Surgical Anatomy of the Retroperitoneal Spaces–Part I: Embryogenesis and Anatomy

2009 ◽  
Vol 75 (11) ◽  
pp. 1091-1097 ◽  
Author(s):  
Petros Mirilas ◽  
John E. Skandalakis

Embryologically, the retroperitoneal (extraperitoneal) connective tissue includes three strata, which respectively form the internal fascia lining of the body wall, the renal fascia, and the covering of the gastrointestinal viscera. All organs, vessels, and nerves, that lie on the posterior abdominal wall, along with their tissues and surrounding connective and fascial planes, are collectively referred to as the retroperitoneum. The retroperitoneal space is the area of the posterior abdominal wall that is located between the parietal peritoneum and the fascia. Within the greater retroperitoneal space, there are also several small spaces, or subcompartments. Loose connective tissue and fat surround the anatomic entities, and, to a variable degree, occupy the subcompartments. The multilaminar thoracolumbar (lumbodorsal) fascia begins at the occipital area and terminates at the sacrum.

2018 ◽  
pp. 529-540
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick

Hernias are abnormal protrusion of an organ through a weakness/defect in the body wall that contains it. Classifications include groin hernias, ventral abdominal wall hernias (umbilical, femoral), incisional, Spigelian, and lumbar hernias. Inguinal hernias are the commonest types of abdominal wall hernias (~75%). Male are affected 15-times more frequently. Hernias are more common in smokers, patients with underlying connective tissue disorders (Ehlers Danlos Syndrome, Marfan syndrome), and patients with increased intra-abdominal pressure (obesity, heavy lifting, chronic cough, and chronic straining during defecation and urination). Hernias present as incidental finding on imaging, asymptomatic lumps, painful lumps, or incarcerated or strangulated hernias. Clinical history and examination are the mainstay of diagnosis. Most hernias are treated with surgical repair (open or laparoscopic). Conservative wait and watch policy is indicated in some cases.


2010 ◽  
Vol 76 (1) ◽  
pp. 33-42 ◽  
Author(s):  
Petros Mirilas ◽  
John E. Skandalakis

The extraperitoneal space extends between peritoneum and investing fascia of muscles of anterior, lateral and posterior abdominal and pelvic walls, and circumferentially surrounds the abdominal cavity. The retroperitoneum, which is confined to the posterior and lateral abdominal and pelvic wall, may be divided into three surgicoanatomic zones: centromedial, lateral (right and left), and pelvic. The preperitoneal space is confined to the anterior abdominal wall and the subperitoneal extraperitoneal space to the pelvis. In the extraperitoneal tissue, condensation fascias delineate peri- and parasplanchnic spaces. The former are between organs and condensation fasciae, the latter between this fascia and investing fascia of neighboring muscles of the wall. Thus, perirenal space is encircled by renal fascia, and pararenal is exterior to renal fascia. Similarly for the urinary bladder, paravesical space is between the umbilical prevesical fascia and fascia of the pelvic wall muscles—the prevesical space is its anterior part, between transversalis and umbilical prevesical fascia. For the rectum, the “mesorectum” describes the extraperitoneal tissue bound by the mesorectal condensation fascia, and the pararectal space is between the latter and the muscles of the pelvic wall. Perisplanchnic spaces are closed, except for neurovascular pedicles. Prevesical and pararectal (presacral) and posterior pararenal spaces are in the same anatomical level and communicate. Anterior to the anterior layer of the renal fascia, the anterior interfascial plane (superimposed and fused mesenteries of pancreas, duodenum, and colon) permits communication across the midline. Thus parasplanchnic extraperitoneal spaces of abdomen and pelvis communicate with each other and across the midline.


2009 ◽  
Vol 54-55 (1-4) ◽  
pp. 5-12 ◽  
Author(s):  
Piotr ŚwiĄtek ◽  
Anna Świder ◽  
Aleksander Bielecki

Sperm Transfer Through the Vector Tissue in Piscicola Respirans (Clitellata, Hirudinea, Piscicolidae) In fish leeches (Piscicolidae) indirect (hypodermic) insemination has evolved, thus the spermatophores are released in the specialised region of the body wall known as a copulatory area or a copulatory region. The way in which the spermatozoa reach the ovaries is not fully understood. In piscicolids beneath the copulatory area there is a specialized connective tissue (vector tissue), which is thought to guide the spermatozoa toward the ovaries. To date the structure of the vector tissue has not been observed in copulating specimens, which have spermatophores implanted in their coplulatory area. Here we present the first ultrastructural observation of massive sperm transfer from the spermatophore throughout the vector tissue to the ovaries. Our results show that the sperm transfer is both massive and rapid. The migrating spermatozoa form huge aggregations which push aside the vector tissue cells, in such a way that between these cells voluminous gaps are formed. Unexpectedly to our previous suggestions, the ultrastructural pictures show that the long cytoplasmic processes of granular cells, which constitute the main mass of the vector tissue, are not engaged in sperm transport. We suggest that the sperm is pumped with a high pressure from the spermatophore into the vector tissue, and as a result the vector tissue cells are pushed aside and spermatozoa can freely pass between them.


