Pelvic and Mesenteric Continuities

Clinical instances of the anatomic continuity of the extraperitoneal conjoined anterior and posterior pararenal spaces below the cone of renal fascia with the extraper-

29 133 134

itoneal spaces within the pelvis provide striking evidence of the continuum of the subperitoneal space and the potential for bidirectional spread between the abdomen and the pelvis.9,12,18,135,136 Figures 8-103 and 8104 demonstrate direct cephalad extension into the anterior pararenal space and small bowel mesentery from pelvic hemorrhage. As a complication of femoral vascular catheterization procedures, bleeding from the femoral sheath may open directly into the prevesical extra-peritoneal compartment and then spread superiorly and posteriorly, deep to the parietal peritoneum into the

Femoral Compartment

Fig. 8-99. Acute bleeding in right anterior pararenal space.

(a) At the time of initial oral cholecystogram, extraperitoneal fat is intact, allowing visualization of the hepatic angle and flank stripe (arrows) and psoas muscle.

(b) Film obtained the next day during abdominal catastrophe documents acute loss of the hepatic angle associated with a diffuse density throughout the right abdomen. Significantly, the flank stripe (arrows) is preserved.

(c) Gross specimen. Ruptured hepatic artery aneurysm, thrombus removed.

Fig. 8-99. Acute bleeding in right anterior pararenal space.

(a) At the time of initial oral cholecystogram, extraperitoneal fat is intact, allowing visualization of the hepatic angle and flank stripe (arrows) and psoas muscle.

(b) Film obtained the next day during abdominal catastrophe documents acute loss of the hepatic angle associated with a diffuse density throughout the right abdomen. Significantly, the flank stripe (arrows) is preserved.

(c) Gross specimen. Ruptured hepatic artery aneurysm, thrombus removed.

Hepatic Artery Aneurysm

Fig. 8-100. Anterior pararenal hemorrhage from a ruptured calcified splenic artery aneurysm (black arrows).

(a) The fluid mass displaces the descending colon laterally as it extends downward within the anterior compartment (white arrows). The prominent localized changes of hematoma in the phrenicocolic ligament on the anatomic splenic flexure of the colon (single white arrow) further localize the effusion to the anterior pararenal space.

(b) Extension from ruptured splenic artery into the anterior pararenal space and into the phrenicocolic ligament. C = colon; P = pancreas; K = kidney.

(Reproduced from Meyers.132)

Fig. 8-100. Anterior pararenal hemorrhage from a ruptured calcified splenic artery aneurysm (black arrows).

(a) The fluid mass displaces the descending colon laterally as it extends downward within the anterior compartment (white arrows). The prominent localized changes of hematoma in the phrenicocolic ligament on the anatomic splenic flexure of the colon (single white arrow) further localize the effusion to the anterior pararenal space.

(b) Extension from ruptured splenic artery into the anterior pararenal space and into the phrenicocolic ligament. C = colon; P = pancreas; K = kidney.

(Reproduced from Meyers.132)

Spontaneous Splenic Bleed

Fig. 8-101. Spontaneous left anterior pararenal hemorrhage in a middle-aged female with a fall in hematocrit from 34-20% within 10 days. No specific etiology could be identified.

(a) A left-sided mass is evident but the contours of the kidney and psoas muscle are clearly maintained.

(b) Small bowel series. Oblique view demonstrates that the intestine is displaced anteriorly.

Fig. 8-101. Spontaneous left anterior pararenal hemorrhage in a middle-aged female with a fall in hematocrit from 34-20% within 10 days. No specific etiology could be identified.

(a) A left-sided mass is evident but the contours of the kidney and psoas muscle are clearly maintained.

(b) Small bowel series. Oblique view demonstrates that the intestine is displaced anteriorly.

Small Intestine Anterior View

Fig. 8-102. Anterior pararenal space urine extravasation accompanying perirenal hematoma.

(a) Fractured right kidney with acute perirenal hematoma (H) after fall from a ladder. Fluid is also present in the right anterior pararenal space.

(b) On delayed image, this is shown to be due to leak of urine from the ureter (arrows). Both CT images are in the right decubitus position.

(Courtesy of Jay P. Heiken, M.D., Mallinckrodt Institute of Radiology, St. Louis, MO.)

Fig. 8-102. Anterior pararenal space urine extravasation accompanying perirenal hematoma.

(a) Fractured right kidney with acute perirenal hematoma (H) after fall from a ladder. Fluid is also present in the right anterior pararenal space.

(b) On delayed image, this is shown to be due to leak of urine from the ureter (arrows). Both CT images are in the right decubitus position.

(Courtesy of Jay P. Heiken, M.D., Mallinckrodt Institute of Radiology, St. Louis, MO.)

Renal Space Radiology

Fig. 8-103. Ascent of pelvic bleeding into anterior pararenal space.

Following pelvic surgery in this female patient receiving anticoagulants, severe pelvic hemorrhage is shown to rise into the anterior pararenal space on the right (H) to the level of the lower cone of renal fascia.

Fig. 8-103. Ascent of pelvic bleeding into anterior pararenal space.

Following pelvic surgery in this female patient receiving anticoagulants, severe pelvic hemorrhage is shown to rise into the anterior pararenal space on the right (H) to the level of the lower cone of renal fascia.

combined pararenal space of the abdomen.137,138 On the other hand, Figure 8—105 documents extension from the anterior pararenal space into the prevesical pelvic space by a pancreatic inflammatory process.

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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