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Diagnostic and Interventional Imaging Feb 2015The retroperitoneum is a space situated behind the parietal peritoneum and in front of the transversalis fascia. It contains further spaces that are separated by the...
The retroperitoneum is a space situated behind the parietal peritoneum and in front of the transversalis fascia. It contains further spaces that are separated by the fasciae, between which communication is possible with both the peritoneal cavity and the pelvis, according to the theory of interfascial spread. The perirenal space has the shape of an inverted cone and contains the kidneys, adrenal glands, and related vasculature. It is delineated by the anterior and posterior renal fasciae, which surround the ureter and allow communication towards the pelvis. At the upper right pole, the perirenal space connects to the retrohepatic space at the bare area of the liver. There is communication between these two spaces through the Kneeland channel. The anterior pararenal space contains the duodenum, pancreas, and the ascending and descending colon. There is free communication within this space, and towards the mesenteries along the vessels. The posterior pararenal space, which contains fat, communicates with the preperitoneal space at the anterior surface of the abdomen between the peritoneum and the transversalis fascia, and allows communication with the contralateral posterior pararenal space. This space follows the length of the ureter to the pelvis, which explains the communication between these areas and the length of the pelvic fasciae.
Topics: Humans; Magnetic Resonance Imaging; Retroperitoneal Space; Tomography, X-Ray Computed
PubMed: 25547251
DOI: 10.1016/j.diii.2014.06.015 -
Journal of Clinical Rheumatology :... Aug 2023
Topics: Humans; Retroperitoneal Space; Tomography, X-Ray Computed
PubMed: 37254253
DOI: 10.1097/RHU.0000000000001990 -
Veterinary Surgery : VS Nov 2016To develop and describe a laparoscopic retroperitoneal access technique, investigate working space establishment, and describe the surgical anatomy in the...
OBJECTIVE
To develop and describe a laparoscopic retroperitoneal access technique, investigate working space establishment, and describe the surgical anatomy in the retroperitoneal space as an initial step for clinical application of retroperitoneal laparoscopy in dogs.
STUDY DESIGN
Cadaveric and experimental study.
ANIMALS
Cadaveric (n=8) and healthy (n=6) adult dogs.
METHODS
The retroperitoneal access technique was developed in 3 cadavers based on the human technique and transperitoneal observation. Its application and working space establishment with carbon dioxide (CO ) insufflation alone was evaluated in 5 cadavers by observing with a transperitoneal telescope and in 6 live dogs by repeated computed tomography (CT) scans at pressure of 0, 5, 10, and 15 mmHg. Recordings of retroperitoneoscopy as well as working space volume and linear dimensions measured on CT images were analyzed.
RESULTS
Retroperitoneal access and working space establishment with CO insufflation alone were successfully performed in all 6 live dogs. The only complication observed was in 1 dog that developed subclinical pneumomediastinum. As pressure increased, working space was established from the ipsilateral to the contralateral side, and peritoneal tearing eventually developed. Working space volume increased significantly from 5 mmHg and linear dimensions increased significantly from 0 to 10 mmHg. With pneumo-retroperitoneum above 5 mmHg, retroperitoneal organs, including kidneys and adrenal glands, were easily visualized.
CONCLUSION
The retroperitoneal access technique and working space establishment with CO insufflation starting with 5 mmHg and increasing to 10 mmHg provided adequate working space and visualization of retroperitoneal organs, which may allow direct access for retroperitoneal laparoscopy in dogs.
Topics: Animals; Cadaver; Carbon Dioxide; Dogs; Insufflation; Laparoscopy; Male; Pilot Projects; Pressure; Retroperitoneal Space
PubMed: 27731512
DOI: 10.1111/vsu.12571 -
Equine Veterinary Journal Mar 2021Surgical approaches to the kidneys and perirenal structures are uncommonly performed in horses and several complications have been described with the current procedures.
BACKGROUND
Surgical approaches to the kidneys and perirenal structures are uncommonly performed in horses and several complications have been described with the current procedures.
OBJECTIVE
To describe the anatomy of the retroperitoneal perirenal space and investigate a retroperitoneal minimally invasive approach to access the kidney and perirenal structures in horses.
STUDY DESIGN
Descriptive, cadaveric study.
METHODS
Anatomical description of the retroperitoneal space was performed on three equine cadavers and the surgical approach was developed based on these dissections. Ten cadaveric horses underwent a retroperitoneoscopy. Five horses were placed in a right lateral recumbency position to explore the left retroperitoneal space and five horses were placed in a standing position to explore both left and right sides. Anatomical landmarks, working space and access to the renal hilus and perirenal structures were evaluated.
