Abdomen and pelvis

A

Anterior abdominal wall

• surface markings, above the umbilicus

The solid white line indicates the costal margin. The blue line indicates the transpyloric plane. The C-shaped duodenum is outlined in pink, the kidneys and liver in brown and the pancreas in pale green.

• 1

  Aortic opening in diaphragm

• 2

  Apex of heart in left fifth intercostal space

• 3

  Dome of diaphragm and upper margin of liver

• 4

  Foramen for inferior vena cava in diaphragm

• 5

  Fundus of gall bladder, and junction of ninth costal cartilage and lateral border of rectus sheath

• 6

  Head of pancreas and level of second lumbar vertebra

• 7

  Hilum of left kidney

• 8

  Hilum of right kidney

• 9

  Oesophageal opening in diaphragm

• 10

  Transpyloric plane

• 11

  Xiphoid process

B

Regions of the abdomen

The abdomen may be divided into regions by two vertical and two horizontal lines. The vertical lines (VL) pass through the midinguinal points: the upper horizontal line corresponds to the transpyloric plane (TP, A10), the lower line is drawn between the tubercles of the iliac crests (transtubercular plane, TT).

• 1

  Epigastric region

• 2

  Hypogastrium or suprapubic region

• 3

  Left hypochondrium

• 4

  Left iliac region or iliac fossa

• 5

  Left lumbar region

• 6

  Right hypochondrium

• 7

  Right iliac region or iliac fossa

• 8

  Right lumbar region

• 9

  Umbilical region

A

Anterior abdominal wall

• 1

  Anterior cutaneous nerve (eighth intercostal)

• 2

  Anterior cutaneous nerve (tenth intercostal)

• 3

  Anterior layer internal oblique aponeurosis

• 4

  External oblique aponeurosis

• 5

  External oblique muscle

• 6

  Ilioinguinal nerve

• 7

  Iliotibial tract

• 8

  Linea alba

• 9

  Linea semilunaris

• 10

  Mons pubis

• 11

  Pectoralis major, abdominal part

• 12

  Posterior layer internal oblique aponeurosis

• 13

  Pyramidalis muscle

• 14

  Rectus abdominis

• 15

  Rectus sheath, anterior

• 16

  Round ligament of uterus

• 17

  Serratus anterior muscle

• 18

  Superficial inguinal lymph node (horizontal group)

• 19

  Superficial inguinal lymph node (vertical group)

• 20

  Superficial inguinal ring

• 21

  Superficial inguinal veins

• 22

  Tendinous intersection of rectus abdominis

• 23

  Umbilicus

B

Rectus sheath

• 1

  Anterior cutaneous nerve (tenth intercostal)

• 2

  Anterior layer of internal oblique aponeurosis

• 3

  Anterior wall of rectus sheath

• 4

  Eighth rib

• 5

  External oblique aponeurosis

• 6

  External oblique muscle

• 7

  Ilioinguinal nerve

• 8

  Inferior epigastric vessels

• 9

  Internal oblique aponeurosis

• 10

  Internal oblique muscle

• 11

  Linea alba

• 12

  Mons pubis

• 13

  Posterior wall of rectus sheath

• 14

  Rectus abdominis

• 15

  Rectus abdominis, reflected

• 16

  Round ligament of uterus

• 17

  Superficial inguinal lymph nodes

• 18

  Tendinous intersection

• 19

  Transversus abdominis

• 20

  Umbilicus

Groin in the male

• 1

  Anterior cutaneous nerve (eleventh intercostal)

• 2

  Anterior cutaneous nerve (twelfth intercostal)

• 3

  Anterior rectus sheath (cut edge)

• 4

  Ductus (vas) deferens

• 5

  External oblique aponeurosis

• 6

  Femoral artery

• 7

  Femoral nerve

• 8

  Femoral vein

• 9

  Great saphenous vein

• 10

  Hernial sac (indirect)

