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DUODENUM
The first & shortest part of SI, is also the widest & most fixed part
Pursues a C shaped course around the head of pancreas
Begins at the pylorus on the right side & ends at the duodenojejunal flexure (junction)
on the left side
Divisible into 4 parts:
i. Superior
Ascends from the pylorus & is overlapped by the liver & gallbladder
Proximal part has the hepatoduodenal ligament attached superiorly & the greater
omentum attached inferiorly
ii. Descending
Runs inferiorly, curving around the head of pancreas
Bile & main pancreatic ducts enter its posteromedial wall, usually unite to form the
hepatopancreatic ampulla, which opens on an eminence called major duodenal
papilla
Entirely retroperitoneal
iii. Inferior
Runs transversely to the left, passing over the IVC, aorta & L3 vertebra
Crossed by the SMA & SMV and root of the mesentery of jejunum and ileum
Superior to it is the head of pancreas & uncinate process
iv. Ascending
Runs superiorly & along the left side of the aorta to reach the inferior border of the
body of pancreas
Then it curves anteriorly to join the jejunum at the duodenojejunal flexure, supported
by attachment of a suspensory muscle of the duodenum (ligament of Treitz)
o Contraction of this muscle, widens the angle of the duodenojejunal flexure,
facilitating movement of the intestinal contents
First 2 cm of superior part, has a mesentery & is mobile which called ampulla (duodenal
cap)
Distal 3 cm of superior part & other 3 parts have no mesentery and are immobile because
they are retroperitoneal
Innervation:
Sympathetic fibers reach the superior mesenteric nerve plexus through
sympathetic trunks & thoracic abdominopelvic splanchnic nerves
Parasympathetic fibers derived from posterior vagal trunks