Oil seals. In the abdominal cavity, two omentums are distinguished - large and small. Questions

Inflammatory disease of the omentum, which is a fold of the visceral peritoneum. The disease is manifested by acute diffuse pain in the abdomen, nausea, fever, headache, vomiting. Patients take a forced half-bent position, with the extension of the trunk there is a sharp pain. Diagnosis includes examination by a surgeon, omentography, CT of the abdominal cavity, diagnostic laparoscopy. Treatment of acute pathology is surgical. The omentum is removed, the abdominal cavity is inspected, and a drain is installed. In a chronic course, antibacterial and anti-inflammatory drugs are prescribed in combination with physiotherapy.

General information

Omentitis is a pathology of the abdominal cavity, which is manifested by inflammation of the omentum - a duplication of the peritoneum, consisting of abundantly vascularized loose connective tissue and adipose tissue. Anatomically, a small and a large omentum are distinguished. The latter starts from the stomach, is fixed to the transverse colon, continues down, freely covering the small intestine. The lesser omentum consists of 3 ligaments that stretch from left to right from the diaphragm to the stomach, then to the liver and duodenum. Rarely, isolated lesions of the greater omentum (epiploit) and ligamentous apparatus (ligamentitis) occur. Omentitis often occurs in children and adolescents due to the imperfection of the functioning of the immune system and the gastrointestinal tract.

Causes of omentitis

Based on the etiology of the inflammatory process, the disease is primary and secondary. Primary omentitis is formed as a result of traumatic injury, infection and intraoperative damage to the peritoneum. In this case, the infection occurs directly in the peritoneal duplication. An isolated lesion of the omentum site is found in tuberculosis and actinomycosis. In surgery, predominantly secondary inflammation occurs, which occurs as a result of the following reasons:

• Contact transmission of infection. The disease is formed during the transition of inflammation from a nearby organ as a result of cholecystitis, pancreatitis, appendicitis, etc.
• Infection through the endogenous route. With the flow of blood or lymph from the primary infectious focus (in the lungs, gastrointestinal tract, liver, etc.), pathogenic microorganisms enter the omentum and cause inflammation.
• intraoperative infection. Occurs as a result of a violation of asepsis and / or antisepsis during intra-abdominal interventions (insufficient sterilization of instruments, surgeon's hands, surgical field, leaving foreign objects in the abdominal cavity - ligatures, napkins).
• Operations on the abdominal cavity. Carrying out surgical procedures for appendicitis, strangulated hernia, etc., can lead to torsion of the omentum, impaired blood circulation in it, the development of ischemia and inflammation. The cause of omentitis can be a resection of an organ with a poorly formed stump.

Pathogenesis

Due to the abundant blood supply and the large amount of loose adipose tissue, the omentum is quickly involved in the inflammation process. The organ has a resorptive and adhesive ability and performs a protective function in the body. With mechanical damage, ischemia, an infectious process, the immunological activity of cells increases, the ability to absorb fluid from the abdominal cavity, and the hemostasis system is activated. With omentitis, there is hyperemia, swelling of the folds of the peritoneum with fibrous stratification and infiltrative tissue compaction. Histological examination reveals signs of inflammation (thrombosis and plethora of blood vessels, hemorrhages, islands of necrosis), areas of leukocyte infiltration, a large number of eosinophils, lymphocytes. With tuberculous omentitis, multiple whitish tubercles are visualized. Small formations acquire a reddish color when the organ comes into contact with air during surgical procedures.

Classification

Based on the severity of the inflammatory process, acute and chronic omentitis are distinguished. The acute form of the disease is accompanied by pronounced symptoms with increasing intoxication, the chronic form is characterized by a sluggish course with periods of exacerbation and remission. Depending on the degree of inflammatory-destructive changes, 3 stages of omentitis are distinguished:

1. Serous. It is manifested by swelling and hyperemia of the tissues of the omentum without signs of destruction. The inflammatory process is reversible. At this stage, complete tissue regeneration is possible during conservative therapy.
2. Fibrous. The hyperemic omentum is covered with a coating of fibrin and acquires a whitish-gray color. Single hemorrhages and impregnation of the tissues of the organ with fibrin threads and leukocytes are noted. In the outcome of the disease, incomplete regeneration is possible with the replacement of part of the affected areas with connective tissue and the formation of adhesions.
3. Purulent. The organ acquires a gray, purple-cyanotic, dark brown hue, which indicates a deep intracellular lesion. Often the greater omentum is fixed to the appendix, forming a single conglomerate. The histological picture is represented by multiple large-focal hemorrhages, areas of impaired tissue microcirculation and necrosis. The transition of acute omentitis to chronic is possible. The outcome of the purulent process is the replacement of the necrotic part of the organ with connective tissue and the formation of adhesions.

