Omental bursa

On the posterior abdominal wall the peritoneum of the general cavity is continuous with that of the Omental Bursa (bursa omentalis; lesser peritoneal sac) in front of the inferior vena cava.

Starting from here, the bursa may be traced across the aorta and over the medial part of the front of the left kidney and diaphragm to the hilus of the spleen as the anterior layer of the phrenicolienal ligament. From the spleen it is reflected to the stomach as the posterior layer of the gastrosplenic ligament. It covers the postero-inferior surfaces of the stomach and commencement of the duodenum, and extends upward to the liver as the posterior layer of the lesser omentum; the right margin of this layer is continuous around the hepatic artery, bile duct, and portal vein, with the wall of the general cavity.

The epiploic foramen (foramen epiploicum; foramen of Winslow) is the passage of communication between the general cavity and the omental bursa. It is bounded in front by the free border of the lesser omentum, with the common bile duct, hepatic artery, and portal vein between its two layers; behind by the peritoneum covering the inferior vena cava; above by the peritoneum on the caudate process of the liver, and below by the peritoneum covering the commencement of the duodenum and the hepatic artery, the latter passing forward below the foramen before ascending between the two layers of the lesser omentum.

The boundaries of the omental bursa will now be evident. It is bounded in front, from above downward, by the caudate lobe of the liver, the lesser omentum, the stomach, and the anterior two layers of the greater omentum. Behind, it is limited, from below upward, by the two posterior layers of the greater omentum, the transverse colon, and the ascending layer of the transverse mesocolon, the upper surface of the pancreas, the left suprarenal gland, and the upper end of the left kidney. To the right of the esophageal opening of the stomach it is formed by that part of the diaphragm which supports the caudate lobe of the liver. Laterally, the bursa extends from the epiploic foramen to the spleen, where it is limited by the phrenicolienal and gastrolienal ligaments.

The omental bursa, therefore, consists of a series of pouches or recesses to which the following terms are applied:

• (1) the vestibule, a narrow channel continued from the epiploic foramen, over the head of the pancreas to the gastropancreatic fold; this fold extends from the omental tuberosity of the pancreas to the right side of the fundus of the stomach, and contains the left gastric artery and coronary vein;
• (2) the superior omental recess, between the caudate lobe of the liver and the diaphragm;
• (3) the splenic recess (lienal recess), between the spleen and the stomach;
• (4) the inferior omental recess, which comprises the remainder of the bursa.

In the fetus the bursa reaches as low as the free margin of the greater omentum, but in the adult its vertical extent is usually more limited owing to adhesions between the layers of the omentum. During a considerable part of fetal life the transverse colon is suspended from the posterior abdominal wall by a mesentery of its own, the two posterior layers of the greater omentum passing at this stage in front of the colon. This condition occasionally persists throughout life, but as a rule adhesion occurs between the mesentery of the transverse colon and the posterior layer of the greater omentum, with the result that the colon appears to receive its peritoneal covering by the splitting of the two posterior layers of the latter fold. In the adult the omental bursa intervenes between the stomach and the structures on which that viscus lies, and performs therefore the functions of a serous bursa for the stomach.