Lesser Sac Abscesses

Anatomically, Morison's pouch communicates with the lesser sac via the epiploic foramen. Noninfected intra-peritoneal fluid originating within the greater peritoneal cavity may thus readily gain entrance to the lesser sac (Figs. 3-68 through 3-71). However, this slitlike connection is easily sealed off by adhesions, so the lesser sac is not usually contaminated in generalized peritonitis unless the primary infection arises in the walls of the lesser sac itself. Abscesses here are therefore encountered most often following perforated posterior ulcers of the stomach or duodenal bulb and pancreatitis (Figs. 3-72 through 3-79).

Lesser sac abscesses typically distend the space and displace the stomach anteriorly and the transverse colon inferiorly. I have noted that adhesions developing along the peritoneal fold raised by the left gastric artery often clearly partition an abscess to one ofits two major compartments (Figs. 3-73, 3-75 through 3-82). This has since been confirmed by others.27 Infection may occasionally follow acute rupture of the gallbladder, presumably since the bile is discharged into the lesser sac before the foramen can be sealed off (Fig. 3-83).

Fluid collections within the lesser sac may occasionally extend into its lower recess between the leaves of the greater omentum (Figs. 3-84 and 3-85).

Perforation of the posterior wall of the intraabdominal esophagus extends directly into the lesser sac.55

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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