Ultrasound examination of the retroperitoneal space. Topography of the lumbar region
The retroperitoneal space, located deep in the lumbar region, is part of the abdominal cavity. In length, it significantly exceeds the lumbar region, since it is lengthened due to the cellular spaces located in the hypochondrium and iliac fossae.
The retroperitoneal space is located between the parietal peritoneum of the posterior abdominal wall and the intra-abdominal fascia (fascia endoabdominalis), which, lining the muscles of the posterior wall of the abdomen, acquires their names. At the top it is limited by the diaphragm, at the bottom it reaches the terminal line.
Retroperitoneal fascia:
1. Intra-abdominal fascia ( f. endoabdominalis).
2. Retroperitoneal fascia ( f. retroperitonealis) starts from the place of transition of the peritoneum from the lateral to the posterior wall of the abdomen, goes laterally and is divided into the prerenal (f. prerenalis) and the renal ( f. retrorenalis) fascia.
3. F. Toldti- located only along the ascending and descending colons.
The layers of the retroperitoneal space begin from the intra-abdominal fascia.
1. Retroperitoneal cellular space in the form of a thick layer of fatty tissue stretches from the diaphragm to the border line. Dividing to the sides, the fiber passes into the preperitoneal fiber of the anterior non-lateral wall of the abdomen. Medially behind the aorta and inferior vena cava it communicates with the same space on the opposite side. From below it communicates with the retrorectal cellular space of the pelvis. At the top it passes into the tissue of the subphrenic space and through the sternocostal triangle (Bochdalek triangle) communicates with prepleural tissue in the chest cavity. In the retroperitoneal space there are the aorta with the abdominal aortic plexus, the inferior vena cava, lumbar lymph nodes, and the thoracic duct.
2. The renal fascia begins from the peritoneum at the place of its transition from the lateral to the posterior wall of the abdomen (from the retroperitoneal fascia), at the outer edge of the kidney it is divided into posterior and anterior layers, limiting perirenal fiber. Medially it is attached to the fascial sheath of the aorta and inferior vena cava.
3. Pericolic tissue located behind the ascending and descending colons. At the top it reaches the root of the mesentery of the transverse colon, at the bottom - the level of the cecum on the right and the root of the mesentery of the sigmoid colon on the left, outside it is limited by the attachment of the renal fascia to the peritoneum, medially it reaches the root of the mesentery of the small intestine, behind it is limited by the prerenal fascia, in front - by the peritoneum lateral canals and retrocolic fascia. The retrocolic fascia (Toldi) is formed as a result of fusion of the layer of the primary mesentery of the colon with the parietal layer of the primary peritoneum during rotation and fixation of the colon; in the form of a thin plate it lies between the paracolic tissue and the ascending and descending colons, separating these formations.
The retroperitoneal space contains the kidneys, ureters, adrenal glands, the aorta and the inferior vena cava with its branches, the pancreas and duodenum.
Table of contents of the topic "Lumbar region. Retroperitoneal space.":Retroperitoneal space located deep in the abdominal cavity - between the parietal fascia of the abdomen (back and sides) and the parietal peritoneum of the posterior wall of the peritoneal cavity (front). It contains organs not covered by the peritoneum (kidneys with ureters, adrenal glands) and areas of organs only partially covered by the peritoneum (pancreas, duodenum), as well as main vessels (aorta, inferior vena cava), giving off branches for blood supply to all organs, lying both retroperitoneally and intraperitoneally. Along with them come nerves and lymphatic vessels and chains of lymph nodes.
Retroperitoneal space extends beyond the boundaries of the lumbar region as a result of the transition of its fiber into the hypochondrium and iliac fossa.
Walls of the retroperitoneum
Upper wall of the retroperitoneum- lumbar and costal parts of the diaphragm, covered with the parietal fascia of the abdomen, up to lig. coronarium hepatis on the right and lig. phrenicosplenicum on the left.
Posterior and lateral walls of the retroperitoneum- spinal column and muscles of the lumbar region, covered with fascia abdominis parietalis (endoabdominalis).
Anterior wall of the retroperitoneum- parietal peritoneum of the posterior wall of the peritoneal cavity. The visceral fascia of the retroperitoneal organs also takes part in the formation of the anterior wall: the pancreas, the ascending and descending colon.
