The Anatomy and Pathology of the Lesser SAC: Implications for Peritoneal Dialysis

Abstract

Pathological conditions involving the lesser sac of the peritoneal cavity in patients on peritoneal dialysis (PD) can pose significant diagnostic and therapeutic challenges. Lack of appreciation of these challenges may delay diagnosis and compromise outcome. A case series by Li and colleagues in this issue of Peritoneal Dialysis International highlights the diagnostic challenges presented by lesser sac infection in PD patients, and in this accompanying commentary we discuss the development and anatomy of the lesser sac, as well as the pathological conditions and investigations relevant to the management of patients on PD.

Intraperitoneal anatomy with the aid of pathologic fluid and gas: An imaging pictorial review

“…[ 43 , 44 ] The lesser sac communicates with the remainder of the peritoneal cavity through the epiploic foramen of Winslow. [ 45 ] The foramen of Winslow is bordered anteriorly by the portal triad (hepatic artery, portal vein, and common bile duct) and posteriorly by the inferior vena cava. The anterior border of the lesser sac includes the gastrohepatic and hepatoduodenal ligaments along with the stomach, greater omentum, and lesser omentum.…”

“…The transverse colon/transeverse mesentery, pancreas, superior aspect of the left kidney, and diaphragm form the posterior border of this space. [ 45 ] Isolated fluid within the lesser sac raises concern for the pathology of organs located within the space, such as perforated peptic ulcer disease, pancreatitis, or cholecystitis. Still, it may represent post-operative fluid from a gastric or hepatobiliary surgery.…”

Response to Prischl and Muhr

“…We are writing in response to Li et al's publication ("Peritoneal dialysis-related infections recommendations: 2010 update") in the July 2010 issue of the journal, which is of immense interest to all of us performing peritoneal dialysis (1).…”

Imaging of the Lesser Sac by Magnetic Resonance Peritoneography

“…We congratulate Shrestha and coworkers (1) for the informative overview on the implications of the lesser sac (bursa omentalis) for peritoneal dialysis (PD) complications. In their manuscript, the authors also focused on diagnostic difficulties and discussed the various imaging techniques in use.…”