Mixed Collections

As a rule, large pelvic collections occupy several spaces with multiple possibilities: involvement of several ex traperitoneal spaces or association of intraperitoneal and extraperitoneal collections (Figs. 8-234 through 8-236). In patients with large amounts of fluid in the infrarenal extraperitoneal space, extension into the pelvic extra-peritoneal space is not rare. The dorsal extension medial to the iliac vessels and/or a more medial extension into the prevesical space are the most common pathways 42,134,136 Mixed collections of both intraperitoneal and extraperitoneal fluid are rare, with the exception of major crash injury with rupture of different organs. Differentiation between intraperitoneal and extraperitoneal pelvic collections can be readily made, but it can be difficult to distinguish whether the fluid originated in the pelvic spaces or the retroperitoneum.

Fig. 8-234. Prevesical hematoma secondary to crash injury in a male.

(a) Typical "molar tooth" configuration with "crown" posterior portion (asterisk). There is a small disruption of the anterior part of the perivesical space (arrow). Note the fluid—fluid level of subacute hemorrhage.

(b) Cephalad extension into the prevesical space. Small hematoma in the laterovesical space (arrowhead). Note hematoma inside left rectus muscle.

Fascial Spaces For Molars

Fig. 8—235. Disruption of the bladder secondary to crash injury in a female.

(a) Liquid in the prevesical space with extension in the perivesical space (asterisk) (there is no space between fluid collection and bladder wall). Contrast medium in the collection (arrow). "Molar tooth" configuration.

(b) Cephalad portion. The perivesical space is occupied by fluid collection.

Paravesical Space

Fig. 8—236. Prevesical and paravesical gas collection secondary to disruption of a sigmoidal abscess in a female.

(a) Gas in the prevesical (A) and paravesical (E) space with anterior extension into the inguinal canal. Thickening of the umbilicovesical fascia (arrow). Si = sigmoid.

(b) Cephalad extension of gas with disruption of transversalis fascia (arrow).

Fig. 8—236. Prevesical and paravesical gas collection secondary to disruption of a sigmoidal abscess in a female.

(a) Gas in the prevesical (A) and paravesical (E) space with anterior extension into the inguinal canal. Thickening of the umbilicovesical fascia (arrow). Si = sigmoid.

(b) Cephalad extension of gas with disruption of transversalis fascia (arrow).

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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