1962 ◽  
Vol 115 (6) ◽  
pp. 1211-1230 ◽  
Author(s):  
James S. Henderson ◽  
Peyton Rous

A procedure analogous to the plating of bacteria is described whereby some complex tumors have been taken apart and their components separately propagated. It was the outcome of finding that the forcible injection of Locke's solution followed by air can be used to split the subcutaneous connective tissue of sucklings and weanlings horizontally over the entire expanse of their backs or bellies, without inducing any complicating inflammation. Tumor fragments suspended in Locke's were widely scattered on the surfaces thus exposed. Most of them remained where they had lodged on the body wall, and rapidly becoming fixed in place, formed growths protected by the overlying cutaneous layer—which, throughout many weeks, remained unattached either to the wall or to them. The procedure is more searching in its disclosure of tumor constituents than those currently employed, and it has the advantage that it preserves the neoplastic components that it reveals. It has been used thus far only to rescue for experimental purposes transplantable, benign, epidermal papillomas from the hidden carcinomas deriving from their cells, and to set free and maintain the neoplastic components of complex mammary tumors of milk factor type. Success was obtained with such of the latter as were chosen for separate propagation, though successive platings were sometimes required for their isolation. Incidentally the procedure revealed two components in the mammary growths which could not have been discerned by previous methods of search. Each formed tumors peculiar to itself.


1993 ◽  
Vol 16 (1) ◽  
pp. 9
Author(s):  
M. Griffiths ◽  
N.G. Simms

The pups of Pseudomys nanus and P. australis are attached to their mothers' teats for extended periods of time, analogous to the situation encountered in pouchless marsupials. The structures in the mammary glands involved in facilitating prolonged attachment are different in the two rodent species and both kinds are different from those in marsupial glands including those of Monodelphis domestica, the subject of the present study. In P. nanus, the teats are anchored to postero-ventrally directed, tubular diverticula of the body wall. In P. australis there are no diverticula. However, support for the mammary glands and teats is afforded by the body wall, in the form of two well-developed fan-shaped muscles dorsal to the mammary glands in conjunction with a broad lamina of connective tissue, smooth and striated muscle situated between the skin of the belly and the mammary glands. In M. domestica, the teats are anchored to swathes of striated voluntary muscle, derived from the ilio-marsupialis muscles which pass ventrally through the secretory parenchyma to be inserted onto the bases of the teats. Since this musculature has not been observed in the mammary glands of any eutherians so far studied, nor in those of Monotremata, it is put that it is a character unique to the Marsupialia.


2001 ◽  
Vol 204 (5) ◽  
pp. 875-885 ◽  
Author(s):  
M.R. Elphick ◽  
R. Melarange

Smooth muscle relaxation in vertebrates is regulated by a variety of neuronal signalling molecules, including neuropeptides and nitric oxide (NO). The physiology of muscle relaxation in echinoderms is of particular interest because these animals are evolutionarily more closely related to the vertebrates than to the majority of invertebrate phyla. However, whilst in vertebrates there is a clear structural and functional distinction between visceral smooth muscle and skeletal striated muscle, this does not apply to echinoderms, in which the majority of muscles, whether associated with the body wall skeleton and its appendages or with visceral organs, are made up of non-striated fibres. The mechanisms by which the nervous system controls muscle relaxation in echinoderms were, until recently, unknown. Using the cardiac stomach of the starfish Asterias rubens as a model, it has been established that the NO-cGMP signalling pathway mediates relaxation. NO also causes relaxation of sea urchin tube feet, and NO may therefore function as a ‘universal’ muscle relaxant in echinoderms. The first neuropeptides to be identified in echinoderms were two related peptides isolated from Asterias rubens known as SALMFamide-1 (S1) and SALMFamide-2 (S2). Both S1 and S2 cause relaxation of the starfish cardiac stomach, but with S2 being approximately ten times more potent than S1. SALMFamide neuropeptides have also been isolated from sea cucumbers, in which they cause relaxation of both gut and body wall muscle. Therefore, like NO, SALMFamides may also function as ‘universal’ muscle relaxants in echinoderms. The mechanisms by which SALMFamides cause relaxation of echinoderm muscle are not known, but several candidate signal transduction pathways are discussed here. The SALMFamides do not, however, appear to act by promoting release of NO, and muscle relaxation in echinoderms is therefore probably regulated by at least two neuronal signalling systems acting in parallel. Recently, other neuropeptides that influence muscle tone have been isolated from the sea cucumber Stichopus japonicus using body wall muscle as a bioassay, but at present SALMFamide peptides are the only ones that have been found to have a direct relaxing action on echinoderm muscle. One of the Stichopus japonicus peptides (holothurin 1), however, causes a reduction in the magnitude of electrically evoked muscle contraction in Stichopus japonicus and also causes ‘softening’ of the body wall dermis, a ‘mutable connective tissue’. It seems most likely that this effect of holothurin 1 on body wall dermis is mediated by constituent muscle cells, and the concept of ‘mutable connective tissue’ in echinoderms may therefore need to be re-evaluated to incorporate the involvement of muscle, as proposed recently for the spine ligament in sea urchins.


