  • Separates greater and lesser sacs on left side
Gastrophrenic ligament [4]
  • Anchors the stomach to the diaphragm
Lesser omentum Hepatogastric ligament
  • Separates greater and lesser sacs on the right side
  • Cut to access lesser sac during surgery
Hepatoduodenal ligament
Liver attachments
Falciform ligament
Triangular ligaments of the liver (paired)
  • Right: right lobe of liver and inferior surface of diaphragm
  • Left: left lobe of liver and inferior surface of diaphragm
Coronary ligament
  • Does not contain any structures
Ligamentum venosum
  • Does not contain any structures
Spleen attachments and supports
Splenorenal ligament
Phrenicocolic ligament
  • Does not contain any structures

Mesentery

Definition: : a contiguous double-layered fold that anchors bowel to the posterior abdominal wall and allows for passage of neurovascular structures.

Mesentery of small and large intestine
Mesentery Attachment Content Clinical significance
Mesentery of the small intestine
Transverse mesocolon
  • Divides the abdominal cavity into supracolic and infracolic compartments
Mesoappendix
  • Mesoappendix is dissected during appendectomy to ligate the appendicular vessels.
Sigmoid mesocolon

Parietal peritoneum of the lower anterior abdominal wall

Peritoneum of the pelvis

See “Ligaments of the female pelvis” and “Pelvic spaces.”

Function

  • Compartmentalization of the abdominal cavity to give rise to distinct recesses (e.g., subphrenic recess)
  • Allows for free movement of organs in relation to each other
  • Provides ligament support to organs (e.g., stomach, liver, spleen)
  • Absorption of peritoneal fluid [9]

Peritoneal cavity

Peritoneal spaces

  • Definition: group of potential spaces between adjacent organs or between an organ and the abdominal wall in which intraperitoneal fluid can accumulate
Peritoneal sacs, foramina, and spaces
Spaces Description Boundaries Clinical significance
Greater sac
  • Surrounds the intraperitoneal organs
  • Divided into supracolic and infracolic compartment by the transverse mesocolon

Lesser sac (omental bursa) [9][10]

Epiploic foramen (foramen of Winslow)

Hepatorenal space (Morison pouch) [10]

  • Space between the inferior surface of the liver and the right kidney
Splenorenal recess (Koller pouch)

Subphrenic space [9]

  • Site of subphrenic abscess (most commonly occurring as a complication of intraabdominal surgery)

Paracolic gutters

Disease can rapidly spread through the peritoneal cavity, e.g., in metastatic ovarian cancer or peritonitis. Paracentesis and analysis of peritoneal fluid can help to diagnose diseases affecting the peritoneal cavity.

Fluid from the abdominal cavity can also collect in the pelvic spaces, e.g., the pouch of Douglas. (See “Pelvic spaces.”)

Bowel perforation can lead to pneumoperitoneum. Since gas is not normally present in the peritoneal cavity, this can be detected with an abdominal x-ray.

Peritoneal folds

Definition

Boundaries

Content

Retroperitoneal spaces
Spaces Boundaries Content Clinical relevance
Perirenal space

Anterior pararenal space

Posterior pararenal space

  • Fat

Clinical significance

Overview of intraperitoneal and retroperitoneal organs
Type of organ Intraperitoneal organs Extraperitoneal organs
Retroperitoneal organs Secondary retroperitoneal organs Subperitoneal organs
Definition
Organs

SAD PUCKER for the retroperitoneal and secondary retroperitoneal organs: Suprarenal (adrenal) glands, Aorta/IVC, Duodenum (except for the first part), Pancreas (except for the tail), Ureters, Colon (ascending and descending parts), Kidneys, Esophagus, Rectum.

Development of peritoneal cavity [9]

Peritoneum and related structures develop from the lateral plate mesoderm. See “Embryology of the gastrointestinal tract”, “Development of the reproductive system”, and “Kidney embryology” to know more about the development of specific organs of the abdominal cavity.

Development of lesser sac

Development of greater sac

Development of mesentery [9]

Abdominal organs and peritoneum are supplied by the branches of abdominal aorta.

Overview [9]

The abdominal aorta bifourcates at the level of L4.

