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Beyond the kidneys, the renal fascia is closed, forming a cone superiorly and an inverted cone inferiorly. A network of interlobular septa acted as a barrier or pathway to the free spread of disease from the perirenal space to the central retroperitoneum or from the central retroperitoneum to the perirenal space.

To clarify the anatomy of the peritoneal reflections of the left perihepatic region, the authors examined 95 cadavers. Thirty-eight were studied radiographically, 37 with sagittal dissection, and 20 with transverse dissection. In over 80% of the cadavers, the left triangular ligament of the liver separated the left suprahepatic space into anterior and posterior sections. The lesser omentum extended to the diaphragm, where its anterior layer reflected and continued as the posterior layer of the left triangular ligament. Thus, the posterior left suprahepatic space and the lesser sac were clearly separated by the lesser omentum and the stomach and over-lapped each other in three dimensions. The posterior left suprahepatic space was located anterosuperior to the lesser sac and in turn was continuous with the gastrohepatic space inferiorly. Carefully researched diagrams of both the midline sagittal and left parasagittal perihepatic spaces were developed. This information has clinical value when the radiologist is called on to drain a left perihepatic abscess.

Our objective was to describe the boundaries and sites of communication of the posterior peritoneal compartments in order to explain extensions of pathological processes in retroperitoneal areas. To this end we examined these distinct bilateral compartments [anterior (AP) and posterior (PP) pararenal and perirenal (P) spaces] in four bodies by CT scans, dissections, crosssections, latex injections, and light microscopy. Perirenal areas bilaterally were closed spaces which extended from the inferior surface of the diaphragm to the superior pelvic aperture (pelvic inlet) tapering superiorly and inferiorly in the shape of two cones with a common base at the midrenal area where they communicated across the median plane. The AP is a potential space on the right but contains the pancreas on the left. Each has shorter superior and inferior extensions than the corresponding PP space. Tough, often multilaminar, fasciae surrounded these spaces and limited the spread of injected latex except where vascular pathways permitted inter-compartmental spread. Computer-assisted 3-D reconstructions showed that these spaces extended potentially from the diaphragm into the pelvis. These compartments and their fasciae help explain the predictable yet restricted clinical extensions of pancreatitis, renal infections, and aortic aneurysms in the posterior abdomen.

No abstract