Michael Oliphant, M.D. Alfred S. Berne, M.D. Morton A. Meyers, M.D.
Conventional distinction between intraperitoneal and extraperitoneal sites is often helpful in differential diagnostic considerations.1'2 Yet it should be understood that the abdomen and pelvis constitute an anatomic continuum that is punctuated by the mesenteries, ligaments, and fasciae, which may either confine pathology or actually provide an avenue for disease spread. It is essential to recognize the anatomic continuity of subserous connective tissue with its vessels and lymphatics— structures deep to the posterior parietal peritoneum with extensions into the peritoneal cavity of the abdomen and pelvis as it is invested between the layers of the mesenteries and ligaments—that underlies the holistic concept of the subperitoneal space. A scaffold with precise anatomic planes is provided for spread of disease not only between intraperitoneal structures, but also between extraperitoneal and intraperitoneal sites.1-7 This unifying schema is the basis for understanding the dissemination of intraabdominal disease, including malignancies and inflammatory and traumatic processes, both focally and at areas distant from the site of origin.
The subperitoneal space's continuity with the thorax above and the lower limbs below also provides access for the bidirectional spread of disease involving these sites. It is the fundamental continuity that provides the rationale for understanding the paradoxical clinical appearance of disease at a distance from its site of origin. The graphic display of the anatomy with modern imaging modalities coupled with the current knowledge of the morphology of the subperitoneal space provides a com prehensive clinical delineation of disease processes and an improved understanding of the pathogenesis of direct spread of disease.
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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.