Branches of the abdominal aorta [9]
Plane of origin Type Area of supply Branches Vertebral level
Anterior
  • T12
  • L1
  • L3
Lateral
  • L1
  • L1–L2
  • L2
Posterolateral
  • Paired parietal
  • Diaphragm
  • Body wall
  • T12
  • L1–L4

Paired aortic branches

Paired branches of the abdominal aorta
Main branches

Course

Branches

Area of supply

Inferior phrenic artery

  • Runs cranially and ventrally along the inferior aspect of the diaphragm towards its domes
  • Divides into a network of terminal branches
  • Superior suprarenal artery
  • Terminal branches
  • Inferior aspect of the diaphragm

Middle suprarenal artery

  • Terminal branches

Renal artery

  • Inferior suprarenal artery
  • Terminal branches

Gonadal artery

  • Testicular artery
Lumbar arteries
(four on each side)
  • Terminal branches

Unpaired aortic branches

Celiac trunk

The celiac trunk emerges approximately at the level of T12 ; and divides into the three following branches to supply the foregut.

Branches of celiac trunk
Main branches Course Branches and their course Area of supply

Splenic artery

Left gastric artery

  • Direct branches
  • Esophageal branches

Common hepatic artery

  • Right hepatic artery
  • Left hepatic artery

A penetrating peptic ulcer or tumor in the posterior duodenal wall can erode into the gastroduodenal artery, leading to torrential hemorrhage.

Superior mesenteric artery

The superior mesenteric artery emerges from the aorta approx. at the level of L1; and then runs anteriorly and inferiorly, dividing into the following branches to supply the midgut.

Branches of superior mesenteric artery
Main branches Course Branches Area of supply
Inferior pancreaticoduodenal artery

Jejunal artery and ileal artery

Ileocolic artery
  • Runs within the mesentery towards the ileocecal region
  • Anterior cecal artery
  • Posterior cecal artery
  • Appendicular artery

Right colic artery

Middle colic artery

Inferior mesenteric artery

The inferior mesenteric artery emerges at the level of L3 and supplies the hindgut with the following branches.

Branches of inferior mesenteric artery
Main branches Course Branches Area of supply

Left colic artery

Sigmoid arteries

  • Multiple small branches
Superior rectal artery
  • Multiple small branches

All unpaired branches of the abdominal aorta form an anastomosis to ensure continued perfusion of organs in the event of vascular occlusion.

Nutcracker syndrome

Celiac artery compression syndrome (median arcuate ligament compression syndrome) [24]

Splenic artery aneurysm [25][26][27]

Other conditions

There are two systems responsible for venous drainage of the abdominal spaces that merge just before the heart, the inferior vena cava and portal hepatic vein.

Main tributaries of the inferior vena cava
Tributaries Area of drainage Note

Inferior phrenic vein
(paired)

  • Inferior aspect of the diaphragm

Lumbar veins
(four on each side)

Renal vein (left and right)

Right gonadal vein

  • The left gonadal vein empties into the left renal vein.

Right suprarenal vein

  • The left suprarenal vein typically drains into the left renal vein.

Hepatic veins (right, intermediate, left) [30]

Overview [9]

Main tributaries [1][32][33]

The hepatic portal vein receives blood directly from smaller veins as well as the splenic vein and the superior and inferior mesenteric vein.

Direct tributaries from smaller veins

Main tributaries of the hepatic portal vein
Tributaries Course Area of drainage Note

Left gastric vein

Right gastric vein
Prepyloric vein (via right gastric vein) [34]
Cystic vein [1][36]
Paraumbilical veins
  • None
Superior pancreaticoduodenal vein (posterior division)

Indirect tributaries via large veins

Main tributaries of the splenic vein

Tributaries Course Area of drainage
Pancreatic veins [33]
Short gastric veins
Left gastroepiploic vein
Posterior gastric vein
Inferior mesenteric vein Left colic vein
Sigmoid veins
Superior rectal vein

Main tributaries of superior mesenteric vein

Tributaries Course Area of drainage
Right gastroepiploic vein
Inferior pancreaticoduodenal veins
Jejunal veins and ileal veins
Ileocolic vein
  • Formed by the confluence of cecal vein and appendicular vein
Right colic vein
Middle colic vein

Overview

Cavocaval anastomoses [9][37][38]

Portocaval anastomoses [29]

Patients with portal hypertension can develop varices of the gut (distal esophagus), butt (rectum and anal canal), and caput (medusae).

