Anatomy of the retroperitoneum: observations of the distribution of pathologic fluid collections.

Molmenti, Ernesto P.; Balfe, Dennis M.; Kanterman, R Y; Bennett, Harold F.

doi:10.1148/radiology.200.1.8657951

Cited by 73 publications

(35 citation statements)

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“…It is now believed that the retroperitoneal fasciae are multilaminated structures with potentially expandable interfascial planes 107) . These planes are represented by the retromesenteric, retrorenal, lateroconal, and combined interfascial planes.…”

Section: Interfascial Planesmentioning

confidence: 99%

Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery

Kanemura

Satake

Nakashima

et al. 2017

Spine Surg Relat Res

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Abstract:Lateral approach spine surgery provides effective interbody stabilization, and correction and indirect neural decompression with minimal-incision and less invasive surgery compared with conventional open anterior lumbar fusion. It may also avoid the trauma to paraspinal muscles or facet joints found with transforaminal lumbar interbody fusion and posterior lumbar interbody fusion. However, because lateral approach surgery is fundamentally retroperitoneal approach surgery, it carries potential risk to intra-and retroperitoneal structures, as seen in a conventional open anterior approach. There is an innovative lateral approach technique that reveals different anatomical views; however, it requires reconsideration of the traditional surgical anatomy in more detail than a traditional open anterior approach. The retroperitoneum is the compartmentalized space bounded anteriorly by the posterior parietal peritoneum and posteriorly by the transversalis fascia. The retroperitoneum is divided into three compartments by fascial planes: anterior and posterior pararenal spaces and the perirenal space. Lateral approach surgery requires mobilization of the peritoneum and its content and accurate exposure to the posterior pararenal space. The posterior pararenal space is confined anteriorly by the posterior renal fascia, anteromedially by the lateroconal fascia, and posteriorly by the transversalis fascia. The posterior renal fascia, the lateroconal fascia or the peritoneum should be detached from the transversalis fascia and the psoas fascia to allow exposure to the posterior pararenal space. The posterior pararenal space, however, does not allow a clear view and identification of these fasciae as this relationship is variable and the medial extent of the posterior pararenal space varies among patients. Correct anatomical recognition of the retroperitoneum is essential to success in lateral approach surgery. Spine surgeons must be aware that the retroperitoneal membrane and fascia is multilayered and more complex than is commonly understood. Preoperative abdominal images would facilitate more efficient surgical considerations of retroperitoneal membrane and fascia in lateral approach surgery.

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Section: Interfascial Planesmentioning

confidence: 99%

Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery

Kanemura

Satake

Nakashima

et al. 2017

Spine Surg Relat Res

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“…Conversely, other authors describe an inferior closure of the renal spaces by fusion of the anterior and posterior layers of the renal fascia at various points lower down (Sappey, 1889;Gerota, 1895;Testut, 1923;Congdon and Edson, 1941;Martin, 1942;Bellocq, 1944;Tobin, 1944;Mitchell, 1950;Amin et al, 1976;Barbaric, 1976;Dodds et al, 1986;Raptopoulos et al, 1995;Molmenti et al, 1996). The renal space is closed on all sides according to the classical authors, such as Sappey (1889), Gerota (1895), and Testut (1923), but also more recently for Martin (1942), Bellocq (1944), Tobin (1944), Mitchell (1950), Amin et al (1976), and Barbaric (1976).…”

Section: Historical Backgroundmentioning

confidence: 99%

Is the renal space closed?

Wolfram-Gabel¹,

Kahn²,

Rapp³

2000

Clin. Anat.

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“…[1][2][3][4][5][6][7][8] Therefore, knowledge of the normal pathways of the retroperitoneal planes is a pre-requisite when predicting the extension of retroperitoneal diseases. Traditionally, retroperitoneal planes were believed to be composed of single layer of the fascia: anterior renal fascia, posterior renal fascia and lateroconal fascia.…”

Section: Introductionmentioning

confidence: 99%

“…1,[6][7][8]10 In many previous literature, configurations of the retroperitoneal planes have been analyzed by using cadaveric models and investigating the distribution of the thickened fascial planes and fluid collections in patients with retroperitoneal pathologies. 1,3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] However, there have been only two previous literature regarding the medial pathways of the right retromesenteric plane. 3,9 The right retromesenteric plane separating the anterior pararenal space from the perirenal space is thought to be composed of the left leaf of the primary mesocolon, primary parietal peritoneum and anterior renal fascia in front of the right kidney, and the right leaf of the primary mesoduodenum, primary parietal peritoneum and anterior renal fascia behind the pancreatic head and descending duodenum ( Figure 1).…”

Section: Introductionmentioning

confidence: 99%

Medial pathway patterns of the right retromesenteric plane: anatomical investigation using MDCT in patients with acute pancreatitis and pyelonephritis

Takaji

Mori

Yamada

et al. 2016

BJR

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Objective: To investigate the medial pathways of the right retromesenteric plane by reviewing multidetector CT (MDCT) findings in patients with acute pancreatitis and pyelonephritis. Methods: 112 patients with acute pancreatitis and 114 patients with pyelonephritis underwent MDCT scans. 64 of the 112 patients with acute pancreatitis and 34 of the 114 patients with pyelonephritis had right retromesenteric plane thickening because of inflammatory extensions. The medial pathways of the right retromesenteric plane were evaluated by two radiologists in consensus. Results: In 18 (28%) of the 64 patients with acute pancreatitis and 10 (29%) of the 34 patients with pyelonephritis, the right retromesenteric plane continued to the central retroperitoneum behind the descending duodenum and pancreatic head (Type 1 pathway). The right retromesenteric plane extended to the right wall of the descending duodenum (Type 2 pathway) in 46 patients (72%) with acute pancreatitis and 24 patients (71%) with pyelonephritis. There was no significant difference in the pathway patterns of the right retromesenteric plane between the acute pancreatitis group and the pyelonephritis group (Type 1 pathway, p 5 0.89; Type 2 pathway, p 5 0.76). Conclusion: Two patterns were confirmed regarding the medial pathways of the right retromesenteric plane; this anatomical knowledge is important for evaluating the extension of retroperitoneal diseases. Advances in knowledge: Medial aspect of the right retromesenteric plane is thought to have two pathways. The right retromesenteric plane continuing to the right duodenal wall is a common type. Knowledge of these variations is important when evaluating the retroperitoneal diseases.

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Anatomy of the retroperitoneum: observations of the distribution of pathologic fluid collections.

Abstract: Embryologic development of the dorsal mesenteries suggests the existence of retromesenteric planes, and clinical observations further support their existence. These findings may explain the observed distribution of retroperitoneal fluid collections from diaphragm to pelvis.

Cited by 73 publications

References 0 publications

Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery

Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery

Is the renal space closed?

Medial pathway patterns of the right retromesenteric plane: anatomical investigation using MDCT in patients with acute pancreatitis and pyelonephritis

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