Retroperitoneal space is 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 leaves. The shape of the space depends on how much fatty fiber is developed, 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, colon of the intestine.
The upper wall extends from the costal and lumbar parts of the 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 spinal column and nearby muscles, covered by the intra-abdominal fascia.
The lower wall is the conditional border through the border line dividing the small pelvis and retroperitoneal space.
Anatomical features
The range of organs is quite diverse. This includes the urinary system, and the digestive, cardiovascular, endocrine. Retroperitoneal organs:
- kidneys
- ureters;
- pancreas;
- adrenal glands;
- the abdominal part of the aorta;
- colon (its ascending and descending parts);
- part of the duodenum;
- vessels, nerves.
Fascial plates, which are in the retroperitoneal space, divide it into several parts. On the outer edge of the kidney are the prerenal and posterior renal fascia, formed from the retroperitoneal fascia. The prerenal centrally connects to the fascial leaves of the inferior vena cava and the abdominal aorta. The subrenal fascia is "embedded" in the intraperitoneal at the site of coverage of the phrenic pedicle and psoas major muscle.
Perinephric fiber passes along the ureter, located between the prerenal and subrenal fascia. Between the posterior surfaces of the colonic part of the intestine and the retroperitoneal fascia there is periopical intestinal tissue (posterior fascia).
Abdomen
The space that is under the diaphragm and is filled with abdominal organs. The diaphragm is the upper wall that separates the chest and abdominal cavities from each other. The front wall is represented by the muscular apparatus of the abdomen. The back is the spinal column (its lumbar part). At the bottom of the space passes into the pelvic cavity.
The peritoneal cavity is lined with peritoneum - a serous membrane that passes to the internal organs. During their growth, organs move away from the wall and extend 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
It is impossible to examine the retroperitoneal space, as well as visually assess the condition, however, examination of the abdominal wall, palpation and percussion are the first clinical methods used during a specialist consultation. Pay attention to the color of the skin, the presence of hollows or protrusions, determine infiltrates, tumors of the abdominal wall.
The patient is placed on a 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. The soreness that appears when pressing or tapping on the abdominal wall may indicate a purulent-inflammatory process, neoplasms (including cystic).
Also use x-ray studies :
- x-ray of the intestines and stomach;
- urography - a study of the functioning of the urinary system with the introduction of a contrast agent;
- pancreatography - an assessment of the state of the pancreas with the introduction of a contrast medium;
- pneumoperitoneum - the introduction of gas into the abdominal cavity with further x-ray examination;
- aortography - examination of patency of the abdominal aorta;
- angiography of the branches of the aorta;
- cavography - an assessment of the state of the vena cava;
- lymphography.
Of the instrumental methods of research, ultrasound, CT and MRI of the retroperitoneal space are used. They are carried out in a hospital or outpatient setting.
Ultrasonography
A versatile, widely used method that is highly regarded for its accessibility, ease of use, and safety. Retroperitoneal space refers to one of the studied areas.
The main reasons for conducting ultrasound:
- pancreatic pathology - pancreatitis, diabetes mellitus, pancreatic necrosis;
- diseases of the duodenum - peptic ulcer, duodenitis;
- diseases of the urinary system - hydronephrosis, renal failure, glomerulonephritis, pyelonephritis;
- adrenal gland pathology - acute failure;
- vascular diseases - atherosclerosis, other blood flow disorders.
It is carried out using a special apparatus having a sensor. The sensor is applied to the anterior abdominal wall, moving along it. When the position changes, a change occurs in the length of the ultrasonic wave, as a result of which a picture of the organ under investigation is drawn on the monitor.
CT scan
CT of the retroperitoneal space is performed to determine pathologies or identify the abnormal structure of internal organs. For convenient holding and a clearer result, the introduction of a contrast medium is used. The procedure is indicated for injuries of the abdomen or lumbar region, suspected neoplasm, with damage to the lymphatic system of this zone, urolithiasis, polycystic kidney disease, omission or the presence of inflammatory diseases.