The lower wall of the retroperitoneum there is no such thing. The conditional lower border is considered to be the plane drawn through the linea terminalis, separating the retroperitoneal space from the pelvis.
Landmarks. Along the upper border of the lumbar region, the XI-XII ribs and their free ends are probed (the XII rib may sometimes be absent). The iliac crest is easily palpable below. The outer border coincides with a vertical line drawn from the end of the 11th rib to the iliac crest. Posterior to the highest point above the iliac crest is a depression known as the lumbar triangle. Upon palpation along the midline, the spinous processes of the two lower thoracic and all lumbar vertebrae are determined. Above the horizontal line connecting the iliac crests, the tip of the spinous process of the IV lumbar vertebra is palpated.
Topography. The skin is thickened and inactive. Subcutaneous tissue is poorly developed. The superficial fascia is well defined and gives off a deep fascial spur, dividing the subcutaneous tissue into two layers. The thoracolumbar fascia, fascia thoracolumbalis, forms cases for the muscles included in the lumbar region: mm. latissimus dorsi, obliquus externus et internus abdominis, serratus posterior inferior, erector spinae, transversus abdominis. First muscle layer The lumbar region consists of two muscles: the latissimus dorsi and the external oblique abdominal muscle. External oblique abdominal muscle, m. obllquus externus abdominis, flat, wide. Its posterior bundles are attached to the iliac crest. As a result, a lumbar triangle, trigonum lumbale, is formed between them. The triangle is bounded on the sides by the edges of these muscles, and below by the crest of the ilium. Its bottom is formed by the internal oblique abdominal muscle. The lumbar triangle is a weak point of the lumbar region, where abscesses of the retroperitoneal tissue can penetrate and, in rare cases, lumbar hernias can emerge. Second muscle layer lumbar region are medial m. Erector spinae, laterally at the top - m. serratus posterior inferior, below - m. obliquus internus abdominis. Serratus posterior inferior, m. Serratus posterior inferior, and internal oblique abdominal muscle, m. obliquus internus abdominis, constitute the lateral section of the second muscular layer of the lumbar region. Both muscles, facing each other with their edges, do not touch, as a result of which a three- or quadrangular-shaped space is formed between them, known as the lumbar quadrangle, tetragonum lumbale. Its sides are the lower edge of the inferior serratus muscle on top, the posterior (free) edge of the internal oblique abdominal muscle on the bottom, the lateral edge of the extensor spinae on the inside, and the 12th rib on the outside and on top. Its bottom is the aponeurosis of the transverse abdominal muscle. Through it, ulcers of the retroperitoneal tissue can spread to the posterior abdominal wall.
Third muscle layer The lumbar region is represented by the transverse abdominal muscle, m. transversus abdominis. The deep surface of the aponeurosis and transverse abdominal muscle is covered with transverse fascia, fascia transversalis, which is part of the intra-abdominal fascia of the abdomen, fascia endoabdominalis, which medially forms cases for m. Quadratus lumborum and mm. psoas major et minor, called respectively fascia quadrata and fascia psoatis. In the upper part of the lumbar region, these fasciae, compacting, form two ligaments that pass into one another and are known as arcus lumbocostalis medialis et lateralis. Along the anterior surface of the quadratus muscle, under the fascia covering it in front, nn pass in an oblique direction from inside to outside from top to bottom. subcostalis, iliohypogastricus, ilioinguinalis, and in a similar gap on the anterior surface of the psoas major muscle there is n. genitofemoralis.
Retroperitoneal space, spatium retroperitoneale. The retroperitoneal space is located between the posterior wall of the abdominal cavity, covered with intraperitoneal fascia, and the parietal peritoneum. The retroperitoneal fascia, fascia retroperitonealis, begins from the fascia endoabdominalis and the parietal peritoneum at the level of the posterior axillary line, where the peritoneum from the side wall of the abdomen passes to the back. Fascia prerenalis passes as a common sheet in front of the fatty tissue covering the kidneys in front, at the top it forms a fascial sheath for the adrenal glands, merging with the corresponding part of the fascia retrorenalis, and is attached on the left to the fibrous tissue surrounding the superior mesenteric artery and the celiac trunk, and on the right - to the fascia sheath of the lower vena cava. The renal fascia, fascia retrorenalis, is also well developed at the level of the kidney. At the top, above the adrenal glands, it fuses with the prerenal fascia and is fixed to the fascial sheaths of the legs of the diaphragm. The fascia of the ascending and descending parts of the colon, or retrocolic fascia, fascia retrocolica, covers their extraperitoneal areas. The retrocolic fascia of the ascending colon is connected medially by numerous plates with the fascia covering the root of the mesentery of the small intestine, and the retrocolic fascia of the descending colon is lost in the tissue at its inner edge. Between the described fascial sheets in the retroperitoneal space, three layers of fiber should be distinguished: retroperitoneal, perinephric and peri-intestinal.
