Angle of Treitz

Angle of Treitz, also known as the duodenojejunal flexure or ligament of Treitz, is an anatomical structure in the digestive system. It is a significant landmark that marks the division between the duodenum and the jejunum, which are the first and second parts of the small intestine, respectively. This angle is formed where the duodenum ends, and the jejunum begins. The ligament of Treitz, which supports this angle, is a muscular structure that plays a crucial role in the suspension of the small intestine from the posterior abdominal wall.

Anatomy

The angle of Treitz is located in the left upper quadrant of the abdomen, at the level of the L2 vertebra, approximately. It is where the fourth part of the duodenum turns anteriorly and superiorly to become the jejunum. The ligament of Treitz, which is a part of the small intestine's suspensory muscle, extends from the right crus of the diaphragm to the connective tissue surrounding the first part of the jejunum. This ligament is composed of smooth muscle fibers, connective tissue, and peritoneal folds. It plays a vital role in maintaining the angle and position of the duodenojejunal junction.

Clinical Significance

The angle of Treitz is of significant clinical importance. It serves as a landmark for various radiological and surgical procedures. In radiology, it is used to differentiate upper from lower gastrointestinal bleeding. In surgery, it is a crucial reference point during procedures involving the small intestine, such as resections or bypass surgeries.

Pathologically, an abnormal location or angle of the ligament of Treitz can lead to intestinal obstruction or malrotation. Moreover, the area around the angle of Treitz can be involved in certain medical conditions, such as Crohn's disease or peptic ulcer disease, which can lead to complications like bleeding or perforation.

Diagnostic and Surgical Approaches

In diagnostic imaging, techniques such as CT scans, Magnetic Resonance Imaging (MRI), and barium studies are used to visualize the angle of Treitz and assess its anatomy and any associated abnormalities. Surgically, the knowledge of the exact location and orientation of the angle of Treitz is essential for procedures involving the small intestine to avoid inadvertent injury and to ensure proper anatomical reconstruction.

Conclusion

The angle of Treitz is a pivotal anatomical landmark in the digestive system, marking the transition from the duodenum to the jejunum. Its significance extends beyond anatomy into clinical practice, where it serves as a crucial reference point in both diagnostic and surgical settings. Understanding its location, structure, and potential pathologies is essential for healthcare professionals involved in the management of gastrointestinal diseases.