The anatomical role of Scarpa's fascia in the manifestation of clinical signs associated with retroperitoneal haemorrhage and bile leakage

Abstract

While the aetiology of eponymous surface signs of pancreatitis, retroperitoneal haemorrhage and bile leakage is known, it is unclear what causes their characteristic appearance. The location of Scarpa's fascia, the membranous layer of superficial fascia, makes it a potential candidate in understanding the pattern of these signs. The goal of this study was to assess the distribution of Scarpa's with respect to each sign. Dissections were performed on 7 embalmed cadavers, 3 males and 4 females, aged 63 to 92. Our results indicate that Scarpa's attaches where the umbilicus emerges from the external oblique aponeurosis providing a deficiency that can cause the bruising in Cullen's sign. As the membranous layer continues into the flanks, it creates a potential space which contributes to the pattern in Turner's sign. The continuation of the membranous layer into the axilla and chest forms another potential space for bile to form the pattern in Icterus Marginatus (demarcated truncal jaundice with retroperitoneal bile leakage). The anatomical characteristics of Scarpa's fascia described by this study support the hypothesis that it is involved in delineating the physical patterns seen in these clinical signs.Grant Funding SourceWestern Graduate Research