1965 ◽  
Vol s3-106 (74) ◽  
pp. 137-146
Author(s):  
W. L. NICHOLAS ◽  
E. H. MERCER

The ultrastructure of the body wall of Moniliformis dubius has been studied in the light and electron microscope. It consists of an apparently syncytial tegument, overlaid by a tenuous cuticle in the form of a finely fibrous extracellular fringe and is backed by a basement membrane and fibrous connective tissue. The tegument contains a framework of fibres, which, distally, is connected to a dense fibrous meshwork separated from the cuticle by two membranes. Within the syncytial tegument are found the usual cytoplasmic organelles: mitochondria (often degenerate in structure), Golgi clusters, small amounts of other smooth membranes, and numerous dense particles (glycogen and perhaps ribosomes). Many mitochondria contain dense particles. Evidence of vacuole formation at the surface of the tegument suggests that pinocytosis plays a part in assimilation.


2018 ◽  
Vol 32 (8) ◽  
Author(s):  
H Fujiwara ◽  
J Kanamori ◽  
Y Nakajima ◽  
T Kawano ◽  
A Miura ◽  
...  

SUMMARY Understanding the surgical anatomy is the key to reducing surgical invasiveness especially in the upper mediastinal dissection for esophageal cancer, which is supposed to have a significant impact on curability and morbidity. However, there is no theoretical recognition regarding the surgical anatomy required for esophagectomy, although the surgical anatomy in abdominal digestive surgery has been developed on the basis of embryological findings of intestinal rotation and fusion fascia. Therefore, we developed a hypothesis of a ‘concentric-structured model’ of the surgical anatomy in the upper mediastinum based on human embryonic development. This model was characterized by three factors: (1) a concentric and symmetric three-layer structure, (2) bilateral vascular distribution, and (3) an ‘inter-layer potential space’ composed of loose connective tissue. The concentric three-layer structure consists of the ‘visceral layer’, the ‘vascular layer’, and the ‘parietal layer’: the visceral layer containing the esophagus, trachea, and recurrent laryngeal nerves as the central core, the vascular layer of major blood vessels surrounding the visceral core to maintain the circulation, and the parietal layer as the outer frame of the body. The bilateral vascular distribution consists of the inferior thyroid arteries and bronchial arteries originating from the bilateral dorsal aortae in an embryo. This bilateral vascular distribution may be related to the formation of the proper mesentery of the esophagus and frequent lymph node metastasis observed in the visceral layer around recurrent laryngeal nerves. The three concentric layers are bordered by loose connective tissue called the ‘inter-layer potential space’. This inter-layer potential space is the fundamental factor of our concentric-structured model as the appropriate surgical plane of dissection. The peripheral blood vessels, nerves, and lymphatics transition between each layer, thereby penetrating this loose connective tissue forming the inter-layer potential space. Recurrent laryngeal nerves also transition from the vascular layer after branching off from the vagal nerves and then ascend consistently in the visceral layer. We investigated the validity of this concentric-structured model, confirming the intraoperative images and the surgical outcomes of thoracoscopic esophagectomy in a prone position (TSEP) before and after the introduction of this hypothetical anatomy model. A total of 226 patients with esophageal cancer underwent TSEP from January 2015 to December 2016. After the introduction of this model, the surgical outcomes in 105 patients clearly improved for the operation time of the thoracoscopic procedure (160 min vs. 182 min, P = 0.01) and the incidence of recurrent laryngeal nerve palsy (19.0% vs. 36.4%, P = 0.004). Moreover, we were able to identify the concentric and symmetric layer structure through surgical dissection along the inter-layer potential space between the visceral and vascular layers (‘viscero-vascular space’) in all 105 cases after introduction of the hypothetical model. The concentric-structured model based on embryonic development is clinically beneficial for achieving less-invasive esophagectomy by ensuring a theoretical understanding of the surgical anatomy in the upper mediastinum.


