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The Ligament of Treitz, also known as the suspensory ligament of the duodenum, is a fibromuscular structure that connects the duodenojejunal flexure (DJ flexure) to the right crus of the diaphragm.

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• It marks the transition between the duodenum and jejunum.
• Clinically, it defines the boundary between upper and lower gastrointestinal tract (important in GI bleeding classification).

![Illustration of coronal section of lower chest and upper abdomen shows anatomy and structural attachments of ligament of Treitz as it arises from right crus of diaphragm at esophageal hiatus and extends inferiorly to duodenum and duodenojejunal junction.

Nassar S, Menias CO, Palmquist S, et al. Ligament of Treitz: Anatomy, Relevance of Radiologic Findings, and Radiologic-Pathologic Correlation. American Journal of Roentgenology. 2021;216(4):927-934. doi:https://doi.org/10.2214/ajr.20.23273](attachment:b8bcc004-f2c7-4fda-bfee-6a7db4aa606b:image.png)

Illustration of coronal section of lower chest and upper abdomen shows anatomy and structural attachments of ligament of Treitz as it arises from right crus of diaphragm at esophageal hiatus and extends inferiorly to duodenum and duodenojejunal junction.

Nassar S, Menias CO, Palmquist S, et al. Ligament of Treitz: Anatomy, Relevance of Radiologic Findings, and Radiologic-Pathologic Correlation. American Journal of Roentgenology. 2021;216(4):927-934. doi:https://doi.org/10.2214/ajr.20.23273

Anatomy

• Origin: Right crus of diaphragm near the esophageal hiatus.
• Insertion: Duodenojejunal junction (between the 4th part of duodenum and jejunum).
• Composition:
  • Skeletal muscle fibers from right crus.
  • Smooth muscle fibers from duodenum.
  • Connective tissue containing elastic fibers.
• Blood supply: branches from inferior phrenic and superior mesenteric arteries.
• Innervation: autonomic plexuses (celiac, superior mesenteric).

![Illustrations of coronal section show anatomic attachments of suspensory ligament of Treitz. A, Illustration shows attachment to third and fourthparts of duodenum and duodenojejunal flexure. This is most common type of attachment, occurring in 40–60% of cases. B, Illustration shows attachment to third and fourth parts of duodenum only. This is second most common type of attachment, occurring in 31–53%of cases. C, Illustration shows attachment to duodeno-jejunal flexure, which occurs in only 0–8% of cases. D, Illustration shows multiple separate attachments.

2021 The University of Texas MD Anderson Cancer Center Nassar S, Menias CO, Palmquist S, et al. Ligament of Treitz: Anatomy, Relevance of Radiologic Findings, and Radiologic-Pathologic Correlation. American Journal of Roentgenology. 2021;216(4):927-934. doi:https://doi.org/10.2214/ajr.20.23273](attachment:4aa2a0ac-5f92-46a8-8d92-d8d4bef96680:Screenshot_2025-08-22_204956.png)

Illustrations of coronal section show anatomic attachments of suspensory ligament of Treitz. A, Illustration shows attachment to third and fourthparts of duodenum and duodenojejunal flexure. This is most common type of attachment, occurring in 40–60% of cases. B, Illustration shows attachment to third and fourth parts of duodenum only. This is second most common type of attachment, occurring in 31–53%of cases. C, Illustration shows attachment to duodeno-jejunal flexure, which occurs in only 0–8% of cases. D, Illustration shows multiple separate attachments.

2021 The University of Texas MD Anderson Cancer Center Nassar S, Menias CO, Palmquist S, et al. Ligament of Treitz: Anatomy, Relevance of Radiologic Findings, and Radiologic-Pathologic Correlation. American Journal of Roentgenology. 2021;216(4):927-934. doi:https://doi.org/10.2214/ajr.20.23273

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Functions

1. Suspensory support of the DJ flexure, keeping it in position.
2. Helps duodenal emptying by widening the angle of the flexure during contraction.
3. Clinical landmark separating:
   • Upper GI (proximal to ligament of Treitz: esophagus, stomach, duodenum).
   • Lower GI (distal small intestine, colon, rectum).

Clinical Significance