The hepatorenal ligament is a peritoneal fold connecting the inferior surface of the right hepatic lobe to the anterior surface of the right kidney, forming the posterior boundary of the hepatorenal recess (Morison pouch). It is continuous with the right layer of the coronary ligament superiorly and with the hepatoduodenal ligament anteriorly. Morison pouch between the liver and the right kidney is the most gravity-dependent part of the peritoneal cavity in the supine position.
Defines the posterior boundary of Morison pouch, contributes to the peritoneal suspension of the right hepatic lobe, and forms the anatomical barrier between the hepatorenal and the subphrenic spaces.
Morison pouch (the hepatorenal recess bounded posteriorly by the hepatorenal ligament) is the most sensitive site for detecting free intraperitoneal fluid on both CT and the FAST (focused assessment with sonography for trauma) ultrasound examination. Fluid in Morison pouch is the initial finding in haemoperitoneum from solid organ injury and bowel perforation. In right hepatic lobe mobilisation for resection, the hepatorenal ligament must be divided to allow the liver to rotate anteriorly and expose the retrohepatic IVC.
Intraperitoneal haemorrhage from any source pools in the gravity-dependent Morison pouch in the supine patient; detection of fluid in this hepatorenal recess by FAST ultrasound or CT indicates significant haemoperitoneum from solid organ injury or hollow viscus perforation, with even small volumes prompting consideration of laparotomy in the haemodynamically unstable trauma patient.