RESULTS
Dissections revealed that kidneys are surrounded by a renal fascia which delimits two spaces: a perirenal space between the kidney and the renal fascia, and a pararenal space between the renal fascia and psoas muscles or peritoneum. The retroperitoneoscopic portal was placed at the level of the dorsal aspect of the tuber coxae, 3 cm caudal to the last rib for the left side and 2 cm caudal to the last rib for the right side. Retroperitoneal access and working space were successfully established in all horses. The standing position allowed an easier dissection than lateral recumbency. Division of the perirenal fat allowed access to the kidney and adrenal glands as well as individualisation of renal vessels and ureter in the renal hilus.
MAIN LIMITATIONS
Study of cadavers precluded appreciation of haemorrhage or use the pulsating vessels as landmarks.
CONCLUSIONS
This study provides a description of the retroperitoneal perirenal space and describes a new surgical approach to access kidneys and perirenal structures in horses.
Topics: Animals; Cadaver; Hemorrhage; Horse Diseases; Horses; Retroperitoneal Space
PubMed: 32473613
DOI: 10.1111/evj.13293 -
Cardiovascular and Interventional... Apr 2023
Topics: Humans; Hemorrhage; Retroperitoneal Space
PubMed: 36917249
DOI: 10.1007/s00270-023-03405-1 -
Journal of Vascular and Interventional... Jul 2022
Topics: Aneurysm, False; Aorta, Abdominal; Humans; Retroperitoneal Space
PubMed: 35777895
DOI: 10.1016/j.jvir.2022.02.001 -
American Journal of Obstetrics and... Jan 2019
Topics: Curriculum; General Surgery; Retroperitoneal Space
PubMed: 30240652
DOI: 10.1016/j.ajog.2018.09.014 -
Laeknabladid Jun 2023A 50-year old male presented to our emergency department with sudden abdominal pain. Upon arrival he was diaphoretic, pale and tachycardic. A CT showed retroperitoneal...
A 50-year old male presented to our emergency department with sudden abdominal pain. Upon arrival he was diaphoretic, pale and tachycardic. A CT showed retroperitoneal hemorrhage with suspected tumor at the left adrenal gland. He was quickly stabilized with intravenous fluids and blood transfusion. Rebleed occurs roughly a week after discharge and a new CT showed a visceral pseudoaneurysm from the left middle adrenal artery. The pseudoaneurysm was embolized and the patient discharged in good condition. Follow-up MRI depicted reabsorption of the hematoma and no adrenal tumor. Thus, the etiology of the previous retroperitonal hemorrhage is considered spontaneous.
Topics: Male; Humans; Middle Aged; Aneurysm, False; Retroperitoneal Space; Hemorrhage; Hematoma; Adrenal Glands
PubMed: 37233620
DOI: 10.17992/lbl.2023.05.744 -
Surgical Infections Jun 2021Retroperitoneal infection is a persistent and widespread infectious disease that is difficult to treat. It is usually caused by secondary complications such as...
Retroperitoneal infection is a persistent and widespread infectious disease that is difficult to treat. It is usually caused by secondary complications such as inflammation, damage, or perforation of adjacent organs in the retroperitoneal space. Pathogenic bacteria invade the retroperitoneal space through retroperitoneal and interstitial organs, peripheral tissue, and the blood. As a result, infections mostly arise from severe acute pancreatitis, acute colonic diverticulitis, inflammatory bowel disease, kidney abscess, and biliary tract injury. Initially manifested by the presence of lumbago, this disease spreads easily, is persistent, and is often misdiagnosed. Review and synthesis of pertinent literature and guidelines pertaining to abdominal infection and retroperitoneal infection. Recent data indicate that mortality rates associated with retroperitoneal infection have been increasing annually. Early diagnosis and treatment have been shown to improve the prognosis. In the early stage, infection is insidious and lacks typical symptoms, and is primarily diagnosed with computed tomography (CT). Strategies that control the source of infection, rational use of antibiotic agents, and nutritional interventions are the primary approaches to treat the infections. Emergence of minimally invasive drainage technologies, including the ultrasound/CT-guided puncture and drainage, percutaneous nephroscope puncture and drainage, and drainage using a catheter through an abdominal puncture device (trocar) have shortened the treatment cycle and disease burden. However, current diagnosis and treatment for retroperitoneal infection are not sufficiently effective because some patients do not show typical clinical manifestations. Moreover, sensitivity and specificity of available auxiliary examination methods are not supported by sufficient evidence-based medical research. Additionally, there are no uniform standards on the timing of surgical intervention and treatment options. Therefore, we summarized the progresses on current diagnosis and treatment approaches for retroperitoneal infection.
Topics: Abdominal Abscess; Acute Disease; Drainage; Humans; Pancreatitis; Retroperitoneal Space
PubMed: 33146587
DOI: 10.1089/sur.2020.126 -
The Journal of Emergency Medicine Jun 2019
Topics: Aged; Aphasia; Hemorrhage; Humans; Male; Retroperitoneal Space; Rupture, Spontaneous; Stroke; Tomography, X-Ray Computed
PubMed: 30879846
DOI: 10.1016/j.jemermed.2019.01.037