• 11

  Iliacus muscle

• 12

  Ilioinguinal nerve

• 13

  Internal oblique muscle

• 14

  Lateral circumflex femoral artery

• 15

  Linea alba

• 16

  Linea semilunaris

• 17

  Lymphatic vessels

• 18

  Rectus abdominis muscle

• 19

  Sartorius muscle

• 20

  Scrotal venous connections

• 21

  Spermatic cord

• 22

  Superficial inguinal lymph node

• 23

  Suspensory ligament of penis

• 24

  Umbilicus

Laparoscopic view of upper abdominal cavity

Laparoscopic view of lower abdominal cavity

• 1

  Caecum

• 2

  Diaphragm

• 3

  Falciform ligament

• 4

  Greater omentum

• 5

  Ileum

• 6

  Right lobe, liver

• 7

  Transverse colon

Adult anterior abdominal wall in the male

• surface markings, right iliac fossa

The caecum with the appendix opening into it from the left and the ascending colon continuing upwards from it are indicated by the brown line. The inguinal ligament, between the anterior superior iliac spine (1) and the pubic tubercle (13), is indicated by the light blue line. The femoral artery (4) has the femoral vein (7) on its medial side and the femoral nerve (6) on its lateral side. The femoral canal (5) is on the medial side of the vein. The deep inguinal ring (3) and inferior epigastric vessels (9) are above the femoral artery, while the superficial inguinal ring (14) is above and lateral to the pubic tubercle (13). McBurney's point (11) is a site on the surface of the anterior abdominal wall indicating the usual location of the base of the appendix internally. It lies one-third of the way along a line from the right anterior superior iliac spine to the umbilicus (red line).

• 1

  Anterior superior iliac spine

• 2

  Bifurcation of aorta (fourth lumbar vertebra)

• 3

  Deep inguinal ring

• 4

  Femoral artery

• 5

  Femoral canal

• 6

  Femoral nerve

• 7

  Femoral vein

• 8

  Iliac crest

• 9

  Inferior epigastric vessels

• 10

  Lower end of inferior vena cava (fifth lumbar vertebra)

• 11

  McBurney's point

• 12

  Pubic symphysis

• 13

  Pubic tubercle

• 14

  Superficial inguinal ring

• 15

  Tubercle of iliac crest

A

Adult anterior abdominal wall

• umbilical folds, from behind

This view of the peritoneal surface of the central region of the anterior abdominal wall shows the peritoneal folds raised by underlying structures. There is one fold above the umbilicus – the falciform ligament – and there are five below it: the median umbilical fold (7) in the midline, and a pair of medial and lateral umbilical folds on each side (6 and 4).

• 1

  Arcuate line

• 2

  Falciform ligament

• 3

  Inguinal triangle (Hesselbach)

• 4

  Lateral umbilical fold which contains the inferior epigastric vessels

• 5

  Linea semilunaris

• 6

  Medial umbilical ligament

• 7

  Median umbilical ligament

• 8

  Umbilicus

B

Foetal anterior abdominal wall

• from behind

In this at term foetus, the peritoneum and extraperitoneal tissues have been removed from the anterior abdominal wall to show the umbilical arteries (9) and left umbilical vein (6) converging at the back of the (unlabelled) umbilicus.

• 1

  Deep inguinal ring

• 2

  Diaphragm

• 3

  External oblique muscle

• 4

  Falciform ligament

• 5

  Inferior epigastric vessels

• 6

  Internal oblique muscle

• 7

  Left umbilical vein

• 8

  Rectus abdominis muscle

• 9

  Rectus sheath (posterior layer)

• 10

  Testis (undescended)

• 11

  Transversus abdominis muscle

• 12

  Urachus

• 13

  Umbilical arteries

• 14

  Urinary bladder

A

Right deep inguinal ring in adult male

• laparoscopic view

  
  

B

Anterior abdominal wall

• abdominal view

  
  

Abdominal viscera have been removed and the anterior abdominal wall detached laterally and reflected anteriorly and inferiorly to reveal the internal surface of the abdominal wall. The parietal peritoneum has been removed from the left side to show deeper structures in the pelvic and abdominal walls.

• 1

  Accessory obturator artery

• 2

  Bladder

• 3

  Deep inguinal ring

• 4

  External iliac artery

• 5

  External iliac vein

• 6

  Femoral nerve

• 7

  Genitofemoral nerve, femoral branch

• 8

  Genitofemoral nerve, genital branch

• 9

  Iliacus

• 10

  Inferior epigastric vessels

• 11

  Inguinal triangle (Hesselbach)

• 12

  Lateral cutaneous nerve of the thigh

• 13

  Lateral umbilical fold (inferior epigastric vessels)

• 14

  Medial umbilical fold (umbilical artery)

• 15

  Median umbilical fold (urachus)

