Anatomic Considerations

Embryologic development explains the continuity of the subpleural and subperitoneal spaces (Fig. 13-5) and the pervasive presence of the subperitoneal space deep to the peritoneum that develops in the abdomen and pelvis (Figs. 13-6 and 13-7). The subperitoneal space includes the areolar and adipose tissue and to a large extent the vascular, lymphatic, and neural scaffolds that form the pathways that serve to facilitate the direct spread of many diseases in the abdomen and pelvis.13,15,16 These scaffolds with accompanying connective tissue course within the ligaments and mesenteries that relate to the intraperitoneal organs but also the extraperitoneal structures and organs such as the kidneys, adrenal glands, and the interstices of the solid peritoneal organs, e.g., the liver and spleen. All of the classical extraperitoneal compartments are similarly interconnected by this single huge potential space that lies beneath the peritoneum and courses through the abdomen and pelvis from the thoracoabdominal diaphragm to the pelvic diagram, containing branches of the scaffold. Once abdominal

Fig. 13—5. Schematic drawing of a coronal section through the thoracoabdominal continuum.

The esophagus (E) and aorta (A) are shown traversing that portion of the subserous space (stippled area) interconnecting the thorax and abdomen. Dark line is the subserous membrane. Cross-hatched area is the diaphragm. L = lung; Lv = liver; St = stomach; Sp = spleen. (Reproduced from Oliphant et al.12)

Sim LigamentDiagram Phrenicocolic Ligament

Fig. 13—6. Anatomic drawing of the upper folds containing the subperitoneal space.

It = ligamentum teres; hdl = hepatoduodenal ligament; dcl = duodenocolic ligament; im = terminus of sim (ileal mesentery); ghl = gastrohepatic ligament; gsl = gastrosplenic ligament; pcl = phrenicocolic ligament; tm = transverse mesocolon; srl = splenorenal ligament; sim = small intestine mesentery. (Reproduced from Oliphant et al.5)

Fig. 13—6. Anatomic drawing of the upper folds containing the subperitoneal space.

It = ligamentum teres; hdl = hepatoduodenal ligament; dcl = duodenocolic ligament; im = terminus of sim (ileal mesentery); ghl = gastrohepatic ligament; gsl = gastrosplenic ligament; pcl = phrenicocolic ligament; tm = transverse mesocolon; srl = splenorenal ligament; sim = small intestine mesentery. (Reproduced from Oliphant et al.5)

disease enters the subperitoneal space, tracking by the directly spreading process can follow the well-known anatomic specifics of these vascular, neural, and lymphatic channels.

The central cephalocaudad spread is directed largely by the dominant paths provided by the aorta and its three major anterior branches (celiac, superior mesenteric, and inferior mesenteric arteries) and its two main lateral branches (the renal arteries) (Fig. 13-8). The anterior arteries and their branches and the lateral arteries course within the subperitoneal space connecting the suspended abdominal organs, the pancreas, kidneys, and adrenal glands.

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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