Symptoms of omentitis

The clinical picture of the pathology depends on the nature of the inflammatory process and the causes of the disease. In acute omentitis, patients complain of intense, sharp pains in the abdomen that do not have a clear localization. Signs of intoxication develop: vomiting, fever to febrile values, headache, dizziness. On examination, the muscle tension of the abdominal wall draws attention, sometimes a painful formation of a dense consistency is palpated. A pathognomonic sign is the inability to straighten the trunk, as a result of which the patient is in a half-bent state. Adhesive processes in the abdominal cavity can lead to disruption of the passage of food through the intestines, the occurrence of constipation, partial or complete intestinal obstruction.

Chronic omentitis is characteristic of postoperative and tuberculous inflammation, manifested by discomfort and aching pains in the abdomen, symptoms of intoxication are absent or mild. With deep palpation of the anterior wall of the abdomen, a mobile formation of a doughy consistency is determined, often painless.

Complications

Delimitation of inflammation leads to the formation of an abscess of the omentum. When an abscess breaks, peritonitis develops, and when pathogenic microorganisms enter the bloodstream, bacteremia develops. In severe advanced cases, necrosis of the peritoneal fold occurs. This condition is accompanied by severe intoxication of the body and can lead to the development of infectious-toxic shock and, in the absence of urgent measures, to death. Chronization of omentitis, fixation of the organ to the peritoneum (visceral or parietal sheet) entails the occurrence of a stretched omentum syndrome, which is characterized by a positive Knoch symptom (increased pain when the body is overextended).

Diagnostics

Due to the rarity of the disease, the absence of a specific clinical picture, preoperative diagnosis presents significant difficulties. To diagnose omentitis, the following examinations are recommended:

• Surgeon's examination. This pathology is almost never diagnosed during a physical examination, however, a specialist, suspecting an acute surgical pathology, directs the patient for additional instrumental diagnostics.
• Omentography. It is an x-ray examination with the introduction of radiopaque preparations into the abdominal space. Allows you to detect an increase in the inflamed organ, adhesions, foreign bodies.
• Abdominal CT. Visualizes additional formations, inflammatory infiltrate and changes in neighboring organs. Helps to identify the cause of intestinal obstruction.
• Diagnostic laparoscopy. This method is the most reliable in the diagnosis of the disease, it allows you to assess in detail the changes in the omentum, the state of the peritoneum, the nature and amount of fluid in the abdominal cavity. If tuberculous omentitis is suspected, material may be taken for histological examination.
• Laboratory research. They are a non-specific diagnostic method. The acute stage of the disease is characterized by leukocytosis, neutrophilia, and accelerated ESR.

Differential diagnosis of omentitis is carried out with other inflammatory intraperitoneal diseases (appendicitis, cholecystitis, pancreatitis, colitis). Pathology may have similar symptoms with peritonitis, perforated gastric ulcer, 12-PC, intestinal obstruction of a different etiology. The disease is differentiated from benign and malignant neoplasms of the intestine, mesentery. For additional diagnosis and exclusion of diseases of nearby organs, an ultrasound of the OBP is performed.

Treatment of omentitis

In severe lesions of the organ and a pronounced clinical picture, an urgent surgical intervention is performed. During the operation, based on the extent of the lesion, an omentectomy and a thorough revision of the abdominal cavity are performed. The resection line is invaginated and sutured with thin catgut threads. Antibacterial drugs are injected into the abdominal cavity and drainage is established. In the postoperative period, antibiotics and analgesics are prescribed.

With confirmed chronic omentitis, conservative therapy is possible. In a hospital setting, antibacterial drugs are prescribed according to the sensitivity of the infectious agent, anti-inflammatory and painkillers. Patients are advised to rest, bed rest. After the inflammation subsides, a course of physiotherapeutic procedures is performed (UHF, magnetotherapy, solux therapy).

Forecast and prevention

The prognosis of the disease depends on the neglect of the pathology and the extent of the lesion of the omentum. With a timely operation and competent management of the rehabilitation period, the prognosis is favorable. Patients return to their normal lifestyle after a few months. A generalized lesion with acute intoxication leads to the development of severe life-threatening conditions (shock, sepsis). Prevention of omentitis consists in a thorough intra-abdominal revision during laparotomy, timely treatment of acute and chronic diseases. Patients after interventions on OBP 1-2 times a year are shown to undergo ultrasound control.

