The suspensory muscle of duodenum (also known as suspensory ligament of duodenum, Treitz's muscle or ligament of Treitz The suspensory muscle arises from the right crus of the diaphragm as it passes around the esophagus, continues as connective tissue around the stems of the celiac artery and superior mesenteric artery, passes behind the pancreas, and enters the upper part of the mesentery, inserting into the junction between the duodenum and jejunum, the duodenojejunal flexure. Here, the muscles are continuous with the muscular layers of the duodenum. Despite the classical description, the muscle only solely attaches to the duodenojejunal flexure in about 8% of people; it is far more common, 40 to 60% of the time to attach additionally to the third and fourth parts of the duodenum; and 20 to 30% of the time it only attaches to the third and fourth parts. Moreover, separate multiple attachments are not that uncommon.
Embryology
Embryologically, the suspensory muscle of the duodenum is derived from mesoderm. It plays an important role in the embryological rotation of the small intestine as the superior retention band. It is an especially important landmark to note when looking at the bowel for the presence of malrotation of the gut, a syndrome often suspected in young children when they have episodes of recurrent vomiting. Visualising a normal location of the ligament of Treitz in radiological images is critical in ruling out malrotation of the gut in a child; it is abnormally located when malrotation is present.
Superior mesenteric artery syndrome (SMA) is an extremely rare life-threatening condition that can either be congenital and chronic, or induced and acute. SMA Syndrome is characterised by compression of the duodenum between the abdominal aorta and the superior mesenteric artery, and may—when congenital—result from a short suspensory muscle. One surgical treatment is Strong's operation, which involves cutting the suspensory muscle, though this is not often carried out.
History
The suspensory muscle of the duodenum was first named in 1853 by Václav Treitz, as the ' (in Latin), and described as consisting of a lower muscular portion with a broad base, and an upper tendinous portion blending with connective tissue around the origins of the superior mesenteric and coeliac arteries. It is commonly termed the ligament of Treitz by clinicians and as the suspensory muscle of the duodenum by anatomists. It has also been likened to "a polar ice cap ... a structure that many refer to but few have seen."
Additional images
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File:Crura 1.png|Depiction of the origin of the suspensory muscle, from the fibres of the right diaphragmatic crus
File:Gray 1913 1285.png|Suspensory muscle of the duodenum or muscle of Treitz seen in a ventral view.
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