The first layer of retroperitoneal tissue, textus cellulosus retroperitonealis, is the retroperitoneal cellular space. Its anterior wall is formed by fascia retrorenalis, and the posterior wall by fascia-endoabdominalis.
Second layer of retroperitoneal tissue surrounds the kidney, located between the fascia retrorenalis and fascia prerenalis, and is the fatty capsule of the kidney, capsula adiposa renis, or paranephron, paranephron. The paranephron is divided into three sections: the upper - the fascial-cellular sheath of the adrenal gland, the middle - the own fatty capsule of the kidney and the lower - the fascial-cellular sheath of the ureter. Periureteric fiber, paraureterium, enclosed between the fascia preureterica and fascia retroureterica, extends along the ureter along its entire length.
Third layer of retroperitoneal tissue located behind the ascending and descending parts of the colon and is called paracolon.
Perinephric block. Indications: renal and hepatic colic, cholecystitis, biliary dyskinesia, pancreatitis, peritonitis, exacerbation of gastric ulcer, dynamic intestinal obstruction, shock in severe injuries of the lower extremities. Position the patient on the healthy side on a bolster. Injection of a needle at the apex of the angle formed by the XII rib and the outer edge of the rectifier muscle; a long needle is inserted perpendicular to the surface of the body. Continuously injecting a 0.25% solution of novocaine, the needle is advanced to such a depth that there is a feeling of penetration of its end through the retrorenal fascia into the free cellular space. When the needle enters the perinephric tissue, the reverse flow of fluid stops. 60 - 80 ml of 0.25% novocaine solution is injected into the perinephric tissue. The blockade is carried out on both sides.
Retroperitoneal space(spatium retroperitoneale; synonym retroperitoneal space) is a cellular space located between the posterior part of the parietal peritoneum and the intra-abdominal fascia; extends from the diaphragm to the pelvis.In the retroperitoneal space there are the kidneys, adrenal glands, ureters, pancreas, descending and horizontal parts of the duodenum, ascending and descending colon, abdominal aorta and inferior vena cava, roots of the azygos and semi-gypsy veins, sympathetic trunks, a number of autonomic nerve plexuses, branches of the lumbar plexuses, lymph nodes, vessels and trunks, the beginning of the thoracic duct and fatty tissue that fills the space between them.
A complex system of fascial plates divides the retroperitoneal space into a number of compartments. Near the lateral edge of the kidney, the retroperitoneal fascia is divided into two layers - the pre- and retrorenal fascia. The first connects medially with the fascial sheaths of the aorta and inferior vena cava, passing to the opposite side, the second is woven into parts of the intra-abdominal fascia covering the pedicle of the diaphragm and the psoas major muscle.
The retroperitoneal fiber layer is located between the intra-abdominal and retroperitoneal fascia.
The fatty capsule of the kidney (perinephron) lies between the layers of the retroperitoneal fascia and continues along the ureter. Paracolon is located between the posterior surfaces of the ascending and descending colons and the retroperitoneal fascia. Laterally it is limited by the fusion of the latter with the parietal peritoneum, medially it reaches the root of the mesentery of the small intestine and contains fibrous plates (Toldt's fascia), vessels, nerves and lymph nodes of the colon. An unpaired median space is also distinguished, containing the abdominal part of the aorta, the inferior vena cava, the nerves located next to them, lymph nodes and vessels, closed in their fascial sheaths.