Inferior vena cava thrombosis [39]

Other conditions

Lymphatic drainage of the abdominal cavity occurs via lymph nodes around the individual organs, lymph node clusters, and, finally, into one of the large lymphatic trunks, which merge at the cisterna chyli to form the thoracic duct.

Lymph node clusters of the abdominal cavity [9][33]

They lie along the course of major blood vessels and are divided into three main groups: preaortic nodes, paraaortic nodes, and iliac lymph nodes. For more information on the lymphatic drainage of these lymph nodes, see “Abdominal lymph nodes.”

Lymphatic drainage of the abdominal cavity
Lymph nodes Location Area of drainage Termination
Preaortic lymph nodes
Paraaortic lymph nodes (lumbar nodes)
Iliac lymph nodes Common iliac lymph nodes
  • Around common iliac vessels
Internal iliac lymph nodes
  • Around internal iliac vessels
External iliac lymph nodes
  • Around external iliac vessels

Lymphatic trunks [9]

The three major lymphatic trunks drain into the cisterna chyli.

Cisterna chyli [9]

Clinical significance

The visceral organs are innervated by sympathetic nervous system, parasympathetic nervous system, and enteric nervous system.

Sympathetic innervation [9][33]

Sympathetic innervation of abdominal organs [9]
Nerve Origin Course Site of synapse
Greater splanchnic nerve
Lesser splanchnic nerve
Least splanchnic nerve
Lumbar splanchnic nerves
Sacral splanchnic nerves

Parasympathetic innervation [9][33]

Parasympathetic innervation of abdominal organs [9]
Nerve Origin Course Site of synapse Area of innervation
Vagus nerve
Pelvic splanchnic nerve

The Cannon point (at the left colic flexure) is where parasympathetic innervation transitions from the vagus nerve to the pelvic splanchnic nerves.

The left vagus nerve is anterior to the stomach, and the right vagus is posterior to it. This can be remembered with the mnemonic LARP: Left Anterior, Right Posterior.

Prevertebral ganglia and autonomic nerve plexus [9]

Prevertebral plexus and ganglia of the abdominal cavity
Name of ganglia/plexus Location Afferent fibers Efferent fibers Area of innervation
Celiac plexus Celiac ganglion (paired)

Superior mesenteric ganglion and superior mesenteric plexus

  • Direct fibers
Aorticorenal ganglion (paired)
Aortic plexus [41] Intermesenteric plexus
Inferior mesenteric plexus and inferior mesenteric ganglion
  • Direct fibers
Superior hypogastric plexus
Inferior hypogastric plexus (pelvic plexus)
  • Direct fibers

