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A Moment in History 
Pare
Ambroise Paré
 
(1510 - 1590) 

French barber-surgeon.  He studied at the Hótel-Dieu, a hospital in Paris. In 1537 he started work as an army surgeon. At the time, the general belief was that gunshot wounds were poisoned by the gunpowder, so the standard procedure was to cauterize bleeding vessels with red hot irons and then burn the open wound with boiling oil. During a battle in Turin he ran out of oil, and in despair, tried to ease the pain and suffering of the soldiers that could not be treated "appropriately" by using the only elements available to him at the moment: a paste made with rose oil, turpentine, and egg yolks.

To his surprise, the soldiers thus treated recuperated faster and with less pain. Paré decided to treat his patients more humanely, and try to reduce pain as much as possible in this pre-anesthesia world. He started using ligatures instead of cautery, and soothing salves and pastes with clean bandages to promote healing.

Paré published several books and is considered by many the first modern surgeon.

Image courtesy of the US National Library of Medicine


 

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Ligament of Treitz


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The ligament of Treitz is formed by a fold of peritoneum over the suspensory muscle of the duodenum. This muscle is also known as the "muscle of Treitz" or "musculus suspensorius duodenii". This muscle was first described in 1853 by Dr. Václav Treitz. 

The muscle (see image #1) has an unusual structure in that it is formed by a tendon with two muscular ends  of dissimilar embryological origin and function. The superior muscular component is skeletal (voluntary) muscle and arises as a slip of muscle (Hilfsmuskel) from the right esophageal crus of the respiratory diaphragm, as well as muscular and ligamentous fibers arising in the region of origin of the celiac trunk and superior mesenteric artery. The inferior portion of the muscle is smooth (involuntary) muscle and has been described as continuous with both the longitudinal and circular muscle layer of the intestine at the duodenojejunal junction.

Anterior view of the duodenum and the suspensory muscle of the duodenum
Click on the image for a larger version
Original image by Dr. Václav Treitz
The ligament of Treitz is an anatomical landmark used by anatomists and surgeons to denote the duodenojejunal junction and the point where the small intestine passes from retroperitoneal duodenum to intraperitoneal jeunum. Surgeons use the ligament of Treitz to measure the jejunum to decide where to perform an anastomosis.Click on the gray bar below the image to see the original sketch published by Dr. Václav Treitz in his 1853 publication "Ueber einen neuen Muskel am Duodenum des Menschens" (On a new muscle in the duodenum of man). The 'muscle of Treitz" is marked by an arrow.

It is important to clarify that the term "ligament" in the abdominopelvic cavity has a different meaning and structure from a skeletal ligament found in a joint. For more information click here.

Clinical anatomy, pathology, and surgery of the gastrointestinal tract are some of the many lecture topics developed and delivered to the medical devices industry by Clinical Anatomy Associates, Inc.

Sources:
1.
"Clinically Oriented Anatomy" Moore, KL. 3r Ed. Williams & Wilkins 1992
2. "The origin of Medical Terms" Skinner, AH, 1970
3. "The suspensory muscle of the duodenum and its nerve supply" Jit, I.; Singh, S. J. Anat. (1977), 123, 2, pp. 397-405
4. "Anatomical and functional aspects of the human suspensory muscle of the duodenum." Costacurta, L. Acta Anat (Basel). 1972;82(1):34-46
Image property of: CAA.Inc. Artists: Dr. E. Miranda and D.M. Klein