Bursa omentalis
Die Bursa omentalis ist ein Nebenraum der Peritonealhöhle, der durch Drehungs- und Umlagerungsbewegungen ursprünglich intraperitoneal gelegener Bauchorgane entstanden ist. Funktionell kann sie als größter intraperitonealer Recessus aufgefasst werden.
Begrenzungen und operative Zugangswege
:background_color(FFFFFF):format(jpeg)/images/library/9973/Vsh8PmZ4sRfHERYbB8ouQ_Bursa_omentalis_2.png "Bursa omentalis - anterior"){kind=logo}
Bursa omentalis - anterior
Da die Bursa kein mit Gewebe gefüllter Raum ist, sondern eine Höhle, wird sie durch die sie begrenzenden Strukturen definiert. Wegen der Lage des Pankreas als dorsale Begrenzung spielt ihre Topographie in der Pankreaschirurgie sowie der Traumatologie eine Rolle.
| Organ Gefäße und Bindegewebsstrukturen | |
| Ventral |
Magenhinterwand Omentum minus, Ligamentum gastrocolicum |
| Dorsal |
Pankreas, oberer Pol der linken Niere, Aorta abdominalis, Truncus coeliacus linke Nebenniere |
| Kranial | Lobus caudatus der Leber |
| Kaudal | Colon transversum Mesocolon transversum |
| Lateral | Milz Ligamentum gastrosplenicum |
| Medial | Leber, Bulbus duodeni |
Der einzige natürlich Zugangsweg zur Bursa omentalis ist über das Foramen omentale (Foramen epiploicum / Winslow-Loch) zwischen rechtem Rand des Ligamentum hepatoduodenale und der Pars superior duodeni.
Von ventral führt eine Durchtrennung des Omentum minus oder des Ligamentum gastrocolicum in die Bursa, von kaudal eine Öffnung des Mesocolon transversum.
:background_color(FFFFFF):format(jpeg)/images/library/10014/TCbPJXoVhxZGGmRn7HtcXw_Foramen_omentale_02.png "Foramen omentale / Winslow-Loch - ventrale Ansicht"){kind=logo}
Foramen omentale / Winslow-Loch - ventrale Ansicht
Klinik
Bei pankreaschirurgischen Eingriffen muss in Abhängigkeit von den zu operierenden Strukturen ein passender Zugangsweg gewählt werden. Der natürliche Zugang über das Foramen omentale wird hierbei jedoch nicht zwangsläufig bevorzugt.
Im Rahmen von Unfällen und anderen stumpfen Bauchtraumata ist die Ansammlung von Blut in der Bursa omentalis ein indirekter Hinweis auf eine mögliche Pankreasverletzung.
Dies ist durch die topographische Beziehung des Pankreas zur Bursa begründet. Bei Verletzungen, aber auch Nekrosen, kann Blut oder andere Gewebeflüssigkeit in die Bursa omentalis hineinlaufen. Diese Flüssigkeitsansammlung kann bildgebend dargestellt werden.
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