The retroperitoneal space. Organs of the abdominal cavity and retroperitoneal space

The retroperitoneal space is the area from the parietal peritoneum of the posterior abdominal wall to the front surfaces of the vertebral bodies and the adjacent groups of the muscular apparatus. The inner walls are covered with fascial leaves. The shape of the space depends on how well the fatty tissue is developed, and also on the localization and size of the internal organs located in it.

The walls of the retroperitoneal space

The anterior wall is the peritoneum of the posterior wall of the abdominal cavity, together with the visceral sheets of the pancreas, the colon of the intestine.

The upper wall extends from the rib and lumbar portion of the diaphragm to the coronary ligament of the liver to the right and the diaphragm-splenic ligament on the left.

The posterior and lateral walls are represented by the vertebral column and the adjacent muscles covered with the intra-abdominal fascia.

The lower wall is the conditional border through the border line separating the small pelvis and retroperitoneal space.

Anatomical features

The spectrum of organs is quite diverse. This includes the urinary system, and digestive, cardiovascular, endocrine. Organs of retroperitoneal space:

• Kidney;
• Ureters;
• pancreas;
• Adrenal glands;
• Abdominal part of the aorta;
• Colon (its ascending and descending part);
• Part of the duodenum;
• Vessels, nerves.

The fascial plates, which are in the retroperitoneal space, divide it into several parts. On the outer edge of the kidney are located the pre-focal and pacific fascia, formed from the retroperitoneal fascia. The preference is centrally connected to the fascial leaves of the inferior vena cava and the abdominal aorta. The posterior-fascial fascia "penetrates" into the intra-abdominal at the site of the covering of the diaphragmatic pedicle and the large lumbar muscle.

The pericardial tissue passes through the ureter, is located between the preference and back-bone fascia. Between the posterior surfaces of the intestinal part of the intestine and the retroperitoneal fascia is okolosnichnaya cellulose (pozadiobedochnaya fascia).

Abdomen

The space that is under the diaphragm and is filled with abdominal organs. Diaphragm - the upper wall, separating the thoracic and abdominal cavities from each other. The front wall is represented by the muscular apparatus of the abdomen. Posterior - vertebral column (its lumbar part). Below the space goes into the pelvic cavity.

The peritoneal cavity is lined with a peritoneum - a shell of serous nature, which passes to internal organs. During its growth, the organs move away from the wall and stretch the peritoneum, growing into it. There are several options for their location:

1. Intraperitoneal - the organ is covered on all sides by the peritoneum (small intestine).
2. Mesoperitoneal - covered with peritoneum on three sides (liver).
3. Extraperitoneal position - the peritoneum covers the organ only on one side (kidneys).

Methods of research

The retroperitoneal space can not be inspected, nor is it possible to visually assess the condition, however, examination of the abdominal wall, palpation and percussion are the first clinical methods used during consultation with a specialist. Pay attention to the color of the skin, the presence of cavities or protrusions, determine infiltrates, neoplasms of the abdominal wall.

The patient is placed on the couch, a cushion is placed under the waist. As a result, the organs of the abdominal cavity and retroperitoneal space protrude forward, which allows palpation. Soreness, which appears when pressing or tapping on the abdominal wall, may indicate a purulent-inflammatory process, neoplasms (including cystic).

Also used X-ray studies :

• X-ray of the intestine and stomach;
• Urography - study of the functioning of the urinary system with the introduction of contrast medium;
• Pancreatography - an estimation of a condition of a pancreas with introduction of a contrast medium;
• Pneumoperitoneum - introduction of gas into the abdominal cavity with further X-ray examination;
• Aortography - examination of the abdominal part of the aorta;
• Angiography of aorta branches;
• Kavografiya - assessment of the condition of the hollow vein;
• Lymphography.

From instrumental methods of research, ultrasound, CT and MRI of retroperitoneal space are used. They are conducted in a hospital or ambulatory.

Ultrasonography

A universal widely used method that is highly valued due to its availability, ease of conduct and safety. The retroperitoneal space refers to one of the investigated zones.

The main reasons for the conduct of ultrasound:

• Pathology of the pancreas - pancreatitis, diabetes, pancreonecrosis;
• Diseases of the duodenum - peptic ulcer, duodenitis;
• Diseases of the urinary system - hydronephrosis, renal failure, glomerulonephritis, pyelonephritis;
• Pathology of the adrenal glands - acute insufficiency;
• Vascular disease - atherosclerosis, other blood flow disorders.

It is carried out with the help of a special apparatus having a sensor. The sensor is applied to the anterior abdominal wall, moving along it. When the position changes, a change takes place in the length of the ultrasonic wave, as a result of which a picture of the organ under study is drawn on the monitor.

CT scan

CT of retroperitoneal space is used to determine pathologies or to detect an abnormal structure of internal organs. For the convenient conduct and a clearer result, the use of contrast medium is used. The procedure is indicated for abdominal or lumbar injuries, a suspected neoplasm, a lesion of the lymphatic system of this zone, urolithiasis, polycystic kidney disease, omission or the presence of inflammatory diseases.

