Location of the Ligament of Treitz
The ligament of Treitz is located at the duodenojejunal junction, extending from the fourth portion of the duodenum to the right crus of the diaphragm near the esophageal opening. 1
Anatomic Position and Relationships
The ligament of Treitz, also known as the suspensory muscle or ligament of the duodenum, serves as a critical anatomic landmark that defines the boundary between the upper and lower gastrointestinal tract 1. Specifically:
- Proximal attachment: Originates from the duodenojejunal flexure (the junction between the fourth portion of the duodenum and the proximal jejunum)
- Distal attachment: Extends superiorly to attach to the right crus of the diaphragm around the esophageal opening 2, 3
- Relationship to major vessels: The duodenum typically crosses anterior to the aorta before reaching the ligament of Treitz 4
Clinical Significance as an Anatomic Landmark
This structure is clinically important because upper gastrointestinal bleeding is defined as bleeding occurring proximal to the ligament of Treitz (from the esophagus, stomach, or duodenum), while bleeding distal to this landmark is considered lower GI bleeding 1. This distinction guides diagnostic and therapeutic approaches.
In endoscopic practice, the ligament of Treitz marks the transition point where:
- Standard esophagogastroduodenoscopy typically ends
- Deep enteroscopy or capsule endoscopy may be needed to evaluate pathology extending beyond this point 5
Structural Characteristics
The ligament is a thin membranous structure that varies considerably in size and shape between individuals 6. It contains smooth muscle fibers throughout most of its length, with some striated muscle fibers present near its diaphragmatic attachment 3. The structure connects to the retropancreatic fascia and extends to approach the fourth portion of the duodenum 7.
Despite its name as a "ligament," this structure is relatively weak and would not prevent displacement of the duodenum by extrinsic masses 6.