Ligament of Treitz

Positioning the tip of the feeding tube past the ligament of Treitz may be more effective than postpyloric placement in high-risk patients... 

Adult patients with less than 100 cm small bowel distal to the ligament of Treitz without a colon Adult patients with less than 50 cm of small bowel if the colon is intact... 

Ligament of Treitz Suspensory muscle of the duodenum the tissue that connects the duodenum to the diaphragm. 

Figure 2.10 The Loc-I-Gut instrument allowing segmental intestinal perfusion in humans. The balloons are filled with air when the proximal balloon has passed the ligament of Treitz. The six-channel tube facilitates infusion of drug and marker, aspiration of perfusate and gastric drainage, and inflation of the two balloons [60].

The duodenum is typically divided into four portions. The first portion is relatively mobile in contrast to the rest of the duodenum which is fixed in the retroperitoneal cavity. The second descending portion of the duodenum is in close contact with the pancreas and receives the common bile duct and duct of Wirsung in its midportion. The third portion is horizontally oriented and is ventrally crossed by the superior mesenteric artery (SMA) and superior mesenteric vein (SMV). The fourth ascending portion will turn ventrally to the duodenojejunal junction, which is additionally held in place by the ligament of Treitz. 

An upper GI study in newborns and small infants will be different from those performed in adolescents. In the former group of children, the study will be performed to evaluate a (known) congenital proximal obstruction (evaluation of antral or duodenal web) or, more importantly, to evaluate the position of the duodenojejunal flexure (the ligament of Treitz). The study will be tailored to answer these specific questions and these will always be single contrast studies. In older children, however, double contrast studies may occasionally be necessary depending on the clinical question (e.g. polyps). 

Fig. 5.6. a UGI determines normal rotation by identifying the duodenojejunal junction (ligament of Treitz). b Intestinal malrotation demonstrated with a barium enema. Localization of jejunum in right upper quadrant. The duodenum does not cross the spine... 

The lesion is endoscopically inaccessible (i.e., localized between the ligament of Treitz and the ileocecal valve). 

Fig. 9.21. Lymphoma. Irregular mural thickening at the level of the ligament of Treitz with an associated irregular central ulcer. (Reprinted with permission from Zissin et al. 2002)...

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