CT of the abdominal cavity and retroperitoneal space requires preparation for the procedure. Within a few days, foods that provoke increased gas production are excluded from the diet. In the presence of constipation, prescribe the intake of laxatives, the setting of a cleansing enema.

The patient is placed on the surface, which is located in the tunnel of the tomograph. The apparatus has a special ring rotating around the body of the subject. The medical staff is outside the office and observes what is happening through the glass wall. Communication is supported through two-way communication. According to the results of the examination, the specialist chooses the method of necessary treatment.

Magnetic resonance imaging

In the case of uninformative ultrasound and CT or when more accurate data are needed, the doctor prescribes retroperitoneal MRI. What this method shows depends on the chosen area of study. MRI allows you to determine the presence of the following conditions:

• Pathological enlargement of organs;
• A tumor of retroperitoneal space;
• The presence of hemorrhages and cysts;
• Condition at elevated pressure in the portal vein system;
• Pathology of the lymphatic system;
• urolithiasis disease;
• Circulatory disturbance;
• Presence of metastases.

Damage of retroperitoneal space

The most common hematoma is due to mechanical trauma. Immediately after the injury, it can reach huge sizes, which makes it difficult to differentiate the diagnosis. A specialist can confuse the hematoma with damage to the hollow organ. Trauma is accompanied by hemorrhagic shock due to massive blood loss.

Brightness of manifestations decreases more rapidly than in case of damage to internal organs. Determine the condition allows laparoscopy. Pneumoperitoneum shows the displacement of retroperitoneal organs and the blurriness of their contours. Ultrasound and computed tomography are also used.

Diseases

A frequent pathology is the development of the inflammatory process. Depending on the place of inflammation, the following conditions are distinguished:

• Inflammation of retroperitoneal tissue;
• Paracolit - the pathological process occurs behind the descending or ascending colon in the cellulose located in the retroperitoneal space;
• Paranephritis - inflammation of the perineal tissue.

Symptoms begin with manifestations of intoxication: chills, hyperthermia, weakness, exhaustion, increase in the number of leukocytes and the rate of erythrocyte sedimentation. Palpation determines the presence of painful areas, protrusion of the abdominal wall, muscle tension.

One of the manifestations of purulent inflammation is the formation of an abscess, whose frequent clinic is considered to be the appearance of a flexural contracture in the hip joint from the affected area.

Purulent processes, in which the organs of the abdominal and retroperitoneal space are involved, are heavy with their complications:

• peritonitis;
• Phlegmon in the mediastinum;
• Osteomyelitis of the pelvis and ribs;
• Paraproctitis;
• Intestinal fistula;
• Sores of pus in the gluteal region, on the thigh.

Tumors

Neoplasms can arise from dissimilar tissues:

• Fatty tissue - lipoma, lipoblastoma;
• Muscular apparatus - myoma, myosarcoma;
• Lymphatic vessels - lymphangioma, lymphosarcoma;
• Blood vessels-hemangioma, angiosarcoma;
• Nerves - neuroblastoma of the retroperitoneal space;
• Fascia.

Tumors can be malignant or benign, as well as multiple or single. Clinical manifestations become noticeable when the neoplasm begins to shift adjacent organs due to its growth, disrupting their functionality. Patients complain of discomfort and pain in the abdomen, back, waist. Sometimes neoplasm is determined accidentally during a preventive examination.

A large tumor of retroperitoneal space causes a feeling of heaviness, venous or arterial stagnation of blood due to the squeezing of blood vessels. It is manifested by edema of the legs, by the expansion of the veins of the pelvis, the abdominal wall.

Benign tumors change the condition of the patient only a little, only in case of especially large sizes of education.

Neuroblastoma

Education has a high degree of malignancy. Affects the sympathetic part of the nervous system and develops predominantly in toddlers. Early appearance is due to the fact that neuroblastoma develops from embryonic cells, that is, the tumor has an embryonic origin.

A characteristic localization is one of the adrenal glands, a vertebral column. Like any tumor, retroperitoneal neuroblastoma has several stages, which allows you to determine the necessary treatment and make a disease prognosis.

• Stage I is characterized by a clear tumor location without lymph node involvement.
• II stage, type A - the location has no clear boundaries, the lesion is partially removed. Lymph nodes are not involved in the process.
• II stage, type B - education has one-sided localization. Metastases are determined in the part of the body where the tumor is located.
• Stage III is characterized by the spread of neuroblastoma to the second half of the body, metastasizing into the local lymph nodes.
• IV stage of the tumor is accompanied by distant metastases - in the liver, lungs, intestines.

The clinic depends on the localization of neuroblastoma. If she is in the abdomen, she easily finds herself with palpation, causes digestive disorders, lameness and pain in the bones in the presence of metastases. Paralysis and paresis may develop.

Conclusion

The retroperitoneal space is located in the depth of the abdominal cavity. Each of the organs located here is an integral part of the whole organism. Violation of the functioning of at least one of the systems leads to general cardinal pathological changes.