CT scan of the abdominal cavity and retroperitoneal space requires preparation for the procedure. For several days, products that provoke increased gas formation are excluded from the diet. In the presence of constipation, laxatives are prescribed, and 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 rotating around the body of the subject. Medical staff is outside the office and monitors what is happening through the glass wall. Communication is supported using two-way communication. Based on the results of the examination, the specialist selects the method of treatment necessary.
Magnetic resonance imaging
If ultrasound and CT scan are not informative or if it is necessary to collect more accurate data, the doctor prescribes an MRI of the retroperitoneal space. What this method shows depends on the chosen area of research. MRI allows you to determine the presence of the following conditions:
- pathological enlargement of organs;
- swelling of the retroperitoneal space;
- the presence of hemorrhages and cysts;
- conditions with increased pressure in the portal vein system;
- pathology of the lymphatic system;
- urolithiasis disease;
- circulatory disturbance;
- the presence of metastases.
Damage to the retroperitoneal space
The most common hematoma resulting from a mechanical injury. Immediately after damage, it can reach enormous dimensions, which makes it difficult to differentiate the diagnosis. A specialist can confuse a hematoma with damage to a hollow organ. Injury is accompanied by hemorrhagic shock due to massive blood loss.
The brightness of manifestations decreases faster than in the case of damage to internal organs. Determine the condition allows laparoscopy. Pneumoperitoneum shows the displacement of the retroperitoneal organs and the blurring of their contours. They also use ultrasound and computed tomography.
Diseases
A frequent pathology is the development of the inflammatory process. Depending on the place of occurrence of inflammation, the following conditions are distinguished:
- inflammation of the retroperitoneal fiber;
- paracolitis - a pathological process occurs behind the descending or ascending colon in the fiber, located in the retroperitoneal space;
- paranephritis - inflammation of the perinephric fiber.
Symptoms begin with manifestations of an intoxication nature: chills, hyperthermia, weakness, exhaustion, an increase in the number of leukocytes and the erythrocyte sedimentation rate. 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, a frequent clinic of which is the appearance of flexion contracture in the hip joint from the affected area.
Purulent processes in which the organs of the abdominal and retroperitoneal space are involved are difficult with their complications:
- peritonitis;
- phlegmon in the mediastinum;
- osteomyelitis of the pelvis and ribs;
- paraproctitis;
- intestinal fistulas;
- pus nerves in the gluteal region, on the thigh.
Tumors
Neoplasms can arise from dissimilar tissues:
- fatty tissue - lipoma, lipoblastoma;
- muscle apparatus - myoma, 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 tumor of the retroperitoneal space causes a feeling of heaviness, venous or arterial stagnation of blood due to vascular compression. Manifested by swelling of the legs, expansion of the veins of the pelvis, abdominal wall.
Benign tumors do not significantly change the patient’s condition, only in the case of especially large sizes of education.
Neuroblastoma
Education has a high degree of malignancy. It affects the sympathetic part of the nervous system and develops mainly in babies. The early appearance is due to the fact that a neuroblastoma develops from embryo cells, that is, the tumor has an embryonic origin.
The characteristic localization is one of the adrenal glands, the spinal column. Like any tumor, retroperitoneal neuroblastoma has several stages, which allows you to determine the necessary treatment and make a prognosis of the disease.
- Stage I is characterized by a clear localization of the tumor without damage to the lymph nodes.
- Stage II, type A - the location does not have clear boundaries, the neoplasm is partially removed. Lymph nodes are not involved in the process.
- II stage, type B - the formation 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, metastasis to the local lymph nodes.
- Stage IV tumor is accompanied by distant metastases - to the liver, lungs, intestines.
The clinic depends on the location of the neuroblastoma. If it is in the abdomen, it easily reveals itself upon palpation, causes digestive upsets, lameness and bone pain in the presence of metastases. Paralysis and paresis may develop.
Conclusion
The retroperitoneal space is deep in the abdomen. Each of the organs located here is an integral part of the whole organism. Malfunctioning of at least one of the systems leads to general cardinal pathological changes.