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Pathways of abdominal tumour spread: the role of the subperitoneal space.

Gore RM, Newmark GM, Thakrar KH, Mehta UK, Berlin JW - Cancer Imaging (2009)

Bottom Line: This space is formed by the subserosal areolar tissue that lines the inner surfaces of the peritoneum and the musculature of the abdomen and pelvis.It contains the branches of the vascular, lymphatic, and nervous systems that supply the viscera.The subperitoneal space extends into the peritoneal cavity and is invested between the layers of the mesenteries and ligaments that support and interconnect the abdominal and pelvic organs.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, North Shore University Health System, University of Chicago, Evanston, IL 60201, USA. rgore@uchicago.edu

ABSTRACT
The subperitoneal space is a large, unifying, anatomically continuous potential space that connects the peritoneal cavity with the retroperitoneum. This space is formed by the subserosal areolar tissue that lines the inner surfaces of the peritoneum and the musculature of the abdomen and pelvis. It contains the branches of the vascular, lymphatic, and nervous systems that supply the viscera. The subperitoneal space extends into the peritoneal cavity and is invested between the layers of the mesenteries and ligaments that support and interconnect the abdominal and pelvic organs. As such, it provides one large continuous space in which infectious, neoplastic, inflammatory, and hemorrhagic disease may spread in many directions.

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Small bowel mesentery: conduit of disease. (A) The anatomy near the root of the SBM (RSBM). The root of the SBM (area within dashed circle) is contiguous superiorly to the hepatoduodenal ligament (HDL) along the SMV, anteriorly to the transverse mesocolon (TM), and posterolaterally to the ascending mesocolon and descending mesocolon (DM). The gastrocolic trunk (GT) is a landmark of the junction between the transverse mesocolon and the root of the SBM. The inferior mesenteric vein (IMV) is a landmark of the descending mesocolon and joins the SMV or splenic vein on the left side of the root of the SBM. IPDA, inferior pancreaticoduodenal artery; IPDV, inferior pancreaticoduodenal vein; PV, portal vein; SRL, splenorenal ligament. (From Okino Y, Kiyosue H, Mori H, et al. Root of the small-bowel mesentery: correlative anatomy and CT features of pathologic conditions. Radiographics 2001; 21: 1476; with permission.) (B) CT scan shows fluid (arrow) in the subperitoneal space of the small bowel mesentery in this patient with pancreatitis.
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Figure 7: Small bowel mesentery: conduit of disease. (A) The anatomy near the root of the SBM (RSBM). The root of the SBM (area within dashed circle) is contiguous superiorly to the hepatoduodenal ligament (HDL) along the SMV, anteriorly to the transverse mesocolon (TM), and posterolaterally to the ascending mesocolon and descending mesocolon (DM). The gastrocolic trunk (GT) is a landmark of the junction between the transverse mesocolon and the root of the SBM. The inferior mesenteric vein (IMV) is a landmark of the descending mesocolon and joins the SMV or splenic vein on the left side of the root of the SBM. IPDA, inferior pancreaticoduodenal artery; IPDV, inferior pancreaticoduodenal vein; PV, portal vein; SRL, splenorenal ligament. (From Okino Y, Kiyosue H, Mori H, et al. Root of the small-bowel mesentery: correlative anatomy and CT features of pathologic conditions. Radiographics 2001; 21: 1476; with permission.) (B) CT scan shows fluid (arrow) in the subperitoneal space of the small bowel mesentery in this patient with pancreatitis.

Mentions: The subperitoneal space of the small bowel mesentery is continuous with the bare area of the ascending colon and the transverse mesocolon (Fig. 7). The leaves of the small bowel mesentery continue as the posterior peritoneum, overlying the posterior abdominal wall. The connective tissue in the small bowel mesentery merges with the subperitoneal tissue of the retroperitoneum. The subperitoneal tissue continues without interruption inferiorly, from the right lower abdomen over the pelvic musculature and along the lateral pelvic side walls. Because this space potentially communicates with the broad ligament, it provides a pathway for bidirectional disease spread between the abdomen and the pelvis[2–4].Figure 7


Pathways of abdominal tumour spread: the role of the subperitoneal space.

