PERITONEAL CAVITY- LESSEER SAC & GREATER SAC
| A | Caudate lobe of liver | |
| B |
Inferior vena cava |
|
| C |
Free border of lesser omentum |
|
| D |
4th part of Duodenum |
The boundaries of the interconnection between greater sac and lesser sac of peritoneum known as ‘Foramen of Winslow’ are all, EXCEPT:
| A |
Caudate lobe of liver |
|
| B |
Inferior vena cava |
|
| C |
Free border of lesser omentum |
|
| D |
4th part of Duodenum |
Interconnection between greater sac and lesser sac of peritoneum is known as Foramen of Winslow. It has the following boundaries:
Superior boundary: Caudate lobe of liver
Anterior boundary: Free edge of lesser omentum containing common bile duct, hepatic artery and portal vein.
Inferior boundary: First part of duodenum
Posterior boundary: Inferior vena cava and abdominal aorta
Epiploic foramen provides communication between greater and lesser sacs. The length of the epiploic foramen is:
| A |
5 cm |
|
| B |
6 cm |
|
| C |
4 cm |
|
| D |
3 cm |
True about boundaries of lesser Sac:
| A |
Posteriorly stomach |
|
| B |
Crus of diaphragm anterior |
|
| C |
Spleen anteriorly |
|
| D |
Greater omentum |
D. i.e. Greater omentum
Lesser sac of stomach is bounded by:
| A |
Posterior wall of stomach |
|
| B |
Visceral surface of spleen |
|
| C |
Under surface of liver |
|
| D |
All |
A. i.e. Posterior wall of stomach
– Lesser sac/ Omental bursa is bounded anteriorly by stomach, caudate lobe of liver, lesser omentum & greater omentum (ant. 2 layers); and posteriorly by structures forming stomach bed (i.e. diaphragm, pancreas, spleen etc) & greater omentum (posterior 2 layers)
Lesser sac or omental bursa is the site for abscess formation in posterior perforation of gastric ulcer and internal hernia through epiploic foramen
Omental bursa (lesser sac)A posteriorly perforating ulcer in the pyloric antrum of the stomach is most likely to produce initial localized peritonitis or abscess formation in the following
| A | Omental bursa (lesser sac) | |
| B |
Greater sac |
|
| C |
Right subphrenic space |
|
| D |
Hepato renal space (pouch of Morison) |
Ans. is ‘a’ i.e., Omental bursa
- BDC writes – “The posterior surface of the stomach is related to structures forming the stomach bed, all of which are separated from the stomach by the cavity of the lesser sac.”
- Thus an ulcer on the posterior wall of stomach would perforate into the lesser sac.
- Also remember
- Most perforated ulcers are located on the anterior wall.
- The mortality rate for perforated gastric ulcer is higher than that for duodenal ulcer. This is generally due to the gastric ulcer patients’ more advanced age, increased medical comorbidities, delay in seeking medical attention, and the larger size of gastric ulcers.
| A |
Foramen of winslow |
|
| B |
Foramen of Monro |
|
| C |
Hepatorenal pouch |
|
| D |
Pouch of Douglas |
Epiploic foramen (foramen of winslow or aditus to lesser sac) is a slit-like opening through which lesser sac communicates with greater sac. It is situated at the level of T12 vertebra. Its boundries are :-
- Anterior :- Right free margin of lesser omentum (contains portal vein, hepatic artery proper and bile duct).
- Posterior :- IVC, right suprarenal gland and T12 vertebra.
- Superior :- Caudate lobe of liver.
- Inferior :- 1 part of duodenum and horizontal part of hepatic artery.