Clinical significance

  1. Moore KL, Agur AMR, Dalley AF, II AF. Clinically Oriented Anatomy. LWW ; 2017
  2. Meza-Perez S, Randall TD. Immunological Functions of the Omentum.. Trends Immunol. 2017; 38 (7): p.526-536. doi: 10.1016/j.it.2017.03.002 . | Open in Read by QxMD
  3. Anatomy, Abdomen and Pelvis, Diaphragm. https://www.ncbi.nlm.nih.gov/pubmed/29262082. Updated: January 1, 2020. Accessed: August 27, 2020.
  4. Sharma M, Senadhipan B, et al. Imaging of peritoneal ligaments by endoscopic ultrasound (with videos). Endoscopic Ultrasound. 2015; 4 (1): p.15-27. doi: 10.4103/2303-9027.151317 . | Open in Read by QxMD
  5. Abdel-Misih SR, Bloomston M. Liver anatomy. Surg Clin North Am. 2010; 90 (4): p.643-653. doi: 10.1016/j.suc.2010.04.017 . | Open in Read by QxMD
  6. Anatomy, Abdomen and Pelvis, Falciform Ligament.
  7. Pickhardt PJ, Bhalla S. Intestinal Malrotation in Adolescents and Adults: Spectrum of Clinical and Imaging Features. American Journal of Roentgenology. 2002; 179 (6): p.1429-1435. doi: 10.2214/ajr.179.6.1791429 . | Open in Read by QxMD
  8. Merrow AC, Jr. AC, Hariharan S. Imaging in Pediatrics E-Book. Elsevier Health Sciences ; 2017
  9. Standring S. Gray's Anatomy: The Anatomical Basis of Clinical Practice. Elsevier Health Sciences ; 2016
  10. Bechtold RE, Dyer RB, et al. The perirenal space: relationship of pathologic processes to normal retroperitoneal anatomy.. RadioGraphics. 1996; 16 (4): p.841-854. doi: 10.1148/radiographics.16.4.8835975 . | Open in Read by QxMD
  11. Tirkes T, Sandrasegaran K, Patel AA, et al. Peritoneal and Retroperitoneal Anatomy and Its Relevance for Cross-Sectional Imaging. RadioGraphics. 2012; 32 (2): p.437-451. doi: 10.1148/rg.322115032 . | Open in Read by QxMD
  12. Coffin A, Boulay-Coletta I, et al. Radioanatomy of the retroperitoneal space. Diagnostic and Interventional Imaging. 2015; 96 (2): p.171-186. doi: 10.1016/j.diii.2014.06.015 . | Open in Read by QxMD
  13. Mariana Horta. Extraperitoneal Space: Anatomic and Radiologic Overview. European Congress of Radiology. 2014 . doi: 10.1594/ECR2014/C-2250 . | Open in Read by QxMD
  14. Drake R. Gray's Anatomy for Students. Elsevier ; 2019
  15. Beveridge TS, Johnson M, et al. Anatomy of the nerves and ganglia of the aortic plexus in males. J Anat. 2014; 226 (1): p.93-103. doi: 10.1111/joa.12251 . | Open in Read by QxMD
  16. Chaurasia BD. BD Chaurasia's Human Anatomy. CBS ; 2017
  17. Richards JR, McGahan JP. Focused Assessment with Sonography in Trauma (FAST) in 2017: What Radiologists Can Learn. Radiology. 2017; 283 (1): p.30-48. doi: 10.1148/radiol.2017160107 . | Open in Read by QxMD
  18. Ishida M, Sakata N, Ise I, et al. The comparative anatomy of the folds, fossae, and adhesions around the duodenojejunal flexure in mammals.. Folia Morphol (Warsz). 2017; 77 (2): p.286-292. doi: 10.5603/FM.a2017.0089 . | Open in Read by QxMD
  19. Nandagopapalan PA. Peritoneal Recesses of Human Duodenum. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. 2016 . doi: 10.7860/jcdr/2016/20395.8829 . | Open in Read by QxMD
  20. Tubbs RS, Shoja MM, Loukas M. Bergman's Comprehensive Encyclopedia of Human Anatomic Variation. John Wiley & Sons ; 2016
  21. Trubel W, Turkof E, et al. Incidence, Anatomy and Territories Supplied by the Posterior Gastric Artery. Cells Tissues Organs. 1985; 124 : p.26-30. doi: 10.1159/000146090 . | Open in Read by QxMD
  22. Anatomy, Abdomen and Pelvis, Superior Mesenteric Artery.
  23. Binit S, Mittal MK. Arc of Riolan.. Indian J Med Res. 2014; 139 (6): p.965-966.
  24. Ha T-S, Lee E-J. ACE inhibition can improve orthostatic proteinuria associated with nutcracker syndrome. Pediatric Nephrology. 2006; 21 (11): p.1765-1768. doi: 10.1007/s00467-006-0206-3 . | Open in Read by QxMD
