Abstract
To investigate the factors affecting the development of the ligament of Treitz, we examined sagittal and frontal histological sections of 35 human fetuses with a crown-rump length of 100–300 mm (approximately 16–38 weeks of gestation). The retropancreatic fascia consistently extended in a layer behind the pancreatic body and the splenic artery and vein, and also in front of the left renal vein and left adrenal. In 18 specimens, a connective tissue band was seen originating from the diaphragmatic crus around the esophageal opening and ending at the retropancreatic fascia to the left of the origin of the celiac artery. In 10 of these 18 specimens, these putative upper parts of the ligament contained striated muscles, or so-called Hilfsmuskel. Although most of other 17 specimens were larger fetuses, the left adrenal, the liver caudate lobe and the celiac ganglion made space for the ligament very limited. In 22 specimens including the above 18, the retropancreatic fascia extended inferiorly to approach the fourth portion of the duodenum (D4) or the duodenojejunal junction (DJJ). However, in 11 of the 22 examples of the putative lower part of the ligament, the connection between the duodenal muscle coat and the fascia was interrupted by developing lymphatic tissues. Consequently, the ligament of Treitz seemed to develop from both pleuroperitoneal membrane-derived cells and the retropancreatic fusion fascia, although the morphology was markedly modified by adjacent structures such as the adrenal gland. The ligament may “recover” after the adrenal becomes reduced in size after birth.
Similar content being viewed by others
References
Androulakis J, Colbom GL, Skandalakis PM, Skandalakis LJ, Skanadalakis JE (2000) Embryologic and anatomic basis of duodenal surgery. Surg Clin N Am 80:171–199
Borghi F, Gattolin A, Bogliatto F, Garavoglia M, Levi AC (2002) Relationships between gastric development and anatomic bases of radical surgery for cancer. World J Surg 26:1139–1144
Cho BH, Kimura W, Song CH, Fujimiya M, Murakami G (2009) An investigation of the embryologic development of the fascia used as the basis for pancreaticoduodenal mobilization. J Hepatobiliary Pancreat Surg 16:824–831
Costacurta L (1972) Anatomical and functional aspects of the human suspensory muscle of the duodenum. Acta Anat 32:34–46
Deki H, Sato T (1988) An anatomic study of the pancreatic lymphatics. Surg Radiol Anat 10:121–135
Haley JC, Perry JH (1943) The suspensory muscle of the duodenum. Am J Surg 59:546–550
Haley JC, Perry JH (1949) Further study of the suspensory muscle of the duodenum. Am J Surg 77:590–595
Hamilton WJ, Mossman HW (1978) Human embryology, 4th edn. MacMillan Press, London, p 339 (351–352)
Hayashi S, Rodríguez-Vázquez JF, Cho BH, Verdugo-López S, Murakami G, Nakano T (2011) Pleuroperitoneal canal closure and fetal adrenal gland. Anat Rec 294:633–644
Hwang SE, Cho BH, Hirai I, Kim HT, Kim JH, Fujimiya M, Murakami G, Kimura W (2010) Topographical anatomy of Spiegel’s lobe and its adjacent organs in mid-term fetuses: its implication on the development of the lesser sac and adult morphology of the upper abdomen. Clin Anat 23:712–719
Inoue Y (1936) Über das Lymphgefässyetem des Magens, Duodenums, Pankreas und des Zwerchfells. Acta Anat Nippon 9:35–117 (In Japanese with German abstract)
Jin ZW, Nakamura T, Yu HC, Kimura W, Murakami G, Cho BH (2010) Fetal anatomy of peripheral lymphatic vessels: a D2–40 immunohistochemical study using an 18-week human fetus (CRL 155 mm). J Anat 216:671–682
Jin ZW, Cho BH, Murakami G, Fujimiya M, Kimura W, Yu HC (2010) Fetal development of the retrohepatic inferior vena cava: re-evaluation of the Alexander Barry’s hypothesis. Clin Anat 23:297–303
Jit I (1952) The development and the structure of the suspensory muscle of the duodenum. Anat Rec 113:395–407
Jit I, Grewal SS (1977) The suspensory muscle of the duodenum and its nerve supply. J Anat 123:397–405
Kim SK, Cho CD, Wojtowycz AR (2008) The ligament of Treitz (the suspensory ligament of the Duodenum): anatomic and radiographic correlation. Abdom Imaging 33:395–397
Kim JH, Han EH, Jin ZW, Lee HK, Fujimiya M, Murakami G, Cho BH (2012) Fetal topographical anatomy of the upper abdominal lymphatics: its specific features in comparison with other abdominopelvic regions. Anat Rec 295:91–104
Low A (1907) A note on the crura of the diaphragm and the muscle of Treitz. J Anat Physiol 42:93–96
Matsubara A, Murakami G, Niikura H, Kinugasa Y, Fujimiya M, Usui T (2009) Development of the human retroperitoneal fasciae. Cells Tissues Organs 190:286–296
Meyers MA (1995) Treitz redux: the ligament of Treitz revisited. Abdom Imaging 20:421–424
Nebot-Cegarra J, Maraculla-Sanz E, Reina-De La Torre F (1999) Factors involved in the “rotation” of the human embryonic stomach around its longitudinal axis: computer-assisted morphometric analysis. J Anat 194:61–69
Treitz W (1853) Uber einem neuren Muskel am Duodenum des Menshen, űber elastische Sehen, und andere anatomische Verhältnisse. Vierteljahsrsschrift fuer die praktische Heilkunde 37:113–144
Van der Zypen E, Révész E (1984) Investigation of development, structure and function of the phrenocolic and duodenal suspensory ligaments. Acta Anat 119:142–148
Acknowledgments
This work was supported by a grant from Marumo Research Foundation for Emergency Medicine in Japan.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yang, J.D., Ishikawa, K., Hwang, H.P. et al. Morphology of the ligament of Treitz likely depends on its fetal topographical relationship with the left adrenal gland and liver caudate lobe as well as the developing lymphatic tissues: a histological study using human fetuses. Surg Radiol Anat 35, 25–38 (2013). https://doi.org/10.1007/s00276-012-0996-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-012-0996-x