Duodenum
Adeena Saher
Overview and Anatomy
Definition and Location
Shortest, widest, and most fixed part of the small intestine.
Extends from the pylorus to the duodenojejunal flexure.
Forms a "C" shape around the head of the pancreas.
Located above the umbilicus at the level of the L1-L3
vertebrae.
Length, Parts, and Peritoneal Relations
length: 25 cm;
divided into four parts:
1. First (superior): 5 cm (2 inches).
2. Second (descending): 7.5 cm (3 inches)
.3. Third (horizontal): 10 cm (4 inches).
4. Fourth (ascending): 2.5 cm (1 inch).
Peritoneal relations:
Mostly retroperitoneal and fixed.
Movable at its ends, where it is attached
by peritoneal folds.
First Part (Superior)
Course:
Begins at the pylorus, moves upward, backward, and to the
right.
Peritoneal relations:
Proximal 2.5 cm is movable; attached to lesser and greater
omentum.
Distal 2.5 cm is retroperitoneal and covered anteriorly.
Visceral relations:
Anterior: Liver (quadrate lobe) and gallbladder.
Posterior: Gastroduodenal artery, bile duct, portal vein.
Superior: Epiploic foramen.
Inferior: Head and neck of the pancreas.
Second Part (Descending)Course:
7.5 cm long;
runs from superior to inferior duodenal flexures.
Peritoneal relations:
Retroperitoneal, covered anteriorly except at the middle
(related to the colon).
Visceral relations:
Anterior: Liver, transverse colon, root of transverse
mesocolon, small intestine.
Posterior: Right kidney, right ureter.
Special features:Major duodenal papilla (opening of
hepatopancreatic ampulla).Minor duodenal papilla (opening
of accessory pancreatic duct).
Third Part (Horizontal)
Course: 10 cm;
crosses horizontally in front of the inferior vena cava and
ends at the fourth part
Peritoneal relations:
Retroperitoneal; anterior surface partly covered by
peritoneum.
Fourth Part (Ascending)Course
Fourth Part (Ascending)
Course: 2.5 cm;
runs upwards and ends at the duodenojejunal flexure.
Peritoneal relations: Mostly retroperitoneal; terminal part is
mobile.
Visceral relations:
Anterior: Transverse colon, mesocolon, lesser sac, stomach.
Posterior: Left renal artery, gonadal artery, sympathetic chain.
To the right: Root of mesentery.
To the left: Kidney and ureter.
Superior: Body of pancreas
Suspensory Muscle of Duodenum
(Ligament of Treitz)Fibromuscular
Suspensory Muscle of Duodenum (Ligament of Treitz)
Fibromuscular band suspending the duodenojejunal flexure.
Made up of striped muscle, elastic fibers, and smooth
muscle.
Functions: Supports flexure and regulates its angle.
Blood Supply Arteries:
Blood Supply Arteries:
Proximal duodenum: Superior pancreaticoduodenal artery.
Distal duodenum: Inferior pancreaticoduodenal artery.
Other branches: Right gastric artery, supraduodenal artery,
retroduodenal branches, right gastroepiploic artery
Veins: Drain into splenic, superior mesenteric, and portal veins.
Lymphatic Drainage
Drains into pancreaticoduodenal, pyloric, hepatic, coeliac,
and superior mesenteric nodes.
Nerve Supply
Sympathetic (T9-T10) and parasympathetic (vagus) via
coeliac plexus.
Common issues:
Peptic ulcers (frequent in the first part).
Duodenal diverticula along concave border
Congenital stenosis or obstruction
Annular pancreas or superior mesenteric artery syndrome.
Diagnostic imaging:
Barium meal reveals duodenal cap in the first part.
Neoplasms:
Duodenal carcinoma.
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