Suspensory muscle of the duodenum
The Suspensory muscle of duodenum or Ligament of Treitz (named after Václav Treitz
Václav Treitz
Václav Treitz was a Czech pathologist who was a native of Hostomice, Bohemia. He studied medicine in Prague, and performed post-graduate studies in Vienna with Joseph Hyrtl...

) connects the duodenum
The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms anterior intestine or proximal intestine may be used instead of duodenum...

 of the small intestines to the diaphragm. It contains a slender band of skeletal muscle from the diaphragm and a fibromuscular band of smooth muscle from the horizontal and ascending parts of the duodenum. When it contracts, the suspensory muscle of the duodenum widens the angle of the duodenojejunal flexure, allowing movement of the intestinal contents.


It arises from the right crus as it passes around the esophagus, continues as connective tissue
Connective tissue
"Connective tissue" is a fibrous tissue. It is one of the four traditional classes of tissues . Connective Tissue is found throughout the body.In fact the whole framework of the skeleton and the different specialized connective tissues from the crown of the head to the toes determine the form of...

 around the stems of the celiac trunk and superior mesenteric artery
Superior mesenteric artery
In human anatomy, the superior mesenteric artery arises from the anterior surface of the abdominal aorta, just inferior to the origin of the celiac trunk, and supplies the intestine from the lower part of the duodenum through two-thirds of the transverse colon, as well as the pancreas.-Location...

 and inserts into the third and fourth portions of the duodenum and frequently into the duodenojejunal (DJ) flexure (between the duodenum and the jejunum
The jejunum is the middle section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms middle intestine or mid-gut may be used instead of jejunum.The jejunum lies between the duodenum...

) as well.

Clinical significance

This ligament is an important anatomical
Anatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy...

 landmark of the duodenojejunal junction.

This is actually a thin muscle that wraps around the small intestine where the duodenum and jejunum meet. It passes behind the pancreas and is attached above to the spine and the diaphragm.

It is an especially important landmark to note when looking at the bowel for the presence of malrotation of the gut
Intestinal malrotation
Intestinal malrotation is a congenital anomaly of rotation of the midgut...

, a syndrome often suspected in young children when they have episodes of recurrent vomiting. Visualizing a normal location of the ligament of Treitz in radiological images is critical in ruling out malrotation of the gut in a child; it is abnormally located when malrotation is present. An abnormally low and fixed position of the ligament of Treitz is a known cause of superior mesenteric artery syndrome
Superior mesenteric artery syndrome
Superior mesenteric artery syndrome is a very rare, life-threatening gastro-vascular disorder characterized by a compression of the third portion of the duodenum by the abdominal aorta and the overlying superior mesenteric artery...

. However, identifying it on a CT scan
Computed tomography
X-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...

 is difficult.

Hematemesis or haematemesis is the vomiting of blood. The source is generally the upper gastrointestinal tract. Patients can easily confuse it with hemoptysis , although the latter is more common.-Signs:...

 (blood in the vomit) or melena
In medicine, melena or melaena refers to the black, "tarry" feces that are associated with gastrointestinal hemorrhage. The black color is caused by oxidation of the iron in hemoglobin during its passage through the ileum and colon.-Melena vs...

 (black tarry stools) usually indicate a gastrointestinal bleed from a location proximal to the ligament. Hematochezia
Hematochezia is the passage of fresh blood per anus, usually in or with stools . Hematochezia is commonly associated with lower gastrointestinal bleeding, but may also occur from a brisk upper GI bleed...

(bright red blood or clots in the stools) usually indicates a gastrointestinal bleed from a location distal to the ligament.
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