Fascial planes and compartments of the posterior abdomen: The perirenal and pararenal pathways

Abstract

Our objective was to describe the boundaries and sites of communication of the posterior peritoneal compartments in order to explain extensions of pathological processes in retroperitoneal areas. To this end we examined these distinct bilateral compartments [anterior (AP) and posterior (PP) pararenal and perirenal (P) spaces] in four bodies by CT scans, dissections, crosssections, latex injections, and light microscopy. Perirenal areas bilaterally were closed spaces which extended from the inferior surface of the diaphragm to the superior pelvic aperture (pelvic inlet) tapering superiorly and inferiorly in the shape of two cones with a common base at the midrenal area where they communicated across the median plane. The AP is a potential space on the right but contains the pancreas on the left. Each has shorter superior and inferior extensions than the corresponding PP space. Tough, often multilaminar, fasciae surrounded these spaces and limited the spread of injected latex except where vascular pathways permitted inter-compartmental spread. Computer-assisted 3-D reconstructions showed that these spaces extended potentially from the diaphragm into the pelvis. These compartments and their fasciae help explain the predictable yet restricted clinical extensions of pancreatitis, renal infections, and aortic aneurysms in the posterior abdomen.

An anatomical, histopathological, and molecular biological function study of the fascias posterior to the interperitoneal colon and its associated mesocolon: their relevance to colonic surgery

“…Subsequent studies by gross anatomy (Congdon, ; Lei et al. ; Molmenti et al. ), radiologic sectional anatomy (Somogyi et al.…”

Single institution results of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of pancreas in 78 patients

“…The radical antegrade modular pancreatosplenectomy (RAMPS) was introduced in 2003 to deal with the lack of standardization of distal pancreatosplenectomy for carcinoma of the pancreas, specifically regarding the methods of developing tangential margins and for obtaining N1 node clearance . The rationale of the tangential margin dissection is based upon the anatomical studies of Lei et al, specifically on the relation of the anterior renal fascia to the posterior border of the pancreas . The N1 node clearance is based on the summary of lymphatic drainage of the pancreas by O'Morchoe .…”

A Modification of Radical Antegrade Modular Pancreatosplenectomy for Adenocarcinoma of the Left Pancreas: Significance of En Bloc Resection Including the Anterior Renal Fascia

“…Because the pancreas body and tail are thin structures, carcinomas can easily spread beyond pancreatic parenchyma. The left pancreas attaches closely superior to retroperitoneal organs, including the kidney, adrenal gland, and IVC, which are demarcated with the anterior renal fascia [ 18 ]. Although the pancreatic carcinoma easily infiltrates near to the anterior renal fascia beyond parenchyma, involvement of retroperitoneal organs beyond the anterior renal fascia is uncommon [ 19 ].…”