Liver ligaments

Coronary ligament

The liver has crucial homeostatic functions and it is the largest accessory digestive organ within the peritoneal space. It consists of four lobes and two major surfaces. Because it is such a large organ, it requires seven ligaments to keep it relatively immobile in its anatomical location. The largest of the seven hepatic ligaments is the coronary (coronal) ligament. This structure is a reflection of the diaphragmatic peritoneum that attaches to the superior and posterior aspects of the right lobe of the liver. 

The coronary ligament is divided into anterior and posterior layers. The anterior (upper) layers further divide to anchor the superior surface of the liver to the inferior surface of the diaphragm on the right-hand side. Also on the right-hand side, the posterior (lower) layers of the coronary ligament attach the posterior surface of the liver to the posterior abdominal wall, right kidney and its associated adrenal (suprarenal) gland. The attachment of the coronal ligament to the liver and its division into the two layers creates a triangular area that is devoid of peritoneum. This is referred to as the bare area of the liver, which is located on its diaphragmatic surface. 

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On the right lobe of the liver, the anterior and posterior layers of the coronary ligament of the liver join to form the right triangular ligament. However, there is no true coronary ligament on the left-hand side. Instead, the layers of the coronary ligament approximate to form the left triangular ligament.

Before diving into further details, revise the location of the liver using the following resources:

Triangular ligaments

The triangular ligaments are asymmetrical bilateral structures that help to hold the liver in place. There are two in total, right and left, both of which are continuations of the coronary ligament. The right triangular ligament is a relatively short structure. It begins at the apex of the bare area of the liver and is formed by the right part of both layers of the coronary ligament. In contrast to its predecessor, the left triangular ligament is much longer. It is formed from the left halves of the two layers of the coronary ligament. Consequently, the left triangular ligament projects over the superior surface of the left lobe of the liver. The ligament lies anterior to the abdominal esophagus, the medial part of the gastric fundus and the cranial segment of the lesser omentum. 

As the left triangular ligament is longer and travels along the liver for a greater distance, it becomes continuous with both the falciform ligament and the lesser omentum along its course. The arrangement is such that the posterior layer of the left triangular ligament is continuous with the lesser omentum inferolaterally. In turn, the anterior layer of the left triangular ligament is continuous with the falciform ligament superomedially.

Falciform ligament 

Now that the main ligaments attached to the superior and posterior aspects of the liver have been examined, it’s time to learn about the ones anchoring the anterior surface. The second-largest hepatic ligament is the falciform ligament. The sickle-shaped ligament (as suggested by its name) takes a craniocaudally course along the anterior surface of the liver. Superiorly, the falciform ligament is attached to the visceral aspect of the anterior abdominal wall (just an inch to the right of the median plane) and the inferior surface of the diaphragm. It is also continuous with the superior surface of the liver between the left and right lobes. 

Like the other hepatic ligaments, the falciform ligament has two layers. The right leaf takes a lateral course to merge with the coronary ligament on the right, while the left leaf unites with the left triangular ligament medially. The two leaves unite to form the falciform ligament, which descends on the anterior surface of the liver between the two lobes. The inferior border of the falciform ligament has no hepatic attachments. Instead, it is occupied by the ligamentum teres hepatis (round ligament of the liver).

More details about the coronary, triangular and falciform ligaments are included below:

Ligamentum teres

The superior and anterior hepatic ligaments have been explained, so it would be a good idea to see the attachments on the inferior and posterior surfaces. During embryonic development, the left umbilical vein drains blood into the left portal vein.

However, about two months after birth, the vein degenerates and forms the ligamentum teres hepatis (Latin for the round ligament of the liver) also just called the ligamentum teres. The ligamentum teres hepatis continues in the inferior border of the falciform ligament and courses in the fissure of the ligamentum venosum on the inferior surface of the liver.

Ligamentum venosum

In utero, the ductus venosum was responsible for shunting blood from the left portal vein to the left hepatic vein, thereby bypassing the hepatic circulation. During the first week of extra-uterine life, the ductus venosum degenerates and becomes the ligamentum venosum. This slender fibrous cord passes from the left branch of the portal vein upwards in the fossa bearing its name to reach the inferior vena cava.

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Are you curious to find out more about the ligamenta teres and venosum? Then take a look at the following:

Lesser omentum: Hepatogastric and hepatoduodenal ligaments

The lesser omentum forms an “L” shaped attachment that extends from the distal segment of the abdominal esophagus, along the lesser curvature of the stomach to the superior part (the first part) of the duodenum. It inserts on the inferior surface of the liver, adjacent to the fissure of the ligamentum venosum and the porta hepatis.

The lesser omentum may be subdivided into the larger hepatogastric ligament and the smaller (but thicker) hepatoduodenal ligament. The hepatogastric ligament extends between the liver and stomach. It consists of two layers that are continuous with the posterior leaf of the left triangular ligament and the right coronary ligament. They later go on to enclose the inferior vena cava. The hepatoduodenal ligament extends between the liver and duodenum and encircles the constituents of the porta hepatis (portal vein, bile duct, and hepatic artery). The hepatoduodenal component of the lesser omentum also forms the anterior border of the epiploic foramen of Winslow, which is the opening to the lesser sac of the peritoneum. 

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