This necessarily accompanies surgery for certain types of abdominal cancer. It is important that in all these operations the abdominal cavity is opened with an extensive longitudinal incision. It is difficult to perform a full omentectomy through a transverse incision, and often the result of such difficult operations is incomplete removal of the metastasized omentum. If the removed omentum does not show signs of damage, it should be carefully examined for the presence of micrometastases.

The purpose of the operation to remove the greater omentum is to remove the omentum with all macro- and micrometastases.

Physiological the consequences of removing the omentum— none.

The progress of the gland removal operation

Features of the operation:

• The greater omentum must be cut off from the greater curvature of the stomach and from the transverse colon.
• Particular care should be taken to ligate the small branches of the right gastric artery. Reliable hemostasis is required.
• In cases of malignant tumors of the stomach, it is recommended to remove the greater omentum due to the possible implantation of metastases in this structure.

Removal of the greater omentum is not difficult and usually requires less technical effort than the separation of the gastric-colon ligament adjacent to the greater curvature. Therefore, some prefer to constantly use this operation, regardless of the indication for almost complete. The transverse colon is removed from the wound, and with assistants they lift the omentum steeply upwards and hold it. Using Metzenbaum scissors, excision is started on the right side adjacent to the posterior band of the colon. In many cases, the peritoneal junction is easier to separate with a scalpel than with scissors. A thin and relatively vascularized peritoneal layer can be seen, which can be quickly incised. The greater omentum continues to be pulled upwards, while with the help of a blunt separation with gauze, the large intestine is shifted down, freeing it from the omentum. During this procedure, several small blood vessels in the anterior cord region of the colon may need to be divided and ligated. As a result, it will be possible to see a thin, vascular-free peritoneal layer above the large intestine. It is dissected, getting a direct entrance to the stuffing bag. In the case of obese patients, as a preliminary step, it may be easier to separate the connections of the omentum with the side wall of the stomach under the spleen.

If the upper edge of the splenic flexure is clearly visible, then the ligament of the spleen and colon is separated and the omental bag is entered from the left side, and not over the transverse colon. The surgeon must be constantly careful not to injure the splenic capsule or the middle vessels of the transverse colon, since the mesentery of the transverse colon may closely adhere to the gastric-colon ligament, especially on the right. As the separation progresses to the left, the omentum of the stomach and colon is separated, and the greater curvature of the stomach is separated from its blood supply to the desired level. In some cases, it may be easier to ligate the splenic artery and vein along the upper surface of the pancreas and remove the liver, especially if there is malignancy in the area. It should be remembered that if the left gastric artery is ligated proximally to its bifurcation, and removed, then the blood supply to the stomach becomes so risky that the surgeon is forced to go for a complete resection of the stomach.

In the presence of a malignant tumor, the greater omentum over the head of the pancreas is removed, as well as the subpyloric lymph nodes. When approaching the wall of the duodenum, small curved clamps should be used, and the medium bowel vessels, which may be adjacent to the gastric-colon ligament at this point, should be carefully examined and bypassed before the clamps are applied. In case of inattention, severe bleeding may occur, and the blood supply to the intestine will be in danger.

Stuffing box I Stuffing box

a fold of the visceral (visceral) peritoneum, wide and extended along its length (See Peritoneum), between the sheets of which is loose connective tissue, rich in blood vessels and fatty deposits. Large S., consisting of 4 sheets of peritoneum, starts from the greater curvature of the stomach, is fixed to the transverse colon and, covering the intestine from the front, descends in the form of an apron ( rice. ). It performs a protective function in case of injuries and inflammatory diseases of the abdominal organs, for example, with Appendicitis e. Small S. - a double peritoneum stretched between the liver, the upper part of the duodenum and the lesser curvature of the stomach. Large S. is often used to cover sutures during operations on the stomach and intestines, as well as for tamponade of wounds of the liver and spleen. Acute inflammation of a large S. (epiploit) may occur as a result of its infection, twisting, or injury; accompanied by symptoms of an acute abdomen (See Acute abdomen).

Great Soviet Encyclopedia. - M.: Soviet Encyclopedia. 1969-1978 .