• 16

  Parietal peritoneum

• 17

  Pelvic brim

• 18

  Posterior surface, rectus sheath

• 19

  Testicular vessels

• 20

  Transversus abdominis

• 21

  Vas/ductus deferens

• 22

  Visceral peritoneum, over bladder

Right inguinal region

• in the male

  
  
  • A

    superficial dissection

  • B

    with the external oblique aponeurosis and spermatic cord incised

In A, the spermatic cord (17) is seen emerging from the superficial inguinal ring (19) and covered by the external spermatic fascia. In B, with the external oblique aponeurosis reflected and the anterior wall of the rectus sheath removed, the cord is emerging from the deep inguinal ring (4) with the cremasteric fascia (2) now the most superficial covering. All three coverings of the cord have been incised (12) to show the ductus/vas deferens (5).

• 1

  Conjoint tendon

• 2

  Cremasteric fascia and cremaster muscle over spermatic cord

• 3

  Cribriform fascia

• 4

  Deep inguinal ring

• 5

  Ductus/vas deferens

• 6

  Edge of rectus sheath

• 7

  External oblique aponeurosis

• 8

  Fascia lata

• 9

  Great saphenous vein

• 10

  Iliohypogastric nerve

• 11

  Ilioinguinal nerve

• 12

  Incised margin of coverings of cord

• 13

  Inguinal ligament

• 14

  Internal oblique

• 15

  Pyramidalis

• 16

  Rectus abdominis

• 17

  Spermatic cord

• 18

  Upper margin of saphenous opening

• 19

  Upper margin of superficial inguinal ring

Right inguinal region

• in the female

The external oblique aponeurosis (2) has been incised and reflected to show the position of the deep inguinal ring (7) which marks the lateral end of the inguinal canal. The round ligament of the uterus (9) emerges from the superficial inguinal ring (8), which marks the medial end of the canal, and becomes lost in the fat of the labium majus (3). The ilioinguinal nerve (5) also passes through the canal and out of the superficial ring.

• 1

  Conjoint tendon

• 2

  External oblique aponeurosis

• 3

  Fat of labium majus

• 4

  Great saphenous vein

• 5

  Ilioinguinal nerve

• 6

  Internal oblique

• 7

  Position of deep inguinal ring

• 8

  Position of superficial inguinal ring

• 9

  Round ligament of uterus

• 10

  Upper surface of inguinal ligament

A

Right deep inguinal ring and inguinal triangle

• internal view

  

This is the view looking into the right half of the pelvis from the left, showing the posterior surface of the lower part of the anterior abdominal wall, above the pubic symphysis. The femoral ring (8), the entrance to the femoral canal, is below the medial end of the inguinal ligament (11). The inferior epigastric vessels (9, 10) lie medial to the deep inguinal ring (4).

B

Left deep inguinal ring in the male

• internal peritoneal (view as seen at laparoscopy)

  

• 1

  Abberant obturator vein

• 2

  Body of pubis

• 3

  Conjoint tendon

• 4

  Deep inguinal ring

• 5

  Ductus/vas deferens

• 6

  External iliac artery

• 7

  External iliac vein

• 8

  Femoral ring

• 9

  Inferior epigastric artery

• 10

  Inferior epigastric vein

• 11

  Inguinal ligament

• 12

  Lacunar ligament

• 13

  Levator ani muscle

• 14

  Medial umbilical fold

• 15

  Medial umbilical ligament

• 16

  Median umbilical ligament

• 17

  Obturator artery

• 18

  Obturator nerve

• 19

  Obturator vein

• 20

  Origin of levator ani from fascia overlying obturator internus muscle

• 21

  Pubic branches of the inferior epigastric vessels

• 22

  Pubic ramus (transected)

• 23

  Rectus abdominis muscle

• 24

  Superior pubic ramus

• 25

  Superior surface of bladder

• 26

  Testicular vessels

• 27

  Transversalis fascia overlying transversus abdominis muscle

Abdominal peritoneal folds

after removal of intra-abdominal organs, to show relations of ligaments and mesenteries

Abdominal viscera

• from the front

  
  

• 1

  Appendices epiploicae

• 2

  Ascending colon

• 3

  Descending colon

• 4

  Falciform ligament

• 5

  Greater omentum

• 6

  Ligamentum teres hepatis (round ligament)

• 7

  Liver

• 8

  Parietal peritoneum on anterior abdominal wall

• 9

  Rectus abdominis muscle, reflected laterally

• 10

  Small intestine

• 11

  Transverse colon

Laparoscopic view of upper abdominal viscera

Abdominal viscera

• from the front

  

