The peritoneal coverings of the duodenum are as follows:
1st (superior) part: the proximal 2.5 cm is intraperitoneal while the distal 2.5 cm is covered by peritoneum on its anterior and superior surfaces
2nd (descending) part: covered by peritoneum only on its anterior proximal surface
3rd (horizontal) part: covered by peritoneum only on the lower anterior surface
4th (ascending) part: the proximal root of the mesentery covers all of the most distal part of the duodenum, and therefore is classified as intraperioneal
Case Discussion
It is important to understand the peritoneal relations of the duodenum in the context of a peptic ulcer. A peptic ulcer that penetrates through a duodenal wall that is covered by peritoneum means that the ulcer has access to the peritoneal cavity and therefore can lead to a perforating peptic ulcer.
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