See what the "Gland" is in other dictionaries:

STUFFING BOX- (omentum, epiploon), large duplications of the peritoneum, going from one abdominal organ to another and consisting of sheets of the peritoneum, large and small peritoneal sacs (Fig. 1). Usually C, i.e., the sheets of the peritoneum, covers the vascular pedicle, ... ... Big Medical Encyclopedia

Fat fold in the peritoneum * * * (Source: United Dictionary of Culinary Terms) Omentum Omentum is a fat fold in the peritoneum. Dictionary of culinary terms. 2012 ... Culinary Dictionary

In engineering, a seal, a sealed gap between moving and stationary parts (e.g. piston rod and cylinder). A stuffing box with soft (asbestos, felt, rubber) and hard (for example, metal) packings is used ...

OIL, omentum, husband. 1. A region of the peritoneum rich in fatty deposits from the stomach to the lower part of the abdominal cavity (anat.). 2. Kind of food from this part of the animal's body (cool). 3. A lubricating device at the piston that prevents steam from escaping, ... ... Explanatory Dictionary of Ushakov

Seal, fixture, gap, gasket Dictionary of Russian synonyms. omentum n., number of synonyms: 9 belly (29) ... Synonym dictionary

stuffing box- a, m. sale adj. obsolete Loving greasiness. Well, how can I go to the mazurka with him as an officer! It would be a keychain on the watch! Papa grimaced, barking: Omentum. White beginning of the century. // Star. Arbat 40 … Historical Dictionary of Gallicisms of the Russian Language

In anatomy, a wide and long fold of the visceral peritoneum in mammals and humans, part of the mesentery. The connective tissue of the omentum is rich in blood vessels and adipose tissue. Protective organ of the abdominal cavity ... Big Encyclopedic Dictionary

OIL, a, husband. (specialist.). 1. Fat fold in the peritoneum. 2. A part that hermetically closes the gap between the moving and stationary parts of the machine. | adj. stuffing box, oh, oh. Explanatory dictionary of Ozhegov. S.I. Ozhegov, N.Yu. Shvedova. 1949 1992 ... Explanatory dictionary of Ozhegov

- (omentum), a wide and long fold of the visceral sheet of the peritoneum of mammals, in which a loose connective tissue is located, rich in blood vessels and fatty deposits. Large S. double fold of the dorsal mesentery of the stomach, consisting of 4 sheets, ... ... Biological encyclopedic dictionary

- (Stuffing box, stuffing gland) a detail for sealing the gaps between the holes and the parts moving in them in order to prevent the leakage of liquid or gas. Sealing is achieved through various packings. Samoilov K. I. Marine ... ... Marine Dictionary

A sealing device for rods, rods and tubes at the point of their passage through a hole in the wall (cover) separating two spaces with unequal pressure. C. a critical part that serves to prevent the passage (leaks) of steam, water ... ... Technical railway dictionary

Big omentum starts from the greater curvature of the stomach and in the form of an apron hangs down to the level of the pubic bones. Its proximal part (from the stomach to the transverse colon) stands out under the name of the gastrocolic ligament. It consists of two peritoneal plates, which are a continuation of the peritoneum of the anterior and posterior walls of the stomach. Having connected, both of these plates follow down anteriorly from the transverse colon and at a different level wrap up again, passing anteriorly and above (one sheet of peritoneum) and below (second sheet of peritoneum) from the transverse colon, to which they are attached. Thus, the gastrocolic ligament consists of two sheets of the peritoneum, and the free part of the omentum of four.

The gap between the leaves of the greater omentum is filled with different amounts of fatty tissue, often reaching a high degree of development. This adipose tissue fills the gap between the anterior and posterior layers of the greater omentum that was in its embryonic state; in the process of further development, this gap is completely overgrown.

The fused two anterior sheets form the anterior plate of the greater omentum, the posterior two sheets, growing together, form the posterior plate of the greater omentum. Between the greater omentum and the anterior abdominal wall is a slit-like space called the preomental space.

Small omentum – is a duplication of the peritoneum, which stretches from the gate of the liver, and from the posterior half of the left sagittal groove of the liver to the lesser curvature of the stomach and to the initial section of the horizontal part of the duodenum. It consists of three ligaments: hepatogastric, hepatoduodenal and diaphragmatic-gastric.

The lesser omentum has the form of a trapezoid with a lower base of about 16-18 cm and an upper short base of about 6 cm.

Like a large sleeping bag, blood and lymphatic vessels, lymph nodes, as well as a certain amount of fatty tissue are enclosed between the sheets of the lesser omentum.

