Retroperitoneal space - an area located from the parietal peritoneum of the posterior abdominal wall to the anterior surfaces of the vertebral bodies and adjacent muscle groups. The inner walls are covered with fascial sheets. The shape of the space depends on how developed fatty tissue is, as well as 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 in conjunction with the visceral sheets of the pancreas, the colon of the intestine.
The upper wall runs from the costal and lumbar diaphragm to the coronary ligament of the liver on the right and the phrenic-splenic ligament on the left.
The posterior and lateral walls are represented by the vertebral column and nearby muscles covered by intra-abdominal fascia.
The lower wall is a conditional border through the boundary line separating the small pelvis andretroperitoneum.
Anatomical features
The range of organs is quite diverse. This includes the urinary system, and the digestive, cardiovascular, endocrine. Retroperitoneal Organs:
- kidneys;
- ureters;
- pancreas;
- adrenals;
- abdominal aorta;
- colon (its ascending and descending parts);
- part of the duodenum;
- vessels, nerves.
Fascial plates, which are located in the retroperitoneal space, divide it into several parts. Along the outer edge of the kidney are the prerenal and retrorenal fascia, formed from the retroperitoneal fascia. The prerenal is centrally connected to the fascial sheets of the inferior vena cava and the abdominal aorta. The retrorenal fascia is "embedded" into the intra-abdominal fascia at the site of coverage of the diaphragmatic pedicle and psoas major.
Perirenal tissue passes through part of the ureter, located between the prerenal and retrorenal fascia. Between the posterior surfaces of the colon and the retroperitoneal fascia is the peri-intestinal fiber (posterior colon fascia).
Abdomen
The space below the diaphragm and filled with the abdominal organs. The diaphragm is the upper wall that separates the thoracic and abdominal cavities from each other. The anterior wall is represented by the muscular apparatus of the abdomen. Back - spinal column (its lumbar part). Bottom spacepasses into the pelvic cavity.
The peritoneal cavity is lined with the peritoneum - a serous membrane that passes to the internal organs. During their growth, the organs move away from the wall and stretch the peritoneum, growing into it. There are several options for their location:
- Intraperitoneal - the organ is covered on all sides by the peritoneum (small intestine).
- Mesoperitoneal - covered with peritoneum on three sides (liver).
- Extraperitoneal position - the peritoneum covers the organ on only one side (kidney).
Research methods
The retroperitoneal space cannot be examined, nor can the condition be visually assessed, however, examination of the abdominal wall, palpation and percussion are the first clinical methods used during a consultation with a specialist. Pay attention to the color of the skin, the presence of depressions or protrusions, determine infiltrates, neoplasms of the abdominal wall.
The patient is placed on the couch, a roller is placed under the lower back. As a result, the organs of the abdominal cavity and retroperitoneal space protrude forward, which allows palpation. Soreness that appears when pressing or tapping on the abdominal wall may indicate a purulent-inflammatory process, neoplasms (including cystic ones).
X-rays are also used:
- X-ray of intestines and stomach;
- urography - a study of the functioning of the urinary system with the introduction of a contrastsubstances;
- pancreatography - assessment of the state of the pancreas with the introduction of a contrast agent;
- pneumoperitoneum - the introduction of gas into the abdominal cavity with further X-ray examination;
- aortography - examination of the patency of the abdominal aorta;
- angiography of aortic branches;
- cavography - assessment of the condition of the vena cava;
- lymphography.
From instrumental research methods, ultrasound, CT and MRI of the retroperitoneal space are used. They are carried out in a hospital or outpatient setting.
Ultrasound
A versatile, widely used method that is highly valued for its affordability, ease of implementation, and safety. The retroperitoneal space belongs to one of the studied areas.
Main Reasons for an Ultrasound:
- pathology of the pancreas - pancreatitis, diabetes mellitus, pancreatic necrosis;
- diseases of the duodenum - peptic ulcer, duodenitis;
- diseases of the urinary system - hydronephrosis, renal failure, glomerulonephritis, pyelonephritis;
- adrenal pathology - acute insufficiency;
- vascular disease - atherosclerosis, other blood flow disorders.
Carried out using a special apparatus with a sensor. The sensor is applied to the anterior abdominal wall, moving along it. When you change the position, there is a change in the wavelength of the ultrasonic wave, as a result of which an image is drawn on the monitor.target organ.
Computed tomography
CT of the retroperitoneal space is performed to determine pathologies or to identify the abnormal structure of internal organs. For convenient conduction and a clearer result, the introduction of a contrast agent is used. The procedure is indicated for injuries of the abdomen or lumbar region, suspected neoplasm, damage to the lymphatic system of this zone, urolithiasis, polycystic kidney disease, prolapse or the presence of inflammatory diseases.
