Learning objectives
To outline the anatomy of retroperitoneal spaces
To describe the causes of air in the retroperitoneal spaces
Role of imaging in pneumoretroperitoneum with emphasis on detecting the source which is pertinent to management
Background
Anatomy
Retroperitoneum is the part of the abdominal cavity that lies between the posterior parietal peritoneum and anterior to the transversalis fascia.
Abdominal retroperitoneum
Tricompartmental retroperitoneumFig. 1a
Anterior pararenal space (APS)
•Most anterior space of retroperitoneum
•Bounded anteriorly by posterior peritoneal fold and posteriorly by anterior renal fascia
•Contents : pancreas, duodenum, ascending & descending colon
Perirenal space (PS)
•Bounded anteriorly by Gerota fascia and posteriorly by Zuckerkandl fascia which join laterally to form lateroconal fascia
•Contents: kidneys, proximal collecting system, renal vasculature and adrenal...
Findings and procedure details
Pneumoretroperitoneum
Pathological accumulation of gas/ air in retroperitoneal spaces
Emergency condition that requires an early diagnosis to ensure optimalmanagement
Imaging plays important role in early diagnosis as clinical symptoms areoften vague and local examination is not easily accessible by clinicians
Correct identification of its etiology is challenging both because pneumoretroperitoneum is not specific and because its differentialdiagnosis is broad
A summary of pathologies associated with pneumoretroperitoneum (Table 1 and 2)
TABLE 1
TABLE 2
Emphysematous pancreatitisFig. 4
•Severe complication of acute necrotising pancreatitis
•Etiology:
◊Polymicrobial...
Conclusion
•Optimal knowledge of the complex retroperitoneal anatomy is essential for correct localization of extraperitoneal air
•CT is the modality of choice for detection of pneumoretroperitoneum and associated findings of fluid and inflammatory collections and their extension
•Radiologist plays an important role in the establishment of the cause of retroperitoneal air which is pertinent for its management
Personal information and conflict of interest
K. Saggar; Ludhiana, PU/IN - nothing to disclose A. Ahluwalia; Ludhiana/IN - nothing to disclose C. Kakkar; Ludhiana, Punjab/IN - nothing to disclose
References
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2.Ong EMW, Venkatesh SK. Ascending retrocecal appendicitis presenting with right upper abdominal pain: utility of computed tomography. World J Gastroenterol. 2009;15:3576-9.
3.Kim SW, Shin HC, Kim IY, Kim YT, Kim CJ. CT findings of colonic complications associated with colon cancer. Korean J Radiol. 2010;11:211-21.
4.Ghanimeh MA, Abughanimeh O, Abuamr K, Yousef O, Sadeddin E. Colopancreatic fistula: an uncommon complication of recurrent acute pancreatitis. American...