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Abdominal and Pelvic Anatomy

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... In a study completed with 56 cadavers, of which 11 spines had spondylophytes on at least one side, the lumbar sympathetic trunk was shifted ventrolateral in 12 sides, dorsolateral in 6 sides, and ventromedial in one side due to the presence of spondylophytes (6). The superior hypogastric plexus (SHP) is a retroperitoneal structure formed from the continuation of thoracic and lumbar splanchnic nerves coursing anteriorly to the lumbar vertebrae located close to the aortic bifurcation at L4-S1 (7,8). Specifically, it extends from the lower third of L5 to the upper third of S1 surrounded by loose connective tissue (9,10). ...
Article
Background and objective: To highlight the surgical anatomy, procedural variations, presentation, and management of sympathetic nerve injury after surgery of the lumbar spine. Methods: PubMed and Google Scholar were searched for publications that were completed between 1951 and 2021. Relevant full-text articles published in the English language were selected and critically reviewed. Key content and findings: Sympathetic injury is a highly variable postsurgical complication with a greater incidence after an anterior or oblique approach to the lumbar spine compared to posterior and lateral approaches. The direct and extreme lateral approaches reduce the need to disturb sympathetic nerves thus reducing the risk of complications. It can present in multiple manners, including complex regional pain syndrome (CRPS) and retrograde ejaculation. These complications can be transient and resolve spontaneously or be treated with medications, physical therapy, and spinal blocks. The severity of the conditions and extent of recovery can vary drastically, with some patients never fully recovering. Conclusions: To access the lumbar spine, there are operational approaches and techniques that should be used to decrease the risk of intraoperative injury. It is crucial to understand the advantages and risks to different approaches and take the necessary steps to minimize complications. Early identification of dysfunction and adequate management of symptoms are imperative to effectively manage patients with lumbar sympathetic trunk and sympathetic nerve fiber injuries.
... The structures within the broad ligament (uterine tubes, ovarian artery, uterine artery, ovarian ligament, round ligament of the uterus, suspensory ligament of the ovary, ovary) are considered retroperitoneal. The broad ligament itself is composed of visceral and parietal peritonea that contain smooth muscle and connective tissue [4,5]. ...
Article
Cirrhosis is the fifth leading cause of death in adults. Advanced cirrhosis can cause significant portal hypertension (PH), which is responsible for many of the complications observed in patients with cirrhosis, such as varices. If portal pressure exceeds a certain threshold, the patient is at risk of developing life-threatening bleeding from varices. Variceal bleeding has a high incidence among patients with liver cirrhosis and carries a high risk of mortality and morbidity. The management of variceal bleeding is complex, often requiring a multidisciplinary approach involving pharmacological, endoscopic, and radiologic interventions. In terms of management, three stages can be considered: primary prophylaxis, active bleeding, and secondary prophylaxis. The main goal of primary and secondary prophylaxis is to prevent variceal bleeding. However, active variceal bleeding is a medical emergency that requires swift intervention to stop the bleeding and achieve durable hemostasis. We describe the pathophysiology of cirrhosis and PH to contextualize the formation of gastric and esophageal varices. We also discuss the currently available treatments and compare how they fare in each stage of clinical management, with a special focus on drugs that can prevent bleeding or assist in achieving hemostasis.
Article
Full-text available
1) Background: This study aimed to explore wearable sensors′ potential use to assess cumulative mechanical kidney trauma during endurance off-road running. (2) Methods: 18 participants (38.78 ± 10.38 years, 73.24 ± 12.6 kg, 172.17 ± 9.48 cm) ran 36 k off-road race wearing a Magnetic, Angular Rate and Gravity (MARG) sensor attached to their lower back. Impacts in g forces were recorded throughout the race using the MARG sensor. Two blood samples were collected immediately pre-and post-race: serum creatinine (sCr) and albumin (sALB). (3) Results: Sixteen impact variables were grouped using principal component analysis in four different principal components (PC) that explained 90% of the total variance. The 4th PC predicted 24% of the percentage of change (∆%) of sCr and the 3rd PC predicted the ∆% of sALB by 23%. There were pre-and post-race large changes in sCr and sALB (p ≤ 0.01) and 33% of participants met acute kidney injury diagnosis criteria. (4) Conclusions: The data related to impacts could better explain the cumulative mechanical kidney trauma during mountain running, opening a new range of possibilities using technology to better understand how the number and magnitude of the g-forces involved in off-road running could potentially affect kidney function.
