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Ligament of Treitz

Recommended video: Duodenum [23:05]
Structure of the duodenum, including the mucosa and muscular layers.
Ligament of Treitz (anterior view)

The ligament of Treitz is a popular eponym that is used for the suspensory muscle of the duodenum. It is actually made up of two separate structures according to the description given in 1853 by Dr. Wenzel Treitz (an Austrian physician). While this is a relatively small structure, it has clinical implications in surgical procedures and in rare cases of small bowel obstruction. It is one of several so-called “ligaments” within the abdominal cavity that support the intraabdominal organs

By formal definition, a ligament is a fibrous connective tissue that connects bone to bone. In the case of the gastrointestinal tract, these ligaments are folds of peritoneum that connect the viscera to adjacent viscera or to the anterior or posterior abdominal wall. While the primary goal of this article is to review the anatomy and function of the suspensory ligament of the duodenum, it will also briefly mention a few other intraabdominal ‘ligaments’ as well. 

Key facts about the ligament of Treitz
Anatomy Made up of two parts:
- celiacoduodenal part
- phrenicoceliac part
Celiacoduodenal part Originates from the duodenojejunal flexure
Inserts at the celiac artery
Contains smooth muscle fibers
Forms inferior part of the suspensory ligament
Phrenicoduodenal part Originates from the right crus of the diaphragm
Inserts at the celiac artery
Contains skeletal muscle fibers
Forms the superior part of the suspensory ligament
Function A landmark for the duodenojejunal flexure
Marks transition from foregut to the midgut
Helps gastric motility
Clinical significance Guide for malrotation syndromes
A rare cause of superior mesenteric artery syndrome
  1. Location
  2. Anatomy
  3. Function
  4. Other ligaments in the gastrointestinal tract
    1. Gastrocolic ligament
    2. Gastrosplenic (gastrolienal) ligament
  5. Development
  6. Clinical significance
  7. Sources
+ Show all


The phrenicoceliac part (a.k.a Hilfsmuskel component, superior part) of the ligament of Treitz extends from the right crus of the diaphragm and wraps around the esophageal hiatus. It continues down to the celiac artery where it joins the connective tissue around the area. Some anatomists refer to this as the upper part of the ligament.

The celiacoduodenal (inferior) part of the ligament arises as a connective tissue band from the paraaortic connective tissue around the celiac artery. It travels between the pancreas and the splenic vein, as well as the left renal vein. It becomes a triangular structure that inserts at the left lateral aspect of the end of the fourth segment of the duodenum - the duodenojejunal flexure.


Wenzel Treitz described two structures that make up the ligament of Treitz. The phrenicoceliac part of the structure arises from the right crus of the diaphragm and loops around the esophagus before inserting as a connective tissue band at the celiac trunk (artery or axis). It is sometimes referred to as Hilfsmuskel, which is German for accessory muscle. The phrenicoceliac part is roughly the shape of an elongated triangle that is widest at its origin and narrowest at its insertion. Histological assessment of the band reveals that it is made up of striated skeletal muscle fibers that come from the diaphragmatic end of the muscle.

The celiacoduodenal part of the suspensory ligament of the duodenum is a thin muscular band originating from the celiac trunk as a connective tissue band. It passes between the splenic vein, left renal vein and the pancreas to insert at the duodenojejunal flexure (DJ flexure) and part of the inferior aspect of the transverse duodenum. This segment is sometimes referred to as the suspensory muscle of the duodenum proper. It is a very thin muscle and is roughly triangular at its origin but tapers and becomes narrower toward its fibrous insertion. Histologically, the suspensory muscle of the duodenum is comprised of smooth muscle fibers arising from the enteric end of the muscle.

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Since the suspensory ligament of the duodenum was discovered, there has been significant discord as to the composition of the suspensory ligament. Some anatomists were only able to identify smooth muscle fibers. Others, however, found just a simple fold of peritoneum that occasionally contained both skeletal and smooth muscle components. One reason for the discord is that there seems to be some degree of variability in the morphology of the structure. Different parts of the ligament of Treitz may either rudimentary or absent. 

However, most modern anatomy texts continue to accept Treitz’s initial description of a mixed muscle. This article will continue to honor that convention as well until further definitive evidence is available.


Some anatomists hypothesized that since the suspensory ligament of the duodenum is a muscle, it should be able to stabilize the duodenojejunal flexure and prevent it from being displaced. However, given the thin nature of the muscle, it has been deemed unlikely to effectively carry out this function.

It does, however, serve as a landmark for surgeons to identify the duodenojejunal flexure. This is the point of transition between the foregut and the midgut. This becomes clinically relevant when discussing gastrointestinal problems such as gastrointestinal bleeding. Bleeding within the gastrointestinal tract that occurs above/proximal to the level of the suspensory ligament of the duodenum is called upper gastrointestinal bleeding. However, if bleeding occurs below/distal to the level of this ligament, then it is referred to as lower gastrointestinal bleeding.

Other ligaments in the gastrointestinal tract

There are numerous other intraabdominal ligaments that help to support the abdominal organs. They also help to divide the intra-abdominal cavity into regions and quadrants. While the majority of these peritoneal folds are associated with the liver (and discussed in its own article), there are a few others that are worth mentioning here.

Gastrocolic ligament

The greater omentum (as well as the lesser omentum) has its origins from the stomach. The greater omentum originates from the greater curvature of the stomach (as opposed to the lesser omentum arising from the lesser gastric curvature). The structure can be described as a double-layered sheet, with the posterior flap inserting along the transverse colon. The segment of the greater omentum that inserts at the transverse colon is known as the gastrocolic ligament or gastrocolic omentum. It forms the anterior boundary of the omental bursa (the lesser sac of the abdomen).

Gastrosplenic (gastrolienal) ligament

A portion of the greater omentum also leaves the greater curvature of the stomach and attaches to the spleen. This is known as the gastrosplenic or gastrolienal ligament. The two layers of the gastrosplenic ligament divide at the hilum of the spleen and envelopes the organ. The layers subsequently re-join to form the lienorenal (splenorenal) ligament, which attaches the spleen to the left kidney. Learn more about the greater and lesser omenta anatomy here to understand everything about these two gastrointestinal ligaments.


The primary dorsal mesentery is an embryonic structure that contributes to the formation of the crura of the diaphragm, the gastrophrenic and gastrocolic ligaments, and the greater omentum. It also plays an important role in the formation of the ligament of Treitz as well. Cells arising from the pleuroperitoneal membrane (one of four embryonic structures that contribute to the formation of the diaphragm) and the retropancreatic fusion fascia (resides between the retroperitoneal organs and the posterior surface of the pancreas) may also contribute to the formation of the ligament of Treitz. 

Read more about the development of the gastrointestinal structures here.

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