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Topographic Anatomy · Topographic Anatomy of the Abdomen

Supramesocolic compartment

Cavitas abdominis (pars supracolica)

The upper floor of the abdominal cavity is an anatomical compartment housing the liver, stomach, spleen, pancreas, and the superior part of the duodenum. Studying this zone is critically important for understanding the spread pathways of peritonitis and the localization of intra-abdominal abscesses.

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Key ZonesIncludes 4 main spaces: two subdiaphragmatic spaces, the subhepatic space, and the omental bursa.
Omental BursaThe most isolated space of this floor, located as a slit-like recess posterior to the stomach.
Infection PathwaysExudate often ascends into the right subdiaphragmatic space via the right paracolic gutter.
Surgical AccessThe omental bursa is accessed through the gastrocolic ligament or the transverse mesocolon.
4 min readFor medical studentsUpdated 09/24/2026
Material prepared by WhiteCoat Pro editorial team based on platform study guidesReviewed by medical editor: Aulov A. A., general practitioner · 09/24/2026

Overview of Organs and Spaces

The abdominal cavity is traditionally divided into two floors. The boundary between them is the transverse colon and its mesentery.

The upper floor houses vital organs of the digestive and immune systems: the liver with the gallbladder, stomach, spleen, the upper half of the duodenum (DU), and the pancreas. In comparison, the lower floor contains the lower half of the DU, the small and large intestines, as well as paracolic gutters and mesenteric sinuses.

Topographically, four key spaces are distinguished in the upper floor:

  1. Right subdiaphragmatic space.
  2. Left subdiaphragmatic space.
  3. Subhepatic space.
  4. Omental bursa.
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Right and Left Subdiaphragmatic Spaces

The right subdiaphragmatic space (or right hepatic pouch, bursa hepatica dextra) is bounded superiorly and anteriorly by the dome of the diaphragm, and inferiorly by the superior-posterior surface of the right hepatic lobe. Posteriorly, it is closed off by the right coronary and right triangular ligaments, and to the left by the falciform ligament of the liver (lig. falciforme hepatis).

Clinically, this zone is hazardous because subdiaphragmatic abscesses frequently form here. They occur as complications of purulent appendicitis, cholecystitis, or perforated ulcers of the stomach and duodenum. Inflammatory exudate flows here from the subhepatic space (along the lateral margin of the liver) or ascends from the right iliac fossa via the right paracolic gutter.

The left subdiaphragmatic space has a more complex structure and consists of two communicating compartments:

  • The left hepatic pouch (bursa hepatica sinistra): a slit between the left lobe of the liver (inferiorly) and the diaphragm (superiorly and anteriorly). To the right, it is bounded by the falciform ligament, and posteriorly by the left part of the coronary ligament and the left triangular ligament of the liver.
  • The pregastric pouch (bursa pregastrica): located between the diaphragm and the left lobe of the liver (anteriorly and superiorly) and the lesser omentum with the stomach (posteriorly). To the right, it is bounded by the round and falciform ligaments.

The lateral division of the pregastric pouch is distinguished separately—this is the blind sac of the spleen (saccus caecus lienis). It lies lateral to the greater curvature of the stomach and contains the spleen. The boundaries of the sac are formed by ligaments: the phrenicocolic ligament (lig. phrenicolienale), gastrosplenic ligament (lig. gastrolienale), and phrenicocolic ligament (lig. phrenicocolicum).

An important feature of the left subdiaphragmatic space is that it is isolated from the left paracolic gutter by a well-developed left phrenicocolic ligament (lig. phrenicocolicum sinistrum). There is no free communication here. Abscesses from this zone can spread to the left (into the blind sac of the spleen) or descend anteriorly between the stomach and the left lobe of the liver.

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Subhepatic Space

The subhepatic space (bursa subhepatica) is located to the right of the porta hepatis and the omental foramen. It is wedged between the inferior surface of the right hepatic lobe and the transverse mesocolon (mesocolon).

Morphologically, the space is divided into two compartments:

  • Anterior compartment: faces the gallbladder and the superior surface of the duodenum. This is a typical localization site for abscesses in duodenal ulcer perforation or purulent cholecystitis.
  • Posterior compartment (hepatorenal recess): the most inaccessible part, located near the posterior edge of the liver, to the right of the spine. Pus predominantly flows here during a periappendicular abscess.

