Seeded Sites

Stasis or pooling of ascitic fluid favors the processes of deposition, fixation, and growth of seeded malignant cells. The seeded deposits coalesce and are then fixed to

Paracolic Ligament

Pelvic cavity b

Fig. 4—105. (a) Posterior peritoneal reflections and intraabdominal spaces.

TrM = transverse mesocolon; PL = phrenicocolic ligament; SBM = small bowel mesentery; AC = attachment of ascending colon; DC = attachment of descending colon; SM = sigmoid mesocolon; R = rectum; B = urinary bladder; RIS = right infracolic space; LIS = left infracolic space; RPG = right paracolic gutter; LPG = left paracolic gutter. (b) Diagram of the pathways of flow of intraperitoneal fluid and the four predominant sites in the lower abdomen.

Pelvic cavity b

Fig. 4—105. (a) Posterior peritoneal reflections and intraabdominal spaces.

TrM = transverse mesocolon; PL = phrenicocolic ligament; SBM = small bowel mesentery; AC = attachment of ascending colon; DC = attachment of descending colon; SM = sigmoid mesocolon; R = rectum; B = urinary bladder; RIS = right infracolic space; LIS = left infracolic space; RPG = right paracolic gutter; LPG = left paracolic gutter. (b) Diagram of the pathways of flow of intraperitoneal fluid and the four predominant sites in the lower abdomen.

Four Spaces Gutters Abdomen Flow

Fig. 4-106. Pelvic drainage of intraperitoneal fluid.

Intraperitoneal opaque contrast material first gravitates to the pelvic cavity, filling the midline pouch of Douglas (PD) and then the two paravesical recesses (PV). B = urinary bladder.

Morrison Pouch Right Paracolic Gutter

Fig. 4-107. Sagittal view of relationships of pouch of Douglas (PD).

This is the lower continuation of the peritoneal cavity between the rectosigmoid and the urinary bladder (B). (Reproduced from Meyers.3)

Fig. 4-107. Sagittal view of relationships of pouch of Douglas (PD).

This is the lower continuation of the peritoneal cavity between the rectosigmoid and the urinary bladder (B). (Reproduced from Meyers.3)

the serosal surfaces by fibrinous adhesions that quickly become organized.95

Analysis of a series of proved cases has shown that the sites of lodgment and growth of intraperitoneal seeded metastases clearly follow the pathways of flow of ascitic fluid.3 The pouch of Douglas is involved in over 50%, the lower small bowel mesentery in about 40%, the sig-moid mesocolon in about 20%, and the right paracolic gutter in about 20% of cases. In males, the primary carcinoma most often arises in the gastrointestinal tract (stomach, colon, pancreas), and in females, in the genital system (ovary).96-102 In carcinoma of the pancreas, intra-peritoneal seeding appears to be more commonly associated with neoplasms of the tail.103 Peritoneal metastases from primary neoplasms of the urinary tract are

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.

Get My Free Ebook


Post a comment