  25. Chen W, Chu J, Yang J, et al. Endovascular Stent Placement for the Treatment of Nutcracker Phenomenon in Three Pediatric Patients. Journal of Vascular and Interventional Radiology. 2005; 16 (11): p.1529-1533. doi: 10.1097/01.rvi.0000178259.87608.ec . | Open in Read by QxMD
  26. Prabhakar D, Venkat D, Cooper GS. Celiac Axis Compression Syndrome: A Syndrome of Delayed Diagnosis?. Gastroenterology & hepatology. 2017; 13 (3): p.192-194.
  27. Abbas MA, Stone WM, Fowl RJ, et al. Splenic Artery Aneurysms: Two Decades Experience at Mayo Clinic. Ann Vasc Surg. 2002; 16 (4): p.442-449. doi: 10.1007/s10016-001-0207-4 . | Open in Read by QxMD
  28. Khosa F, Krinsky G, et al. Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 2: White Paper of the ACR Incidental Findings Committee II on Vascular Findings. Journal of the American College of Radiology. 2013; 10 (10): p.789-794. doi: 10.1016/j.jacr.2013.05.021 . | Open in Read by QxMD
  29. Sadat U, Dar O, et al. Splenic artery aneurysms in pregnancy – A systematic review. International Journal of Surgery. 2008; 6 (3): p.261-265. doi: 10.1016/j.ijsu.2007.08.002 . | Open in Read by QxMD
  30. Chaer RA, Abularrage CJ, et al. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. Journal of Vascular Surgery. 2020; 72 (1): p.3S-39S. doi: 10.1016/j.jvs.2020.01.039 . | Open in Read by QxMD
  31. Sharma M, Rameshbabu CS. Collateral Pathways in Portal Hypertension. Journal of Clinical and Experimental Hepatology. 2012; 2 (4): p.338-352. doi: 10.1016/j.jceh.2012.08.001 . | Open in Read by QxMD
  32. Mehran R, Schneider R, et al. The minor hepatic veins: Anatomy and classification. Clinical Anatomy. 2000; 13 (6): p.416-421. doi: 10.1002/1098-2353(2000)13:6<416::aid-ca4>3.0.co;2-h . | Open in Read by QxMD
  33. Tang W, Zhang XM, et al. Hepatic caudate vein in Budd-Chiari syndrome: Depiction by using magnetic resonance imaging. Eur J Radiol. 2011; 77 (1): p.143-148. doi: 10.1016/j.ejrad.2009.06.026 . | Open in Read by QxMD
  34. Lee W-K, Chang SD, Duddalwar VA, et al. Imaging Assessment of Congenital and Acquired Abnormalities of the Portal Venous System. RadioGraphics. 2011; 31 (4): p.905-926. doi: 10.1148/rg.314105104 . | Open in Read by QxMD
  35. Thorek P. Anatomy in Surgery. Springer Science & Business Media ; 2011
  36. Philips CA, Arora A, et al. A Comprehensive Review of Portosystemic Collaterals in Cirrhosis: Historical Aspects, Anatomy, and Classifications. International Journal of Hepatology. 2016; 2016 (6170243). doi: 10.1155/2016/6170243 . | Open in Read by QxMD
  37. Fine A. The cystic vein: the significance of a forgotten anatomic landmark.. JSLS : Journal of the Society of Laparoendoscopic Surgeons. 1997; 1 (3): p.263-266.
  38. Kapur S, Paik E, Rezaei A, Vu DN. Where There Is Blood, There Is a Way: Unusual Collateral Vessels in Superior and Inferior Vena Cava Obstruction. RadioGraphics. 2010; 30 (1): p.67-78. doi: 10.1148/rg.301095724 . | Open in Read by QxMD
  39. Bashist B, Parisi A, et al. Abdominal CT findings when the superior vena cava, brachiocephalic vein, or subclavian vein is obstructed.. American Journal of Roentgenology. 1996; 167 (6): p.1457-1463. doi: 10.2214/ajr.167.6.8956577 . | Open in Read by QxMD
  40. McAree B, O’Donnell M, et al. Inferior vena cava thrombosis: A review of current practice. Vascular Medicine. 2013; 18 (1): p.32-43. doi: 10.1177/1358863x12471967 . | Open in Read by QxMD
  41. Gayer G, Luboshitz J, Hertz M, et al. Congenital Anomalies of the Inferior Vena Cava Revealed on CT in Patients with Deep Vein Thrombosis. American Journal of Roentgenology. 2003; 180 (3): p.729-732. doi: 10.2214/ajr.180.3.1800729 . | Open in Read by QxMD