Book
Detailed anatomic drawings and state-of-the-art radiologic images combine to produce this essential Atlas of Lymph Node Anatomy. Utilizing the most recent advances in medical imaging, this book illustrates the nodal drainage stations in the head and neck, chest, and abdomen and pelvis. Also featured are clinical cases depicting drainage pathways for common malignancies. 2-D and 3-D maps offer color-coordinated representations of the lymph nodes in correlation with the anatomic illustrations. This simple, straightforward approach makes this book a perfect daily resource for a wide spectrum of specialties and physicians at all levels who are looking to gain a better understanding of lymph node anatomy and drainage. Edited by Mukesh G. Harisinghani, MD, with chapter contributions from staff members of the Department of Radiology at Massachusetts General Hospital.
Article
Primary epithelial neoplasms of the pancreas can be divided into those of exocrine and endocrine origin. Nonepithelial and secondary pancreatic neoplasms are uncommon, and will not be covered in this chapter. Surgical therapy may be appropriate for some of these tumors, depending on the clinical situation, and the principles outlined for primary neoplasms can usually be followed. Pancreatic exocrine neoplasms are relatively common, with adenocarcinoma accounting for most cases. Early signs and symptoms of pancreatic exocrine tumors vary with tumor location, and are usually vague and nonspecific (e.g., anorexia, malaise, abdominal pain, and weight loss), often resulting in slower diagnosis. Adeno-carcinomas of the pancreatic head are more likely to be resectable at diagnosis than body and tail lesions, as they often cause biliary obstruction and jaundice. In general, pancreatic adenocarcinoma is a rapidly progressive and lethal cancer. Pancreatic endocrine neoplasms (PEN) are encountered less frequently, and vary considerably in presentation and prognosis. Patients with these tumors may be asymptomatic; they may exhibit nonspecific symptoms such as pain or weight loss; or they may manifest recognizable signs and symptoms of clearly defined syndromes. Examples include insulinoma and carcinoid tumors. Malignancy is often defined by tumor behavior and histology. In general, surgical resection is the mainstay of therapy for PENs. It may be appropriate to surgically remove PENs despite the presence of metastatic disease, given the relative chronic nature of these tumors.
Article
Soft tissue sarcomas are rare tumors, with less than 8,500 cases predicted in the United States in 2008. Tumors of the retroperitoneum are even more unusual because they comprise 10–20% of all sarcomas in adults. Of the malignancies that arise in the retroperitoneal space, and not in the retroperitoneal viscera, soft tissue sarcomas account for 40–70%. Lymphomas account for 15–30% of the total, and the less common tumors such as paragangliomas and malignant teratomas account for the remainder. The most frequent histologic types of retroperitoneal sarcoma are lipos-arcoma and leiomyosarcoma, followed by malignant fibrous histiocytoma and fibro-sarcoma. Less common histologic types include malignant peripheral nerve tumors, lymphangiosarcoma, rhabdomyosarcoma, and hemangioendothelioma.
Chapter
The gastrointestinal tract terminates at the colon, which is involved in absorption of water and electrolytes, mucus secretion, and the propagation and storage of fecal material. The colon measures approximately 150-180 cm in length and comprises one-fifth of the total intestinal length. It begins just distal to the terminal ileum at the ileocecal valve and extends to the dentate line, which includes the proximal two-thirds of the anal canal. © 2013 Springer-Verlag Berlin Heidelberg. All rights are reserved.
