Imaging of peritoneal ligament by endoscopic ultrasound

Double layered peritoneal folds, variously named as ligaments, omenta and mesenteries connect the intraperitoneal organs to the abdominal wall. Some of these ligaments contain blood vessels and lymph nodes while others are avascular. The peritoneal folds not only act as conduits for the passage of blood vessels from the retroperitoneum to reach intraperitoneal organs, but also provide a pathway for the spread of disease processes. It is difficult to identify these normal peritoneal folds at imaging. Computed tomography is the most common imaging modality used to detect diseases of the peritoneum to fully delineate peritoneal anatomy and the extent of disease. The endoscopic ultrasound (EUS) can be used to image peritoneal ligaments with the advantage of lack of ionizing radiation and lower cost. Though EUS is being increasingly used both for diagnostic and interventional purposes in the abdomen, it has not been used to assess the peritoneal ligaments till now.

We did this study in 50 patients using linear echo endoscope to delineate various peritoneal ligaments. The technique of evaluation of ligament has been described in this review.

The peritoneal ligaments can be delineated with accuracy by EUS.