Of particular importance are the formations enclosed between the sheets of the hepatoduodenal ligament. Here lie the portal vein, the common bile duct, and the hepatic artery.

Abdominal bags. Four bags are distinguished in the abdominal cavity.

1. Stuffing bag, or small abdominal cavity - is a slit-like cavity located behind the stomach. In this cavity, the following six walls can be distinguished - anterior, posterior, upper, lower, right and left.

The anterior wall of the omental bag, if you go from top to bottom, is formed by the lesser omentum, the posterior surface of the stomach and the gastrocolic ligament. Its posterior wall is represented by the parietal peritoneum lining the pancreas and large vessels lying on the spine. The upper wall is formed by the left and caudate lobes of the liver, and the lower wall is formed by the transverse colon and its mesentery. The left and right borders of the bag are formed by transitional folds of the peritoneum.

The gastro-pancreatic ligaments subdivide the cavity of the bag into distinct two floors: the upper one is the cavity of the lesser omentum, the lower one is the cavity of the greater omentum.

The cavity of the lesser omentum is much smaller and narrower than the cavity of the greater omentum. It is located to the right of the spine and does not extend to the left of the midline of the spine further than 1–2 cm. .

A wide exposure of the omental bursa can be made anteriorly by transection of the gastrocolic ligament to penetrate the cavity of the lesser omentum.

The stuffing bag communicates with the large abdominal cavity through Winslow's stuffing foramen.

2. Right hepatic sac located between the diaphragm and the right lobe of the liver. It is limited: from above by the tendon center of the diaphragm; below - the upper surface of the right lobe of the liver; from the inside - the suspension, or falciform ligament of the liver; outside - the muscular part of the diaphragm. This bag occasionally serves as a receptacle for subphrenic abscesses.

3. Left hepatic sac located between the left lobe of the liver and the diaphragm. Its borders: in front - the muscular part of the diaphragm; behind - the left coronary ligament of the liver; inside - falciform ligament of the liver and outside - the left triangular ligament of the liver.

4. Pregastric bag located between the stomach and the left lobe of the liver. Its more precise boundaries are as follows: in front - the lower surface of the left lobe of the liver; behind - the anterior wall of the stomach; from above - a small omentum and gates of the liver.

The last three of the four bags described - the right and left hepatic, as well as the pancreatic from the bottom, freely communicate with the rest of the upper and lower floors of the abdominal cavity.

Sinuses and channels of the lower floor of the abdominal cavity. In the lower floor of the abdominal cavity are the right and left mesenteric sinuses (sinuses). Both sinuses are triangular in shape.

Right sinus limited to the right by the ascending colon, to the left by the root of the mesentery of the small intestine, and from above by the transverse colon and its mesentery.

Left mesenteric sinus limited to the left by the descending colon, to the right by the oblique root of the mesentery of the small intestine, and from below by the sigmoid colon.

The base of the right mesenteric sinus is directed upward, and the base of the left mesenteric sinus is directed downward. The right sinus is closed, the left freely communicates with the pelvic cavity, which is essential in the presence of effusions in the abdominal cavity.

There are two canals in the abdominal cavity, located in the longitudinal direction - the right and left lateral canals.

Right side channel located between the parietal peritoneum and the ascending colon. It extends from the lower surface of the liver, where it communicates with the hepatic sac, to the caecum, near which it passes into the retrocecal eversion.

The left lateral canal is located between the parietal peritoneum and the descending colon. It starts below the left phrenic-colic ligament, stretches down and freely communicates with the pelvic cavity between the parietal peritoneum and the sigmoid colon.

In pathological conditions, the described channels are often a receptacle for various exudates or blood.

Pockets of the lower floor of the abdominal cavity. In the lower floor of the abdominal cavity, the following pockets, or eversion of the peritoneum, are distinguished :

1. Duodeno-jejunal eversion - enclosed between two folds of the peritoneum (upper and lower duodenojejunal) within the duodenojejunal flexure . Between these folds a deepening is formed, which is called the duodenal-jejunal pocket. This pocket is very important in the formation of retroperitoneal hernias of the abdomen, or retroperitoneal hernias of Treitz. The inferior mesenteric vein is enclosed in the superior fold.

2. Superior ileocecal pouch - enclosed in the upper corner between the ileum and the caecum. It is bounded above by a special ileocolic fold, below by the horizontally extending terminal part of the ileum, and outside by the initial section of the ascending colon.

3. Inferior ileocecal pouch represents a special depression located below the distal ileum. The pocket is limited: from above - by the ileum, from behind - by the mesentery of the appendix, and from the front - by the ileocecal fold of the peritoneum stretched between the distal part of the ileum and the cecum.