Gore RM, Newmark GM, Thakrar KH, Mehta UK, Berlin JW - Cancer Imaging (2009)

Small bowel mesentery: conduit of disease. (A) The anatomy near the root of the SBM (RSBM). The root of the SBM (area within dashed circle) is contiguous superiorly to the hepatoduodenal ligament (HDL) along the SMV, anteriorly to the transverse mesocolon (TM), and posterolaterally to the ascending mesocolon and descending mesocolon (DM). The gastrocolic trunk (GT) is a landmark of the junction between the transverse mesocolon and the root of the SBM. The inferior mesenteric vein (IMV) is a landmark of the descending mesocolon and joins the SMV or splenic vein on the left side of the root of the SBM. IPDA, inferior pancreaticoduodenal artery; IPDV, inferior pancreaticoduodenal vein; PV, portal vein; SRL, splenorenal ligament. (From Okino Y, Kiyosue H, Mori H, et al. Root of the small-bowel mesentery: correlative anatomy and CT features of pathologic conditions. Radiographics 2001; 21: 1476; with permission.) (B) CT scan shows fluid (arrow) in the subperitoneal space of the small bowel mesentery in this patient with pancreatitis.
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Related In: Results  -  Collection

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Figure 7: Small bowel mesentery: conduit of disease. (A) The anatomy near the root of the SBM (RSBM). The root of the SBM (area within dashed circle) is contiguous superiorly to the hepatoduodenal ligament (HDL) along the SMV, anteriorly to the transverse mesocolon (TM), and posterolaterally to the ascending mesocolon and descending mesocolon (DM). The gastrocolic trunk (GT) is a landmark of the junction between the transverse mesocolon and the root of the SBM. The inferior mesenteric vein (IMV) is a landmark of the descending mesocolon and joins the SMV or splenic vein on the left side of the root of the SBM. IPDA, inferior pancreaticoduodenal artery; IPDV, inferior pancreaticoduodenal vein; PV, portal vein; SRL, splenorenal ligament. (From Okino Y, Kiyosue H, Mori H, et al. Root of the small-bowel mesentery: correlative anatomy and CT features of pathologic conditions. Radiographics 2001; 21: 1476; with permission.) (B) CT scan shows fluid (arrow) in the subperitoneal space of the small bowel mesentery in this patient with pancreatitis.
Mentions: The subperitoneal space of the small bowel mesentery is continuous with the bare area of the ascending colon and the transverse mesocolon (Fig. 7). The leaves of the small bowel mesentery continue as the posterior peritoneum, overlying the posterior abdominal wall. The connective tissue in the small bowel mesentery merges with the subperitoneal tissue of the retroperitoneum. The subperitoneal tissue continues without interruption inferiorly, from the right lower abdomen over the pelvic musculature and along the lateral pelvic side walls. Because this space potentially communicates with the broad ligament, it provides a pathway for bidirectional disease spread between the abdomen and the pelvis[2–4].Figure 7

Bottom Line: This space is formed by the subserosal areolar tissue that lines the inner surfaces of the peritoneum and the musculature of the abdomen and pelvis.It contains the branches of the vascular, lymphatic, and nervous systems that supply the viscera.The subperitoneal space extends into the peritoneal cavity and is invested between the layers of the mesenteries and ligaments that support and interconnect the abdominal and pelvic organs.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, North Shore University Health System, University of Chicago, Evanston, IL 60201, USA. rgore@uchicago.edu

ABSTRACT
The subperitoneal space is a large, unifying, anatomically continuous potential space that connects the peritoneal cavity with the retroperitoneum. This space is formed by the subserosal areolar tissue that lines the inner surfaces of the peritoneum and the musculature of the abdomen and pelvis. It contains the branches of the vascular, lymphatic, and nervous systems that supply the viscera. The subperitoneal space extends into the peritoneal cavity and is invested between the layers of the mesenteries and ligaments that support and interconnect the abdominal and pelvic organs. As such, it provides one large continuous space in which infectious, neoplastic, inflammatory, and hemorrhagic disease may spread in many directions.

Show MeSH
Related in: MedlinePlus