The ligament of Treitz (suspensory muscle of the duodenum) is a fibromuscular band containing smooth muscle that suspends the duodenojejunal flexure from the right crus of the diaphragm and the connective tissue around the coeliac trunk. It marks the anatomical boundary between the upper GI tract (proximal to this point, including the stomach and duodenum) and the lower GI tract (the jejunum onward). Blood loss arising proximal to this point defines upper GI bleeding.
| Origin | Right crus of the diaphragm and connective tissue at the celiac axis |
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| Insertion | Duodenojejunal flexure (junction of the fourth part of the duodenum and jejunum) |
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Suspends the duodenojejunal flexure and widens its angle to help the passage of intestinal contents.
The duodenojejunal flexure held by the ligament of Treitz normally lies left of the midline at about the level of L2; on an upper GI contrast study an abnormal position is the key sign of intestinal malrotation, which is treated with Ladd's procedure. In superior mesenteric artery syndrome, the third part of the duodenum is compressed between the SMA and the aorta just proximal to the flexure, producing high-grade obstruction from a narrowed aortomesenteric angle. The flexure is also the reference point for placing feeding tubes into the jejunum.
Duodenal compression at the aortomesenteric angle proximal to the ligament of Treitz producing high-grade obstruction from acute weight loss or spinal casting narrowing the SMA-aorta angle.
Abnormal right-sided or low duodenojejunal flexure on contrast study, with risk of midgut volvulus, treated surgically with Ladd's procedure.
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