Treitz redux: the ligament of Treitz revisited
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.