The retro-intestinal pocket (or fossa) is located behind the initial section of the large intestine and is limited in front by the visceral peritoneum covering the caecum, and behind by the parietal peritoneum.

5. Intersigmoid eversion - is located in the form of a recess in the loop of the mesentery of the sigmoid colon.

Openings of the abdominal cavity. In the cavity of the peritoneum, two holes are described, formed due to the peritoneal folds.

1. Winslow stuffing hole - communicates with the cavity of the omental bag (more precisely, the cavity of the lesser omentum with the greater cavity of the peritoneum). Its borders: in front - the hepatoduodenal ligament, behind - the parietal sheet of the peritoneum covering the inferior vena cava (or hepato-renal ligament), below - the upper horizontal part of the duodenum, and above the caudate lobe of the liver. Normally, this hole passes two fingers and can be used to revise the cavity of the omental sac, as well as to temporarily stop bleeding during operations on the liver, by digitally pressing the hepatic artery and portal vein (going between the layers of the hepatoduodenal ligament).

2. Gastro-pancreatic opening. Its boundaries are: on the right - the pyloric-pancreatic ligament, on the left - the gastro-pancreatic ligament, in front - the lesser curvature, and behind - the anterior surface of the pancreas. ligaments from each other), semi-covered (with some convergence of these ligaments), covered (option when the left edge of the pyloric-pancreatic ligament is located at the level of the gastro-pancreatic fold) and in the form of a canal (when the pyloric-pancreatic ligament is superimposed on the gastro-pancreas) .

The ratio of the abdominal organs to the peritoneum.

All organs of the abdominal cavity, depending on their relationship to the peritoneum, are divided into three groups:

1. intraperitoneal ( intraperitoneal) organs, covering the peritoneum from all sides. These include the stomach, spleen, small intestine (in particular the jejunum and ileum), appendix, transverse colon, sigmoid colon, and the initial section of the rectum.

2. Mesoperitoneal organs covered with peritoneum on three sides and uncovered behind. These include the liver, gallbladder, upper horizontal and ascending duodenum, caecum, ascending and descending colon, middle rectum, uterus, bladder.

3. Retroperitoneal(retroperitoneal) organs covered with peritoneum on one side only, in front. These include the descending and lower horizontal parts of the duodenum, pancreas, kidneys, ureters, adrenal glands, anal rectum, large vessels - aorta, inferior vena cava.

Mesentery of the small and large intestine. The name "mesenter" refers to a duplication of the peritoneum, on which the intestinal tube is fixed. It consists of two fused sheets of the serous membrane with numerous lymphatic and blood vessels, lymph nodes and nerves enclosed in it.

A feature of the structure of the mesentery of the small intestine is that it forms numerous folds at the edge adjacent to the intestine. The posterior half of the mesentery and its posterior edge are attached to the spine without forming folds. Due to this structure, the mesentery, upon its extraction from the abdominal cavity, takes the form of a helical plane with several turns.

The root of the mesentery crosses the spine in an oblique direction from left to right and from top to bottom from the level of the left lateral surface of the second lumbar vertebra to the level of the right edge of the iliac sacral joint. The width of the mesentery is different at different levels of its fixation. It reaches its greatest width (up to 15-17 cm) at the border of the upper and middle thirds of the small intestine, as well as at a distance of 20-40 cm to the place where it flows into the large intestine. Thus, from the beginning of the jejunum, the width of its mesentery gradually increases; before the confluence of the ileum into the thick, the width of the mesentery gradually decreases, and near the caecum, the mesentery is completely lost.

There are the following types of mesentery:

1. Mesentery of the small intestine.

2. The mesentery of the appendix is ​​a triangular-shaped plate between the wall of the large pelvis and the appendix.

3. The mesentery of the transverse colon is a wide plate stretching in the transverse direction and, together with the transverse colon, dividing the abdominal cavity into two floors: upper and lower.

4. The mesentery of the sigmoid colon is a duplication of the peritoneum, stretching from the middle of the left iliac fossa to the cape. The average length of its root is 6-8 cm, its free edge is longer, there are also more folds here.

5. Mesentery of the supraampullary part of the rectum. This mesentery is located only within the nadampular part of the rectum, and below, at the level of the second sacral vertebra, it completely disappears. Due to this, most of the rectum, that is, its ampullar part and the anal canal, are completely devoid of mesentery.