THE GREATER OMENTUM

THE GREATER OMENTUM

The greater omentum corresponds to the anterior wall of the upper region of the mesentery . Rutherford Morison called the greater omentum ‘the abdominal policeman’. The greater omentum attempts, often successfully , to limit intraperitoneal infective and other noxious processes. For instance, an acutely inflamed appendix is often found wrapped in omentum, and this saves many patients from developing di ff use peritonitis. The omentum often plugs the neck of a hernial sac and prevents a coil of intestine from entering and becoming strangulated. The omentum can also be a cause of obstruction (acting as a large adhesion). The omentum is usually involved in tuberculous peritonitis and carcinomatosis of the peritoneum. The mesoappendix arises from the posterior aspect of the ileocaecal region of the mesentery ( Figure 65.18 a result, it often occupies a retrocaecal position, as does the adjoining appendix. The position of the mesoappendix is thus a determinant of the symptoms and signs associated with acute appendicitis (see Chapter 76 ). A Meckel’s diverticulum (see Chapter 74 ) resembles the appendix in that it comprises an intestinal diverticulum at the periphery of a flange of mesentery . The latter arises from a nearby small intestinal region of mesentery . The bloodless fold of Treves, a flange of mesentery at the antimesenteric side of the ileum just proximal to the ileocaecal valve, is a mesenteric remnant that arises after di ff erentiation of the intestine at that level. James Rutherford Morison , 1853–1939, Professor of Surgery , University of Durham, Durham, UK. Sir Fredrick Treves , 1853–1923, surgeon, the London Hospital, London, UK, renowned for operating on King Edward VII for appendicitis, resulting in the postponement of the coronation and his care for Joseph Merrick, the ‘elephant man’. Carl T oldt , 1840–1920, Professor of Anatomy in Prague, the former Czechoslovakia, and later Vienna, Austria. Wilhelm von Waldeyer-Hartz , 1836–1921, Professor of Anatomy , Berlin, Germany . Charles-Pierre Denonvilliers , 1808–1872, Professor of Surgery and Anatomy , Paris, France. Dimitrie Gerota , 1867–1939, Professor of Surgical Anatomy , Bucharest, Romania. Pierre Fredet , 1870–1946, surgeon, Paris, France.

Mesoappendix Ileocaecal Mesoappendix mesentery Mesenteric principles of gastrointestinal