Corpus: Omental bursa

The bursa omentalis is a recess (fissure-shaped displacement space) of the peritoneal cavity (cavitas peritonealis).

The bursa omentalis lies dorsal to the omentum minus and the stomach. The aorta and the inferior vena cava run along the posterior surface of the omental bursa. The pancreas can be seen at its base as the omental tuberosity. The spleen is located to the left of the omental bursa, while the liver borders it on the right.

Borders[Bearbeiten]

• Anterior: Lobus quadratus of the liver, omentum minus, stomach, ligamentum gastrocolicum
• Lateral: gastrosplenic ligament, spleen, phrenicosplenic ligament
• Posterior: left kidney and adrenal gland, pancreas
• Inferior: Mesocolon transversum, colon transversum^[1]
• Superior: liver

Pockets (recessus)[Bearbeiten]

The bursa forms 3 pockets or protrusions:

• Superior recessus: the cranial bulge of the bursa, here the bursa omentalis pushes between the inferior vena cava and oesophagus. Here it has a direct positional relationship to the pars lumbalis of the diaphragm.
• Recessus inferior: The caudal pocket of the bursa lies between the stomach and the transverse colon. Here the omental bursa extends caudally to the transverse mesocolon. The anterior border of the inferior recess is formed by the gastrocolic ligament.
• Recessus splenicus: bulge on the left side of the bursa that extends to the spleen. It is bounded by the gastrosplenic ligament and the splenorenal ligament.

Folds (plicae)[Bearbeiten]

• Plica gastropancreatica: The arteria gastrica sinistra, which runs from the cardia of the stomach towards the pancreas, raises a fold in the median plane in the bursa omentalis. This plica gastropancreatica separates the bursa from its anterior space on the right, the vestibulum bursae omentalis.
• Plica hepatopancreatica: This fold on the back wall of the bursa is raised by the common hepatic artery.

Foramen epiploicum[Bearbeiten]

The only natural entrance into the bursa omentalis is via the foramen epiploicum (Winslowi), which is also called the foramen omentale. The boundaries of the foramen are:

• Dorsal: primary peritoneum (in front of the inferior vena cava)
• Ventral: hepatoduodenal ligament (part of the omentum minus)
• Cranial: Processus caudatus hepatis
• Caudal: Pars superior duodeni

Normally the bursa is a small cleft space, but it can acutely hold large amounts of fluid. This is of particular interest in cases of haemorrhage, e.g. in the context of a perforated gastric ulcer. The topography is important in pancreatic surgery, as the bursa is the access route to the pancreas:

• Antecolic approach: transection of the gastrocolic ligament
• Colic approach: transection of the transverse mesocolon
• Access via the omentum minus
• Access via the gastrocolic ligament

Attention must be paid to vessels in these peritoneal duplicates. The antecolic approach is the access route that is usually chosen. Here, special attention must be paid to the vascular arch at the large curvature of the stomach (gastroomental or gastroepiploic vessels in the gastrocolic ligament)

• Waschke et al. Anatomy. The textbook. 2nd ed. (2019). Munich: Elsevier, Urban & Fischer (Sobotta Textbook)
• Wessling et al Peritoneal and retroperitoneal anatomy for radiologists, Radiologie up2date, Georg Thieme Verlag KG, 2020