Omental Bursa

The omental bursa (bursa omentalis) is the most isolated space of the upper floor of the abdominal cavity, appearing as a slit-like cavity posterior to the stomach. Abscesses often localize here in perforations of the posterior gastric wall and pancreatic diseases.

The only natural entrance into the bursa is the omental foramen (foramen epiploicum), located near the porta hepatis. During inflammation, the foramen quickly closes with adhesions, completely blocking the bursa. Boundaries of the foramen:

  • Anteriorly: hepatoduodenal ligament (lig. hepatoduodenale).
  • Posteriorly: hepatorenal ligament (lig. hepatorenale) and peritoneum over the inferior vena cava.
  • Superiorly: caudate lobe of the liver.
  • Inferiorly: duodenorenal ligament (lig. duodenorenale) and the superior part of the duodenum.

Immediately beyond the foramen lies the vestibule (vestibulum bursae omentalis). The omental bursa proper has a complex shape and is bounded by the following walls:

  • Anterior: lesser omentum (hepatogastric and hepatoduodenal ligaments), posterior wall of the stomach, and gastrocolic ligament.
  • Posterior: parietal peritoneum covering the aorta, inferior vena cava, pancreas, and nerve plexuses.
  • Superior: caudate lobe of the liver and part of the diaphragm.
  • Inferior: transverse mesocolon.
  • Left: spleen with its ligaments.

For surgical access to the omental bursa, surgeons typically dissect the gastrocolic ligament (lig. gastrocolicum) closer to the left colic flexure, or approach it through the transverse mesocolon.

Briefly: answers to topical questions

What surgical approaches to the omental bursa exist?

  • Through the gastrocolic ligament (lig. gastrocolicum) — incision in an avascular area closer to the greater curvature; the stomach is retracted superiorly and the transverse colon inferiorly.
  • Through the transverse mesocolon (mesocolon transversum) — used when other approaches are impossible; also used for internal cyst drainage.
  • Through the lesser omentum — incision of the hepatogastric ligament (lig. hepatogastricum), which is particularly convenient when the stomach is ptotic.
  • By detaching the greater omentum from the transverse colon.

Class and exam questions

Why can an abscess occur under the diaphragm in purulent appendicitis?

Exudate from the right iliac fossa can ascend freely up the right paracolic gutter and accumulate in the right subdiaphragmatic space.

Does the left subdiaphragmatic space communicate with the left paracolic gutter?

No, there is no direct free communication. It is reliably demarcated by a well-defined left phrenicocolic ligament.

Where is the most isolated space of the upper floor located?

This is the omental bursa. It is located posterior to the stomach and communicates with the rest of the cavity only via a narrow omental foramen, which is easily blocked by adhesions during inflammation.

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What else to study on this topic

  • Topography and Surgical Anatomy of the Stomach
  • Ligamentous Apparatus of the Liver and Lesser Omentum
  • Anatomy of the Lower Floor of the Abdominal Cavity (Gutters and Sinuses)
  • Surgical Approaches to the Pancreas

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Other topics in the section "Topographic Anatomy of the Abdomen"

Topographic Anatomy of the AbdomenProjection of organs onto the abdominal wallTopographic anatomy of the anterolateral abdominal wallExternal oblique abdominal muscleInternal oblique abdominal muscleRectus abdominis muscleEndoabdominal fascia and extraperitoneal adipose tissueRelief of the posterior surface of the anterior abdominal wallBlood supply to the anterolateral abdominal wallLymphatic system and innervation of the anterior abdominal wallLinea albaTopographic anatomy of the umbilical regionTopography of the abdominal cavity organsInguinal canalInguinal trianglePeritoneal cavityTopographic anatomy of the liverBlood supply and innervation of the liverTopographic anatomy of the portal veinTopographic anatomy of the gallbladderTopographic anatomy of the extrahepatic biliary ductsAbdominal part of the esophagusTopographic anatomy of the stomachLigamentous apparatus of the stomach
The entire section "Topographic Anatomy of the Abdomen"

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