• 1

  Appendices epiploicae

• 2

  Ascending colon

• 3

  Descending colon

• 4

  Greater omentum

• 5

  Ligamentum teres hepatis in falciform ligament

• 6

  Liver, left lobe

• 7

  Rectus abdominis muscle, reflected laterally

• 8

  Small intestine

• 9

  Stomach

• 10

  Stomach, greater curvature

• 11

  Transverse colon

Abdominal viscera

• from the front

  
  

• 1

  Appendices epiploicae

• 2

  Ascending colon

• 3

  Descending colon

• 4

  Falciform ligament

• 5

  Ligamentum teres hepatis

• 6

  Liver, right lobe

• 7

  Posterior surface of greater omentum

• 8

  Rectus abdominis muscle, reflected laterally

• 9

  Small intestine (ileum)

• 10

  Small intestine (jejunum)

• 11

  Transverse colon

Laparoscopic view of abdominal viscera

Lesser omentum and epiploic foramen

• A

  from the front

• B

  from the front and the right

• 1

  Descending (second) part of duodenum

• 2

  Diaphragm

• 3

  Epiploic foramen* (Winslow)

• 4

  Falciform ligament

• 5

  Gall bladder

• 6

  Inferior vena cava

• 7

  Left lobe of liver

• 8

  Lesser curvature of stomach

• 9

  Lesser omentum

• 10

  Pericardium

• 11

  Quadrate lobe of liver

• 12

  Right free margin of lesser omentum

• 13

  Right lobe of liver

• 14

  Superior (first) part of duodenum

• 15

  Upper pole of right kidney

In A, a finger* has been placed in the epiploic foramen (3) behind the right free margin of the lesser omentum (12), and the tip can be seen in the lesser sac, through the transparent lesser omentum (9) which stretches between the liver (7) and the lesser curvature of the stomach (8). In the more lateral view in B, looking into the foramen from the right, the foramen (3) is identified between the right free margin of the lesser omentum (12) in front and the inferior vena cava (6) behind, above the first part of the duodenum (14).

Laparoscopic view of lesser omentum (free margin)

A

Upper abdominal viscera

• from the front

  

In this view the stomach, transverse colon (9) and greater omentum (5) have been lifted up to show the region of the duodenojejunal flexure (3).

• 1

  Ascending colon

• 2

  Coils of the small intestine

• 3

  Duodenojejunal flexure

• 4

  Duodenum, first part

• 5

  Greater omentum

• 6

  Jejenum

• 7

  Mesentery

• 8

  Parietal peritoneum on anterior abdominal wall, reflected superiorly

• 9

  Transverse colon, reflected superiorly

• 10

  Transverse mesocolon

B

Lesser sac in upper abdomen

• 1

  Appendices epiploicae

• 2

  Gall bladder

• 3

  Greater omentum, reflected inferiorly

• 4

  Lesser sac (omental bursa)

• 5

  Ligamentum teres hepatis in falciform ligament

• 6

  Parietal peritoneum on anterior abdominal wall

• 7

  Peritoneum of lesser sac overlying pancreas

• 8

  Rectus abdominis muscle, reflected

• 9

  Right and left gastro-epiploic veins

• 10

  Right lobe of the liver

• 11

  Stomach, greater curvature

• 12

  Stomach, posterior surface

• 13

  Transverse colon, reflected inferiorly

• 14

  Transverse mesocolon

Mesentery and colon

• from the front

  
  

• 1

  Appendices epiploicae

• 2

  Appendix

• 3

  Ascending colon

• 4

  Caecum

• 5

  Coils of small intestine

• 6

  Distal ileum

• 7

  Duodenojejunal junction

• 8

  Greater omentum

• 9

  Ileocaecal junction

• 10

  Liver

• 11

  Mesentery of small intestine

• 12

  Mesoappendix

• 13

  Parietal peritoneum on anterior abdominal wall

• 14

  Proximal jejunum

• 15

  Rectus abdominis muscle, reflected

• 16

  Transverse colon

A

Hepatorenal pouch of peritoneum

• from the right and below

  
  

With the body lying on its back and seen from the right, the liver (15) has been turned upwards (towards the left) to open up the gap between the liver and upper pole of the right kidney (18) – the hepatorenal pouch of peritoneum (8, Morison's pouch or the right subhepatic compartment of the peritoneal cavity).

