Answer to Tricky Treitz
Correct answer is D. The Ligament of Treitz (LoT) is a fold of peritoneum suspending the duodenojejunal flexure from the retroperitoneum. It attaches to the posterior aspect of the 4th part of the Duodenum. The image is that of the abdominal content after it was removed from the cadaver and now viewed from behind. The 4th part of the Duodenum can be distinguished by its ascending course, as well as it being to the right (in the anatomical position) of the superior mesenteric artery and vein.The LoT is often used as a landmark in HPB, Trauma, and emergency abdominal surgery to identify the parts and directionality of the small bowel. It is identified by elevating the transverse colon. Interestingly, in patients with midgut volvulus/malrotation, the LoT may be on the right side.
= 1st part of duodenum
= 2nd part of duodenum
= 3rd/4th part of duodenum
= Rectum
= Esophagus
Answer to this question is based on material presented in lectures 7 of the Abdomen Lecture Series.
