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General Surgery
Retroperitoneum
Built from Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
What’s inside
12 sections · 133 slides
Overview
- Scope of this topic
- Retroperitoneal contents
Development and historical background
- Development of the peritoneum and retroperitoneal fasciae
- Mesodermal origin of the lumbar fasciae
- Retroperitoneal fascial development at five weeks
- Distribution of the retroperitoneal fasciae at seven months
- Congenital anomalies of the retroperitoneum
- Historical description of the retroperitoneal spaces
- Anatomic and Surgical History of the Retroperitoneum
- Anatomic and Surgical History of the Retroperitoneum (continued)
- Anatomic and Surgical History of the Retroperitoneum (continued)
Fasciae of the posterior abdominal wall
- Definition and limits of the retroperitoneal space
- Retroperitoneal spaces in schematic cross section
- Transversalis fascia and its continuities
- Cross section of the posterior body wall in the lumbar region
- Extraperitoneal fascial layers over the iliacus
- Thoracolumbar fascia: layers and terminology
- Laminae of the thoracolumbar fascia
- Middle lamina and the lumbocostal ligament
- Anterior lamina and the muscular compartments
- Thoracolumbar fascia
- Three compartments formed by the thoracolumbar fascia
- Compartments for erector spinae and quadratus lumborum
- Thoracolumbar fascia in cross section of the posterior abdominal wall
- Surgical landmarks and nerves at risk in posterior incisions
Retroperitoneal connective tissue
- Hinman's three strata of extraperitoneal connective tissue
- Contents of each stratum
- Davies' two-layer concept of extraperitoneal tissue
Boundaries, zones and the iliac fossa
- Boundaries of the retroperitoneal region
- Three anatomic zones of the retroperitoneum
- Three anatomic zones of the retroperitoneum
- Predictors of urgent exploration after blunt injury
- Radiologic evaluation of the retroperitoneum
- The iliac fossa
- Neurovascular relations in the iliac fossa
Perirenal space and the renal fascia
- The perirenal space
- Character and attachments of the renal fascia
- Horizontal section through the left kidney, spleen and stomach
- Reich's finding at the duodenum
- Lower extent of the renal fascia: fusion versus nonunion
- Nephroptosis and the periureteral sheath
- Presacral pneumography
- Lateroconal fascia
- Radiologic visibility of Gerota's laminae
- Renal fascia and the three retroperitoneal compartments
- Layers of the renal fascia on computed tomography
Pararenal compartments and fluid pathways
- Anterior pararenal compartment
- Abscess in the anterior pararenal space
- Retrorenal extension of pancreatitic fluid
- Pathway of extravasation from the tail of the pancreas
- Posterior pararenal compartment
Communication between the retroperitoneal spaces
- Communication of the retroperitoneal spaces
- Infrarenal confluence of the pararenal spaces
- Medial attachment of the posterior renal lamina
- Midline communication of the perirenal spaces
- Behaviour of collections in the retroperitoneal compartments
- Limits of the current fascial map
Extraperitoneal spaces of the pelvis and anterior wall
- Subperitoneal pelvic space
- Layers of the abdominal wall and inguinal area
- Vesicoumbilical fascia and the vesical spaces
- Prevesical and perivesical spaces
- Prevesical and perivesical spaces in sagittal section
- Digital exploration of the retropubic space
- Extraperitoneal spaces of the ventral abdominal wall in midsagittal section
- Muntean's urogenital fascia
- Rectovesical and rectovaginal septa
- Extraperitoneal pelvic fluid collections
- Molar tooth configuration of a prevesical collection
- Umbilicovesical fascia and the vesical spaces in sagittal diagram
- Prevesical space distended by a large fluid collection
- Continuities of the prevesical space
- Retroperitoneal haematoma after femoral catheterization
- Extraperitoneal haematoma in the prevesical space
- Extension of the same haematoma into the posterior pararenal space
Psoas, lymphatics and innervation
- Relations of the psoas muscle
- Psoas abscess
- Neoplastic involvement of psoas
- Retroperitoneal lymphatics: general arrangement
- Groups of retroperitoneal lymph nodes
- Preaortic nodes
- Retroaortic and paraaortic nodes
- Caval group of nodes
- Common and external iliac nodes
- Internal iliac, obturator and sacral nodes
- Retroperitoneal lymph nodes and the lumbar chains
- Lumbar nodal chains in cross section
- Formation of the cisterna chyli and thoracic duct
- Nerves of the retroperitoneum
- Iliohypogastric nerve: T12 to L1
- Ilioinguinal nerve: L1
- Genitofemoral nerve: L1 and L2
- Lateral femoral cutaneous nerve: L2 and L3
- Obturator nerve: anterior divisions of L2, L3, L4
- Femoral nerve: posterior divisions of L2, L3, L4
- Nerves of the retroperitoneum
- Lumbar sympathetic chains
Pathology, neoplasia and operative exposure
- Spectrum of retroperitoneal pathology
- Ruptured aortic aneurysm presenting as a groin mass
- Haematoma from a ruptured aortic aneurysm contained by the transversalis fascia
- Retroperitoneal infection and perforation
- Retroperitoneal fibrosis
- Other reported retroperitoneal pathology
- Retroperitoneal neoplasia reported in the chapter
- Retroperitoneal cysts of mullerian type
- Operative routes to the retroperitoneum
- Outcomes of surgery for retroperitoneal sarcoma
- Retroperitoneal haematoma from trauma
- Operative Management of Retroperitoneal Hematomas
- Cattell manoeuvre
- Right-sided exposure of retroperitoneal structures
- Mattox manoeuvre
- Left-sided exposure of the retroperitoneum
- Laparoscopic and retroperitoneoscopic access
- Anatomic complications of retroperitoneal surgery
Summary
- Key points: architecture
- Key points: pathways and clinical anatomy
- Unresolved questions in this anatomy
- Sources cited in the text: anatomy of the spaces
- Sources cited in the text: radiologic anatomy
- Sources cited in the text: clinical and operative
- Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
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