Abdominal Imaging

, Volume 20, Issue 5, pp 421–424 | Cite as

Treitz redux: the ligament of Treitz revisited

  • M. A. Meyers
Article

Abstract

In the medical literature, the ligament of Treitz is frequently used as a term to designate the duodenojejunal flexure, but the attributes of the structure itself are not generally known. Indeed, anatomists describe it as the suspensory muscle of the duodenum, arising from the connective tissue around the stems of the celiac and superior mesenteric arteries and inserting as nonstriated muscle commonly into the third and fourth portions of the duodenum and frequently into the duodenojejunal flexure as well. Misconceptions regarding its configuration and anatomic relationships continue to be widely illustrated. The fibromuscular structure plays an important role in the embryologic rotation of the bowel and in facilitating normal progression of contents from the extraperitoneal duodenum to the mesenteric small bowel and contributes to the effects of the superior mesenteric artery syndrome. Whereas virtually all other ligaments and mesenteries in the abdomen have been imaged, features of the ligament of Treitz render its visualization by CT or MRI challenging.

Key words

Ligament of Treitz Suspensory muscle of the duodenum 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Treitz W. Uber Einen Neven Muskel Am Duodenum.Vjschr prakt Heilk (Prague) 1853;37:113–144Google Scholar
  2. 2.
    Meyers MA.Dynamic radiology of the abdomen: normal and pathologic anatomy, 4th ed. New York: Springer-Verlag, 1994Google Scholar
  3. 3.
    Crymble PT. The muscle of Treitz and the plica duodeno-jejunalis.Br Med J 1910;2:1156–1159Google Scholar
  4. 4.
    Low A. A note on the crura of the diaphragm and the muscle of Treitz.J Anat Physical 1908;42:93–96Google Scholar
  5. 5.
    Meschan I.An atlas of anatomy basic to radiology. Philadelphia: WB Saunders, 1975Google Scholar
  6. 6.
    Romanes GJ.Cunningham's manual of practical anatomy, vol. 2: Thorax and abdomen. Oxford: Oxford University Press. 1986Google Scholar
  7. 7.
    Sobotta. Atlas of human anatomy. In: Staubesand J, ed.Thorax, abdomen, pelvis, lower limbs, vol. 2, 11th English ed. Baltimore: Urban and Schwarzenberg. 1990Google Scholar
  8. 8.
    Argeme M, Mambrin A, Lebreuil G, Guerninel G. Dissection du muscle de Treitz.CR Ass Anat 1970;147:76–86Google Scholar
  9. 9.
    Costacurta L. Anatomical and functional aspects of the human suspensory muscle of the duodenum.Acta Anatom 1972;82:34–46Google Scholar
  10. 10.
    Jit I, Grewal SS. The suspensory muscle of the duodenum and its nerve supply.J Anat 1977;123:397–405Google Scholar
  11. 11.
    Haley JC, Perry JH. Further study of the suspensory muscle of the duodenum.Am J Surg 1949;77:590–595Google Scholar
  12. 12.
    Uchikura R, Harada T, Shirahama T. On the suspensory muscle of duodenum [in Japanese].Med J Kagoshima Univ 1965;16:787–791Google Scholar
  13. 13.
    Repciuce, Campeanu R. The suspensory muscle of the duodenum.Morphol Embryol 1981;27:123–126Google Scholar
  14. 14.
    van der Zypen E, Revesz E. Investigation of development, structure and function of the phrenicocolic and duodenal suspensory ligaments.Acta Anatom 1984;119:142–148Google Scholar
  15. 15.
    Jit I. The development and the structure of the suspensory muscle of the duodenum.Anat Rec 1952;113:395–407Google Scholar
  16. 16.
    Netter FH.Digestive system, vol. 3: Upper digestive tract, part I. The Ciba Collection of Medical Illustrations, 1989Google Scholar
  17. 17.
    Hollinshead WH, Rosse C.Textbook of anatomy, 4th ed. Philadelphia: Harper & Row. 1985Google Scholar
  18. 18.
    Schey SL, Donaldson JS, Sty JR. Malrotation of bowel: variable patterns with different surgical considerations.J Pediatr Surg 1993;28:96–101Google Scholar
  19. 19.
    Friedman SM. The position and mobility of the duodenum in the living subject.Am J Anat 1946;79:147–165Google Scholar
  20. 20.
    Cantor MO. The ligament of Treitz as a barrier to intestinal intubation: a clinical and anatomic study.Surgery 1949;26:673–681Google Scholar
  21. 21.
    Hamilton WJ, Mossman HW.Human embryology: prenatal development of form and function, 4th ed. Cambridge: Heffer & Sons/Baltimore: Williams & Wilkins. 1972Google Scholar
  22. 22.
    Akin JT Jr, Gray SW, Skandalakis JE. Vascular compression of the duodenum: presentation of ten cases and review of the literature.Surgery 1976;79:515–522Google Scholar
  23. 23.
    Kalouche I, Leturgie C, Trone F, Bokobza B, Michot F, Pons P, Menard G. Le syndrome de la pince mesenterique. A propos d'une observation et revue de la literature.Ann Chirurg 1991;45:609–612Google Scholar
  24. 24.
    Haley JC, Peden JK. The suspensory muscle of the duodenum.Am J Surg 1943;59:546–550Google Scholar
  25. 25.
    Chou C-K, Liu G-C, Chen L-T. MRI demonstration of peritoneal ligaments and mesenteries.Abdom Imaging 1993;18: 126–130Google Scholar
  26. 26.
    Gambarelli J, Guerinel, Chevrot L, Mattei M.Computerized axial tomography: an anatomical atlas of serial sections of the human body. Berlin: Springer-Verlag. 1977Google Scholar
  27. 27.
    Christofordis AJ.Atlas of axial, sagittal, and coronal anatomy with CT and MRI. Philadelphia: WB Saunders. 1988Google Scholar
  28. 28.
    El-Khury GY, Bergman RA, Montgomery WJ.Sectional anatomy by MRI/CT. New York: Churchill Livingstone. 1990Google Scholar
  29. 29.
    Chacko AK, Katzberg RW, Mackay A.MRI atlas of normal anatomy. New York: McGraw-Hill. 1991Google Scholar
  30. 30.
    Cahill DR, Orland MJ, Reading CC.Atlas of human cross-sectional anatomy with CT and MR images, 2nd ed. New York: Wiley-Liss. 1990Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1995

Authors and Affiliations

  • M. A. Meyers
    • 1
  1. 1.Department of RadiologyHSC, Level 4, Room 092, State University of New YorkStony BrookUSA

Personalised recommendations