Compartmentalization of the Anterior Pararenal Space

Maarten S. van Leeuwen, M.D. Michiel A.M. Feldberg, M.D.

The space based on fascial boundaries, enclosed by the posterior parietal peritoneum anteriorly, the anterior renal fascia posteriorly, and the lateroconal fascia laterally, has been termed the anterior pararenal space by Meyers et al.12 It contains the extraperitoneal alimentary structures, namely the pancreas, duodenum, and ascending and descending colon. Because the spread of fluids, inflammation, and gas does not always conform to the anterior pararenal space as a distinct compartment, Dodds et al.31 stressed the importance of the em-bryologic development of the anterior pararenal space from three major compartments: the bilateral perico-lonic spaces and the pancreaticoduodenal space. They stated that the secondary or anterior retroperitoneuni is a laminated space, bounded by folded, fused leaves of mesentery that contain the distinct and generally separate colonic and pancreaticoduodenal subcompart-ments. Whereas the anterior renal fascia and similarly the lateroconal fascia, although fusional in nature,139 have been considered as single laminae, Molmenti et al.34 recently emphasized the existence of a dissectable set of planes on CT. The fact that these fusion planes of the mesenteric surfaces with the primary retroperitoneum may reopen by the entrance of fluid supports the clinical identification and extent of fluid collections, seen occasionally in pancreatitis, less frequently in duodenal lesions, and rarely in appendicitis, diverticulitis, or colitis.

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Essentials of Human Physiology

Essentials of Human Physiology

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