CT of the abdominal cavity and retroperitoneal space requires preparation for the procedure. For a few days, foods that provoke increased gas formation are excluded from the diet. In the presence of constipation, laxatives are prescribed, a cleansing enema is prescribed.
The patient is placed on the surface, which is located in the tunnel of the tomograph. The device has a special ring that rotates around the body of the subject. The medical staff is outside the office and watches what is happening through the glass wall. Communication is supported by two-way communication. Based on the results of the examination, the specialist chooses the method of necessary treatment.
Magnetic resonance imaging
If ultrasound and CT are not informative or if more accurate data is needed, the doctor prescribes an MRI of the retroperitoneal space. What this method reveals depends on the chosen area of study. MRI can determine the presence of the following conditions:
- pathological enlargement of organs;
- retroperitoneal tumor;
- availabilityhemorrhages and cysts;
- states with increased pressure in the portal vein system;
- pathology of the lymphatic system;
- urolithiasis;
- circulatory disorders;
- presence of metastases.
Retroperitoneal injuries
The most common hematoma is the result of mechanical trauma. Immediately after damage, it can reach a huge size, which makes it difficult to differentiate the diagnosis. A specialist may confuse a hematoma with damage to a hollow organ. The injury is accompanied by hemorrhagic shock due to massive blood loss.
The manifestations decrease faster than in case of damage to internal organs. Laparoscopy allows to determine the condition. The pneumoperitoneum shows the displacement of the retroperitoneal organs and the blurring of their contours. Ultrasound and computed tomography are also used.
Diseases
The development of the inflammatory process becomes a common pathology. Depending on the site of inflammation, the following conditions are distinguished:
- inflammation of the retroperitoneal tissue;
- paracolitis - a pathological process occurs behind the descending or ascending colon in the fiber located in the retroperitoneal space;
- paranephritis - inflammation of the perirenal tissue.
Symptoms begin with manifestations of an intoxication nature: chills, hyperthermia, weakness, exhaustion, an increase in the number of leukocytes and an erythrocyte sedimentation rate. Palpation determinesthe presence of painful areas, protrusion of the abdominal wall, muscle tension.
One of the manifestations of purulent inflammation is the formation of an abscess, a frequent clinic of which is the appearance of a flexion contracture in the hip joint from the affected area.
Purulent processes involving the abdominal and retroperitoneal organs are severe in their complications:
- peritonitis;
- phlegmon in mediastinum;
- osteomyelitis of the pelvis and ribs;
- paraproctitis;
- intestinal fistulas;
- streaks of pus in the gluteal region, on the thigh.
Tumors
Neoplasms can arise from dissimilar tissues:
- adipose tissue - lipoma, lipoblastoma;
- muscular system - fibroids, myosarcoma;
- lymphatic vessels - lymphangioma, lymphosarcoma;
- blood vessels - hemangioma, angiosarcoma;
- nerves - retroperitoneal neuroblastoma;
- fascia.
Tumors can be malignant or benign, as well as multiple or single. Clinical manifestations become noticeable when the neoplasm begins to displace neighboring organs due to its growth, disrupting their functionality. Patients complain of discomfort and pain in the abdomen, back, lower back. Sometimes a neoplasm is determined by chance during a routine examination.
A large retroperitoneal tumor causes a feeling of heaviness, venous or arterial blood stasis due tosqueezing of blood vessels. Manifested by swelling of the legs, dilatation of the veins of the pelvis, abdominal wall.
Benign tumors change the patient's condition little, only in the case of especially large tumors.
Neuroblastoma
Education has a high degree of malignancy. Affects the sympathetic part of the nervous system and develops mainly in babies. Early appearance is explained by the fact that neuroblastoma develops from embryonic cells, that is, the tumor is of embryonic origin.
One of the adrenal glands, the spinal column, becomes a characteristic localization. Like any tumor, retroperitoneal neuroblastoma has several stages, which allows you to determine the necessary treatment and make a prognosis of the disease.
- I stage is characterized by a clear localization of the tumor without involvement of the lymph nodes.
- II stage, type A - the location has no clear boundaries, the neoplasm is partially removed. Lymph nodes are not involved in the process.
- II stage, type B - education has unilateral localization. Metastases are determined in the part of the body where the tumor is located.
- III stage is characterized by the spread of neuroblastoma to the second half of the body, metastasis to local lymph nodes.
- IV stage of the tumor is accompanied by distant metastases - in the liver, lungs, intestines.
The clinic depends on the location of the neuroblastoma. If it is in the abdomen, it easily detects itself on palpation, causes digestive disorders,there is lameness and pain in the bones in the presence of metastases. Paralysis and paresis may develop.
Conclusion
The retroperitoneal space is located deep in 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.
