The suspensory ligament of the duodenum (ligament of Treitz) is a fibrotic band with smooth muscle fibres connecting the right crus of the diaphragm and the celiac axis connective tissue to the duodenojejunal flexure (DJ flexure). It suspends and anchors the DJ flexure at the junction of the fourth part of the duodenum and the beginning of the jejunum, marking the anatomical boundary between the upper and lower gastrointestinal tract.
Anchors the duodenojejunal flexure to the posterior abdominal wall and maintains its position, preventing kinking at the important junction between the duodenum and jejunum.
The ligament of Treitz is the key surgical landmark for the DJ flexure in intestinal malrotation, where its normal left paramedian position may be absent or right-sided (confirming malrotation). In Ladd's procedure for malrotation, the ligament is divided (if present) to untwist the mesentery and widen the mesenteric base. In upper GI haemorrhage, the DJ flexure marks the boundary for upper versus lower GI bleeding investigation. In percutaneous radiological feeding tube placement, the DJ flexure is the target for positioning the tube tip in the jejunum.
Intestinal malrotation presents with absence of the normal DJ flexure position left of the midline at the L2 level; the ligament of Treitz is not identifiable in its normal position on upper GI contrast study, confirming malrotation and requiring Ladd's procedure to correct the abnormal mesenteric attachment and reduce volvulus risk.