• 1

  Ascending colon

• 2

  Epiploic foramen (Winslow)

• 3

  Falciform ligament

• 4

  Gall bladder

• 5

  Gastroduodenal junction

• 6

  Greater curvature of stomach

• 7

  Greater omentum

• 8

  Hepatorenal (Morison's) pouch

• 9

  Inferior vena cava

• 10

  Left lobe of liver

• 11

  Lesser curvature of stomach

• 12

  Lesser omentum overlying pancreas

• 13

  Right colic (hepatic) flexure

• 14

  Right free margin of lesser omentum

• 15

  Right lobe of liver

• 16

  Superior (first) part of duodenum

• 17

  Transverse colon

• 18

  Upper pole of right kidney

Diagrams of peritoneum

• (see pages 237–242 )

  
  • B

    normal position

  • C

    with the lower part of the greater omentum lifted up

  • D

    with the greater omentum lifted up and separated from the transverse mesocolon and colon, with an opening into the lesser sac

  • E

    with the greater omentum and transverse mesocolon and colon lifted up, with an opening into the lesser sac through the mesocolon

These drawings of a sagittal section through the middle of the abdomen, viewed from the left, illustrate theoretically how the peritoneum forms the lesser omentum (L, passing down to the stomach, S), greater omentum (G), transverse mesocolon (TM) passing to the transverse colon (TC), and the mesentery (M) of the small intestine (SI). The layer in blue represents the peritoneum of the lesser sac. The superior mesenteric artery passes between the head and uncinate process of the pancreas (P and U), and continues across the duodenum (D) into the mesentery (M) to the small intestine (SI), giving off the middle colic artery which runs in the transverse mesocolon (TM) to the transverse colon (TC). The greater omentum (G) is formed by four layers fused together and also fused with the front of the transverse mesocolon (TM, two layers) and transverse colon. On dissection, no separation between any layers is possible except between the greater omentum and the transverse mesocolon. The six layers between the stomach and transverse colon are sometimes collectively known as the gastrocolic omentum. B corresponds to the dissections on pages 237 and 238 , C to page 239 , D to page 241A , and E to page 241B . The small arrows in D and E indicate the layers cut to make artificial openings into the lesser sac.

Coeliac trunk

• 1

  Caudate lobe of liver

• 2

  Coeliac trunk

• 3

  Common hepatic artery

• 4

  Epiploic foramen – arrow

• 5

  Free edge, lesser omentum

• 6

  Gall bladder

• 7

  Gastroduodenal artery

• 8

  Greater curvature of stomach

• 9

  Greater omentum

• 10

  Hepatic artery, proper

• 11

  Left gastric artery

• 12

  Left gastric, anterior branch

• 13

  Left gastric, anterior branch to body of stomach

• 14

  Left gastric, posterior branch

• 15

  Left gastric, posterior branch to lesser curvature of stomach

• 16

  Left gastroepiploic vessels

• 17

  Left portal vein

• 18

  Ligamentum teres hepatis within falciform ligament

• 19

  Liver, left lobe

• 20

  Liver, right lobe

• 21

  Lymph node, enlarged coeliac node

• 22

  Oesophageal branch of left gastric artery

• 23

  Quadrate lobe of liver

• 24

  Right gastric artery, antral branch

• 25

  Splenic artery

• 26

  Stomach, lesser curvature

• 27

  Visceral peritoneum, cut edge

Superior mesenteric vessels, origins

• A

  duodenum and pancreas in situ

• B

  duodenum reflected to reveal posterior relations of vessels

• 1

  Aorta

• 2

  Duodenum reflected and pinned

• 3

  Duodenum, ascending (fourth) part

• 4

  Duodenum, descending (second) part

• 5

  Duodenum, horizontal (third) part

• 6

  Falciform ligament

• 7

  Gall bladder, fundus

• 8

  Inferior mesenteric artery

• 9

  Inferior mesenteric vein

• 10

  Inferior vena cava

• 11

  Jejunum, origin

• 12

  Left gonadal vein

• 13

  Left renal artery

• 14

  Left renal vein

• 15

  Liver, left lobe

• 16

  Liver, Riedel's lobe

• 17

  Liver, right lobe

• 18

  Lymph nodes, moderately enlarged pre- and para-aortic

• 19

  Pancreas, body

• 20

  Pancreas, head

• 21

  Pancreas, tail

• 22

  Pancreas, uncinate process

• 23

  Renal cyst, benign

• 24

  Right gonadal vein

• 25

  Spleen

• 26

  Splenic artery

• 27

  Splenic vein

• 28

  Subcostal nerve

• 29

  Superior mesenteric artery

• 30

  Superior mesenteric vein

• 31

  Ureter

Coeliac trunk, upper abdomen

• detailed dissection

  

The stomach has been sectioned to expose the dissected liver, biliary tree, pancreas, duodenum, and superior mesenteric vessels lying posterior to the stomach bed.

