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ArticlesAnatomyAbdomenSmall intestineDuodenum
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ArticlesAnatomyAbdomenSmall intestineDuodenum

Duodenum

Author: Achudhan Karunaharamoorthy, MD • Reviewer: Dimitrios Mytilinaios, MD, PhD
Last reviewed: November 29, 2023
Reading time: 7 minutes

Recommended video: Duodenum [23:05]
Structure of the duodenum, including the mucosa and muscular layers.
Duodenum
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Synonyms: Intestinum duodenum

The duodenum is the first of the three parts of the small intestine that receives partially digested food from the stomach and begins with the absorption of nutrients. It is directly attached to the pylorus of the stomach. It has a C-shape, it is closely related to the head of the pancreas and consists of four sections: superior, descending, horizontal, and ascending parts.

Histologically speaking, the duodenum consists of the typical three layers common to all hollow organs of the gastrointestinal tract, but it has Brunner's glands, which is the characteristic feature of the duodenum.

This article will describe the anatomy (sections, bloody supply, innervation) and histology of the duodenum, as well as its important functions.

Key facts about the duodenum
Location 25-30 cm long, C-shaped around the head of the pancreas, L1-L3 level
Sections Superior (->superior duodenal flexure), descending (->inferior duodenal flexure), horizontal (aorta -> inferior vena cava), asceding (-> duodenojejunal flexure)
Blood supply Superior (anterior, posterior) and inferior pancreaticoduodenal arteries
Innervation Celiac plexus, vagus nerve
Histology Layers: mucosa (lamina epithelialis, lamina propria, lamina muscularis), submucosa, muscularis (inner circular, outer longitudinal)
Characteristic feature - Brunner's glands
Functions Neutralization of the acidic gastric juice, mechanical digestion of chyme, mixing of bile and pancreatic enzymes, absorption of water, electrolytes, and nutrients
Contents
  1. Anatomy 
    1. Sections
    2. Blood supply
    3. Innervation
  2. Histology 
  3. Functions
  4. Summary
  5. Sources
+ Show all

Anatomy 

Sections

The duodenum is about 25 to 30 cm long (“twelve fingers' length”), C-shaped and is located in the upper abdomen at the level of L1-L3. The head of the pancreas lies in the C loop. It may be subdivided into four sections: superior part, descending part, horizontal part and ascending part.

  • The superior part (first part, D1) lies intraperitoneally and is enlarged proximally (duodenal bulb). It is connected to the liver by the hepatoduodenal ligament. The superior part ends at the superior duodenal flexure and becomes the descending part.
  • The descending part (second part, D2) and the rest of the duodenum lie retroperitoneally. The (common) bile duct and the pancreatic duct unify to a conjoint duct at the hepatopancreatic ampulla (=ampulla of Vater) and empties into the descending part of the duodenum. At the opening there is an elevation of the mucosa, the major duodenal papilla (=papilla of Vater). Many people have an accessory pancreatic duct which empties into an additional papilla, the minor duodenal papilla (=papilla of Santorini). The transition from the descending to the horizontal part of the duodenum takes places at the inferior duodenal flexure.

Soon you'll be a master on the anatomy of the duodenum - but how well do you know the other structures of the digestive system? Find out with our digestive system quizzes and free learning tools. 

  • The horizontal part (inferior or third part, D3) runs from right to left ventrally from the abdominal aorta and inferior vena cava.
  • The ascending part (fourth part, D4) runs cranially along the left side of the vertebral column. This last part of the duodenum joins the intraperitoneally lying jejunum at the duodenojejunal flexure. Here the duodenum is attached to the back of the abdominal wall through the suspensory ligament of duodenum (=ligament of Treitz). Clinically the ligament of Treitz marks the border between the upper and lower gastrointestinal tract.
Duodenum in a cadaver: It is easy to locate the duodenum and pancreas during a dissection. The duodenum follows a C-shaped trajectory around the head of the pancreas.