Article
It is difficult to identify normal peritoneal folds and ligaments at imaging. However, infectious, inflammatory, neoplastic, and traumatic processes frequently involve the peritoneal cavity and its reflections; thus, it is important to identify the affected peritoneal ligaments and spaces. Knowledge of these structures is important for accurate reporting and helps elucidate the sites of involvement to the surgeon. The potential peritoneal spaces; the peritoneal reflections that form the peritoneal ligaments, mesenteries, and omenta; and the natural flow of peritoneal fluid determine the route of spread of intraperitoneal fluid and disease processes within the abdominal cavity. The peritoneal ligaments, mesenteries, and omenta also serve as boundaries for disease processes and as conduits for the spread of disease.
Article
Understanding the complexities of the liver has been a long-standing challenge to physicians and anatomists. Significant strides in the understanding of hepatic anatomy have facilitated major progress in liver-directed therapies--surgical interventions, such as transplantation, hepatic resection, hepatic artery infusion pumps, and hepatic ablation, and interventional radiologic procedures, such as transarterial chemoembolization, selective internal radiation therapy, and portal vein embolization. Without understanding hepatic anatomy, such progressive interventions would not be feasible. This article reviews the history, general anatomy, and the classification schemes of liver anatomy and their relevance to liver-directed therapies.
Article
This article deals with injuries to the celiac trunk, superior and inferior mesenteric arterial injuires. Surgical approaches and physiological implications of interruption of the mesenteric arterial circulation are addressed in detail. Surgical techniques for the management of these injuries and the need for second look operations are also examined.
Article
Surgery remains the most radical method of treatment of many solid tumors, including colorectal cancer; in these tumors, surgery is the only method that can offer the chance of cure. To avoid early postoperative morbidity (mainly, anastomotic leak) and to achieve good long-term results (low incidence of tumor recurrence, long overall and disease-free survival, and optimal quality of life), the surgeon should have an in-depth knowledge of vascular anatomy of the colon and rectum. This essential requirement is based on the fact that the actual course followed by lymph fluid drainage from any part of the colon/rectum is determined by its blood supply; therefore, the extent of resection for colorectal cancer follows the principles of blood supply and lymphatic drainage. Knowledge of the colorectal vascular anatomy and its variations is of vital importance in the planning of radical surgical treatment and in appropriately performing colorectal resections, particularly in the patient who underwent in the past colectomy or aortic surgery that has changed the usual pattern of collateral blood supply to the colon. This review summarizes currently available data regarding vascular anatomy of the colon and rectum, from a surgical perspective.
Article
Cancer spreads locally through direct infiltration into soft tissues, or at distance by invading vascular structures, then migrating through the lymphatic or blood flow. Although cancer cells carried in the blood can end in virtually any corner of the body, lymphatic migration is usually stepwise, through successive nodal stops, which can temporarily delay further progression. In radiotherapy, irradiation of lymphatic paths relevant to the localisation of the primary has been common practice for decades. Similarly, excision of cancer is often completed by lymphatic dissection. Both in radiotherapy and in surgery, advanced knowledge of the lymphatic pathways relevant to any tumour location is an important information for treatment preparation and execution. This second part describes the lymphatics of the upper limb, of the thorax and of the upper abdomen. Providing anatomical bases for the radiological delineation of lymph nodes areas in the axilla, in the chest and in the abdomen, it also offers a simplified classification for labeling the mediastinal and intra-abdominal nodal levels, grouped in each location inside three major functional areas (called I, II and III) which are all divided into three sublevels (named a, b or c).
Morrow's Gynecologic Cancer Surgery
  • C P Morrow
Morrow CP, ed. Morrow's Gynecologic Cancer Surgery. 2nd ed. South Coast Medical Publishing; 2013.
Atlas of Vascular Anatomy: An Angiographic Approach
  • R Uflacker
Uflacker R, ed. Atlas of Vascular Anatomy: An Angiographic Approach. 2nd ed. Lippincott Williams & Wilkins; 2007.