• 1

  Common hepatic artery

• 2

  Cystic artery

• 3

  Cystic duct

• 4

  Duodenum

• 5

  Gall bladder

• 6

  Gastroduodenal artery

• 7

  Hepatopancreatic ampulla

• 8

  Left gastric artery

• 9

  Left gastroepiploic artery

• 10

  Left gastroepiploic vein

• 11

  Left hepatic artery

• 12

  Left hepatic duct

• 13

  Oesophagus

• 14

  Pancreatic duct

• 15

  Portal vein

• 16

  Proper hepatic artery

• 17

  Pylorus

• 18

  Caudate lobe (liver)

• 19

  Right gastric artery

• 20

  Right hepatic artery

• 21

  Right hepatic duct

• 22

  Stomach

• 23

  Superior mesenteric vein

• 24

  Transverse colon

Coeliac trunk, upper abdomen

• detailed dissection

  

• 1

  (Common) bile duct

• 2

  Caudate lobe of liver

• 3

  Cut edge of the liver

• 4

  Cystic duct

• 5

  Fundus of gallbladder

• 6

  Gastroduodenal artery

• 7

  Greater curvature of stomach

• 8

  Greater omentum

• 9

  Left and right hepatic artery

• 10

  Left and right hepatic duct

• 11

  Left gastric artery

• 12

  Lesser curvature of stomach

• 13

  Pancreas

• 14

  Parietal peritoneum on anterior abdominal wall, reflected laterally

• 15

  Proper hepatic artery

• 16

  Gastroepiploic artery

• 17

  Gastroepiploic vein

• 18

  Transverse colon

Superior mesenteric vessels

• 1

  Third part of the duodenum

• 2

  Anastomotic arcades

• 3

  Appendicular artery

• 4

  Appendix

• 5

  Ascending colon

• 6

  Caecum

• 7

  Greater omentum

• 8

  Ileocaecal junction

• 9

  Ileocolic artery

• 10

  Ileocolic vein

• 11

  Ileum

• 12

  Jejunal artery

• 13

  Jejunal vein

• 14

  Jejunum

• 15

  Mesentery of the ileum

• 16

  Middle colic artery

• 17

  Right colic artery

• 18

  Straight arteries

• 19

  Superior mesenteric vein

• 20

  Transverse colon

Inferior mesenteric vessels

• from the front

  
  

• 1

  Abdominal aorta

• 2

  Descending colon

• 3

  Greater omentum

• 4

  Ileum and jejunum

• 5

  Inferior mesenteric artery

• 6

  Left colic artery

• 7

  Left common iliac artery

• 8

  Marginal artery

• 9

  Transverse abdominis

• 10

  Renal artery

• 11

  Renal vein

• 12

  Right common iliac artery

• 13

  Left kidney

• 14

  Sigmoid arteries

• 15

  Spleen

• 16

  Superior hypogastric plexus

• 17

  Superior rectal artery

• 18

  Superior rectal vein

• 19

  Transverse colon

A

Small bowel radiograph

• enema via a tube in the proximal jejunum Enteroclysis

  

• 1

  Loops of ileum

• 2

  Loops of jejunum

• 3

  Descending (second) part of duodenum

• 4

  Stomach

• 5

  Plicae circulares

B

Double-contrast

• Barium enema

In this double-contrast barium enema (barium and air), the sacculations (haustrations, 9) of the various parts of the colon allow it to be distinguished from the narrower terminal ileum (11), which has become partly filled by barium flowing into it through this incompetent ileocaecal junction (5).

• 1

  Ascending colon

• 2

  Caecum

• 3

  Descending colon

• 4

  Hip joint

• 5

  Ileocaecal junction

• 6

  Left colic (splenic) flexure

• 7

  Rectum

• 8

  Right colic (hepatic) flexure

• 9

  Sacculations

• 10

  Sigmoid colon

• 11

  Terminal ileum

• 12

  Transverse colon

C

3D scout scan from CT cologram