Blood supply

The supply of blood to the duodenum is carried by the anterior and posterior superior pancreaticoduodenal arteries (branches of the gastroduodenal artery) and the inferior pancreaticoduodenal artery (branch of the superior mesenteric artery) which form an arterial arcade. The correspondent veins are responsible for the venous drainage.

Innervation

The sympathetic innervation is carried by nerves of the coeliac plexus, the parasympathetic innervation by the vagus nerve (cranial nerve X).

For more details about the duodenum, take a look at the following resources:

Duodenum Explore study unit
Arteries of the pancreas, duodenum and spleen Explore study unit
Lymphatics of the pancreas, duodenum and spleen Explore study unit

Histology 

Histologically the duodenum is similar to all the other hollow organs of the gastrointestinal tract: mucosa, submucosa and muscularis.

  • The mucosa consists of simple columnar epithelium (lamina epithelialis), a connective tissue layer (lamina propria) and a smooth muscle layer (lamina muscularis). The intestinal epithelial cells (enterocytes) are overlaid by a layer of glycoproteins and mucin.
  • The submucosa comprises loose connective tissue, numerous blood vessels and the Meissner's plexus.
  • The muscularis consists of an inner circular and an outer longitudinal musculature between which the Auerbach’s plexus lies.

Typical for all sections of the small intestines are microvilli (hairlike structures projecting from the surface), finger-shaped villi and circular folds of the mucosa and submucosa (valves of Kerckring). These structures increase the absorption area of the duodenum up to 1500 times.

The duodenum is rich of absorbing enterocytes, mucus producing goblet cells and peptide hormone producing endocrine cells.

Need more help identifying tissues? Try our tissue quizzes!

A characteristic feature of the duodenum is the Brunner’s glands embedded in the submucosa. These produce – amongst others – mucous secret containing bicarbonate which serves to neutralize the gastric acid. Furthermore crypts of Lieberkuhn lie between the villi. Paneth cells are found in the lumen of these crypts. According to today’s knowledge Paneth cells play a role in the antimicrobial defense however their functions are not fully understood yet.

Small intestine Explore study unit

Functions

The main tasks of the duodenum are:

  • Neutralization of the acidic gastric juice through production of alkaline secrets.
  • Mechanical processing and digestion of chyme.
  • Mixing bile and pancreatic enzymes.
  • Absorption of water, electrolytes and nutrients (especially water-soluble substances such as monosaccharides).

Now that you learned everything about the duodenum, test and consolidate your knowledge with he quiz below!

Summary

Anatomy:

  • Attached to pylorus of stomach and C-shaped
  • Superior part, descending part, horizontal part and ascending part

Histology:

  • Mucosa, submucosa and muscularis
  • Microvilli, finger-shaped villi and circular folds of the mucosa
  • Enterocytes, goblet cells, endocrine cells
  • Brunner’s glands and Paneth cells

Functions:

-> Neutralization of gastric acid, absorption of water and nutrients, mixing enzymes

Sources

All content published on Kenhub is reviewed by medical and anatomy experts. The information we provide is grounded on academic literature and peer-reviewed research. Kenhub does not provide medical advice. You can learn more about our content creation and review standards by reading our content quality guidelines.

References:

  • D. Drenckhahn/J. Waschke: Taschenbuch Anatomie, 1.Auflage, Urban & Fischer Verlag/Elsevier (2008), S.265-267
  • U. Welsch: Lehrbuch Histologie, 2.Auflage, Urban & Fischer Verlag/Elsevier (2006), S.370-378
  • M. Schünke/E. Schulte/U. Schumacher: Prometheus – LernAtlas der Anatomie – Innere Organe, Thieme Verlag (2009), S.222-223
  • Martin: Concise Medical Dictionary, 8th edition (2010)

Illustrators:

  • Overview of the duodenum (anterior view) - Begoña Rodriguez
  • Duodenum in a cadaver - Prof. Carlos Suárez-Quian

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