Author(s):  
V.S. Drabovskiy ◽  
N.R. Kerbazh ◽  
A.K. Akeyshi ◽  
Ya.V. Rybalka

Biomechanics is a science that studies the mechanical properties of tissues, individual organs and systems and the body as a whole. The unique mechanical properties of the skin provide the function of support and protection of internal organs through the skin mobility and elasticity. This feature of the skin is determined by its microstructural organization and arrangement of connective tissue fibres. The mechanical properties of the skin are mainly determined by the collagen-rich dermis. The mechanics of the dermis, in turn, depends on the structure, density and direction of collagen fibres. Each biological tissue is able to acquire deformation properties i.e. stretching or contraction. At each stage of deformation in the tissues of different topographic and anatomical areas there are changes in histoarchitectonics (within the plastic characteristics, and outside these parameters). Different structural interactions are expressed by different mechanical factors, which are adequate to the magnitude and direction of tensile forces (deformation vectors), form the typical features of the connective tissue matrix of abdominal wall tissues. Normalization of the direction of tissue stress vectors, uniform distribution of the direction and force of deformation prevent microstructural rearrangement of the surface tissues of the abdominal wall. Dynamic changes in the histological structure and biomechanical behaviour of the skin are closely related to the aging process, hormonal background, mechanical factors: physiological stretching of the skin during rapid growth in adolescence, pregnancy, overweight (or rapid weight loss), under the influence of physical load and wound healing. All these factors lead to connective tissue remodelling. Thus, the skin has a complex three-dimensional morphological structure; it is subjected to prolonged exposure to internal and external factors that determines its mechanical properties.


2020 ◽  
Author(s):  
Shunsaku Homma ◽  
Takako Shimada ◽  
Ikuo Wada ◽  
Katsuji Kumaki ◽  
Noboru Sato ◽  
...  

ABSTRACTOne of the decisive questions about human gross anatomy is unmatching the adult branching pattern of the spinal nerve to the embryonic lineages of the peripheral target muscles. The two principal branches in the adult anatomy, the dorsal and ventral rami of the spinal nerve, innervate the intrinsic back muscles (epaxial muscles), as well as the body wall and appendicular muscles (hypaxial muscles), respectively. However, progenitors from the dorsomedial myotome develop into the back and proximal body wall muscles (primaxial muscles) within the sclerotome-derived connective tissue environment. In contrast, those from the ventrolateral myotome develop into the distal body wall and appendicular muscles (abaxial muscles) within the lateral plate-derived connective tissue environment. Thus, the ventral rami innervate muscles that belong to two different embryonic compartments. Because strict correspondence between an embryonic compartment and its cognate innervation is a way to secure the development of functional neuronal circuits, this mismatch indicates that we may need to reconcile our current understanding of the branching pattern of the spinal nerve with regard to embryonic compartments. Accordingly, we first built a model for the branching pattern of the spinal nerve, based on the primaxial-abaxial distinction, and then validated it using mouse embryos.In our model, we hypothesized the following: 1) a single spinal nerve consists of three nerve components: primaxial compartment-responsible branches, a homologous branch to the canonical intercostal nerve bound for innervation to the abaxial compartment in the ventral body wall, and a novel class of nerves that travel along the lateral cutaneous branch to the appendicles; 2) the three nerve components are discrete only during early embryonic periods but are later modified into the elaborate adult morphology; and 3) each of the three components has its own unique morphology regarding trajectory and innervation targets. Notably, the primaxial compartment-responsible branches from the ventral rami have the same features as the dorsal rami. Under the above assumptions, our model comprehensively describes the logic for innervation patterns when facing the intricate anatomy of the spinal nerve in the human body.In transparent whole-mount specimens of embryonic mouse thoraces, the single thoracic spinal nerve in early developmental periods trifurcated into superficial, deep, and lateral cutaneous branches; however, it later resembled the adult branching pattern by contracting the superficial branch. The superficial branches remained segmental while the other two branches were free from axial restriction. Injection of a tracer into the superficial branches of the intercostal nerve labeled Lhx3-positive motoneurons in the medial portion of the medial motor column (MMCm). However, the injection into the deep branches resulted in retrograde labeling of motoneurons that expressed Oct6 in the lateral portion of the medial motor column (MMCl). Collectively, these observations on the embryonic intercostal nerve support our model that the spinal nerve consists of three distinctive components.We believe that our model provides a framework to conceptualize the innervation pattern of the spinal nerve based on the distinction of embryonic mesoderm compartments. Because such information about the spinal nerves is essential, we further anticipate that our model will provide new insights into a broad range of research fields, from basic to clinical sciences.


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