Lateral Continuity

The lateral pathways of communication of the subper-itoneal space between the abdomen and pelvis are formed by the convergence of the pararenal spaces caudal to the perirenal space and their descent into the pelvis. The lateral extent of the distal anterior renal fascia lies dorsal to the ascending and descending colon. This portion of the colon is covered ventrally by the posterior parietal peritoneum. The transversalis fascia covers the inner surface of the abdominal musculature, attaches to the crest of the ilium, and continues into the pelvis to become the endopelvic fascia covering the pelvic musculature. These fasciae and the peritoneal lining define the lateral continuation of the subperitoneal space from the abdomen into the pelvis.

On the right side, the junction of the root of the small intestine mesentery in the right lower quadrant with the subperitoneal space at the proximal ascending colon provides continuity with all the above-described connections of the root of the mesentery in addition to the continuity with the right lateral abdomen and right lat-eralpelvis.14

On the left side, there are two main avenues of communication within the subperitoneal space between the left lower abdomen and the pelvis: the central pathway and the lateral pathway.21

The central pathway contains the lower abdominal aorta and inferior mesenteric artery, forming a major communication between the left abdomen and the pelvis. The inferior mesenteric artery arises at the level of the third lumbar vertebra and passes caudally within the subperitoneal space ventral and to the left of the aorta and in relationship to the root of the sigmoid mesocolon as it descends into the pelvis. At its plane of reflection from the lateral pelvic wall, the root of the sigmoid me-socolon is in intimate relationship to the left ureter. The sigmoid mesocolon extends to and envelops the sigmoid colon.

The aorta also interconnects laterally with the pelvis as it bifurcates, forming the common iliac arteries that course to the lateral pelvis. Thus, the central and lateral pathways of the subperitoneal space interconnect also along the major arterial pathways.

These central and lateral pathways, along with the root of the sigmoid mesocolon provide continuity for spread of disease between the abdomen and the pelvis on the left.

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