Detailed Anatomy of the Right Upper Quadrant

Morison Pouch

Since Barnard's original classification8 in 1908, a great deal of confusion in the definition and true anatomic Fig. 3-3. Rutherford Morison 1853-1939 . Morison, an English surgeon, is best known for the pouch that he described in The Anatomy of the Right Hypochondrium Relating Especially to Operations for Gallstones in 1894. He emphasized that bile leaks drain into this area but the external drain must extend to the very depths of the pouch. Courtesy of Wellcome Institute of the History of...

Lymphatic Drainage of the Liver and Pathways of Lymph Node Metastasis

Foramen Foramen Winslow Lymph Node

The lymphatic drainage of the liver consists of two major pathways the deep pathways and the superficial pathways.1 The lymphatic vessels in the liver are believed to originate in the perilobular connective tissue. The perilobular lymphatic vessels from the lobules deep inside the parenchyma drain into the deep networks along the periportal space in the Glisson's sheath toward the porta hepatis and along the hepatic veins. The perilobular lymphatic vessels from the lobules near the surface of...

Distinction Between Perirenal and Subcapsular Collections

Hematoma Subcapsular Renal

Abscesses or hematomas in the perirenal space and in the subcapsular region of the kidney can simulate each other and a host of other conditions closely. Identification of their specific localization may be very important in the clinical diagnosis and in determining the most appropriate therapy. Advances in establishing the characteristic features of abscesses or hematomas are based on the anatomic structures that define their collection.11 Anatomic Considerations. The renal capsule Fig. 8158...

The Three Extraperitoneal Compartments and Perirenal Fasciae

Extraperitoneum Pararenal Fascia

Detailed evaluation shows that the extraperitoneal region, rather than being composed of amorphous straggling mesenchyme, is distinctly demarcated by well-defined fascial planes. Figure 8-1a is an enlarged horizontal cross-section through the flank at the lower pole of the kidney. Central to the division of the extra-peritoneal region are the conspicuous anterior and posterior layers of renal fascia. The posterior renal fascia was first described by Zuckerkandl21 Fig. 8-2 and the anterior renal...

Direct Invasion from Noncontiguous Primary Tumors

Infrapyloric Lymph Node

Invasion Along Mesenteric Reflections The mesenteric reflections provide an important natural pathway for extension of primary neoplasms to other sites that may not be in actual contiguity.1'9 In the upper abdomen, peritoneal reflections constitute nine major ligaments and mesenteries that provide continuity of anatomic planes for the spread of malignancies Figs. 4-1 and 4-2 Table 4-2 . These not only connect intraperitoneal sites, but also extend between intraperitoneal and extraperitoneal...

Lymphatic Drainage of the Stomach and Pathways of Lymph Node Metastasis

Lymphatic Drainage Stomach

The lymphatic drainage of the stomach consists of intrinsic and extrinsic systems. The intrinsic system in cludes intramural submucosal and subserosal networks, and the extrinsic system forms lymphatic vessels outside the stomach and generally follows the course of the arteries in various ligaments around the stomach.9,10 These lymphatic vessels drain into the lymph nodes at nodal stations in the corresponding ligaments and drain into the central collecting nodes at the root of the cellac axis...

Diverticulosis and Diverticulitis

Microcolon

Colonic diverticula do not arise randomly from the circumference of the large intestine but tend to originate in four distinct rows Fig. 15-48 a on either side of the TM and b near the mesenteric borders of the TO and TL.5,21 These are related to the points of intramural penetration through connective tissue septa of the co-lonic wall.21 Their sites of origin from the TM-TL and TM-TO haustra can be identified clearly on routine radiographic studies Fig. 15-49 . Bona fide diverticula do not...

Lymphatic Drainage of the Colon and Pathways of Lymph Node Metastasis

Regional nodal metastasis is one of the most common modes of tumor spread in carcinoma of the colon. The lymph nodes draining lymphatics from the colon can be classified into four groups the epicolic nodes, the para-colic nodes, the intermediate mesocolic nodes, and the principal nodes.16,17 The epicolic nodes lie on the wall of the colon beneath the peritoneum covering the colon, generally on the antimesocolic side of the colonic wall. The paracolic nodes lie along the marginal vessels along...

Seeded Perihepatic and Subdiaphragmatic Metastases

Ruptured Cyst Ovaries

Conventional radiologic studies have disclosed the intraperitoneal spread of seeded metastases to the supra-mesocolic compartment only on occasion. This pathway of spread is illustrated graphically in Figure 4-148 in an instance of a spilled ovarian dermoid cyst.110 The avenue and characteristic sites of implantation are clearly mapped out in the patient studied by CT in Figure 4149. Seeded deposits in both Morison's pouch and the right subphrenic space are therefore not uncommon (Fig. 4-150)....