Research methods:
Clinical methods are used - inspection, palpation, percussion. Pay attention to skin color, protrusions or swellings, infiltrates or tumors of the abdominal wall. The most informative is palpation of the abdominal wall with the patient in the supine position with a cushion placed under the lumbar region. Clinical examination allows one to suspect a purulent-inflammatory disease, a cyst or tumor of the retroperitoneal space, as well as some diseases of the organs located in it.The methods of X-ray examination used to diagnose diseases of the retroperitoneal space are varied: survey radiography of the thoracic and abdominal cavities, X-ray contrast examination of the stomach and intestines, pneumoperitoneum, pneumoretroperitoneum, urography, pancreatography, aortography, selective angiography of the branches of the abdominal aorta, cavography, lymphography, etc.
Among instrumental research methods, the leading role in the diagnosis of diseases of the retroperitoneal space is played by ultrasound scanning and computed x-ray tomography, which can be performed on an outpatient basis in a diagnostic center. They make it possible to establish the localization of the pathological focus, its size, and relationships with surrounding organs and tissues. Diagnostic or therapeutic puncture is possible under X-ray television control.
Damage to the retroperitoneum:
Retroperitoneal hematoma caused by mechanical trauma is more common. A large hematoma, especially in the first hours, in clinical symptoms resembles damage to a hollow or parenchymal organ of the abdominal cavity. Acute bleeding can cause the development of hemorrhagic shock. Symptoms of peritoneal irritation are detected - severe pain and tension in the muscles of the abdominal wall, a positive Blumberg-Shchetkin sign, which allows one to suspect the development of peritonitis.However, unlike damage to the hollow organs of the abdominal cavity, which are characterized by the progression of clinical manifestations of peritonitis, with retroperitoneal hematoma they are less pronounced and gradually disappear. With a massive retroperitoneal hematoma, paresis of the gastrointestinal tract increases, the content of hemoglobin, hematocrit and the number of red blood cells in the blood decreases. The leading role in differential diagnosis belongs to laparoscopy. With large retroperitoneal hematomas, blood can leak into the abdominal cavity through an intact posterior layer of the peritoneum, which makes diagnosis difficult.
Using X-ray examination methods, it is possible to detect pneumoperitoneum in case of damage to a hollow organ of the abdominal cavity, and in case of retroperitoneal hematoma, blurred contours and displacement of the kidney, psoas muscle, bladder, and retroperitoneal sections of the intestine. More complete and accurate information is obtained from ultrasound and computed x-ray tomography.
Treatment of injuries to the retroperitoneal space is carried out in a hospital. In some cases, in the absence of signs of bleeding, damage to the abdominal organs and changes in the blood and urine, outpatient treatment is possible with mandatory daily monitoring of the victim’s condition for 2-3 days after the injury. Treatment of isolated retroperitoneal hematomas without damage to the organs of the gastrointestinal tract is conservative and includes a set of measures aimed at combating shock, blood loss and paresis of the gastrointestinal tract. If internal bleeding continues or signs of damage to the cervical organs (kidneys, pancreas, large vessels) are detected, emergency surgery is indicated.
The prognosis for isolated retroperitoneal hematomas is in most cases (favorable if infection does not occur.
Diseases of the retroperitoneal space:
Purulent-inflammatory processes in the retroperitoneal tissue can be serous, purulent and putrefactive. Depending on the location of the lesion, paranephritis, paracolitis and inflammation of the retroperitoneal tissue are distinguished. The clinical picture of purulent-inflammatory processes in the retroperitoneal space consists of signs of general intoxication (chills, high body temperature, anorexia, weakness, apathy, leukocytosis and a shift of the leukocyte blood count to the left, in severe cases, progressive dysfunction of the cardiovascular system, etc.). At the same time, changes in the contours or bulging of the abdominal wall in the lumbar or epigastric regions, the formation of infiltrate, muscle tension, etc. are detected.A retroperitoneal abscess is often accompanied by flexion contracture in the hip joint on the affected side. Severe complications of purulent-inflammatory processes in the retroperitoneal space are the breakthrough of a retroperitoneal abscess into the abdominal cavity with the subsequent development of peritonitis, the spread of retroperitoneal phlegmon into the mediastinum, the occurrence of secondary osteomyelitis of the pelvic bones or ribs, intestinal fistulas, paraproctitis, purulent leaks in the gluteal region, on the thigh.
The diagnosis of a purulent-inflammatory process is made on the basis of the clinical picture, as well as ultrasound and x-ray data. Treatment of inflammatory processes in the stomach in the absence of signs of suppuration is conservative (antibacterial, detoxification and immunostimulating therapy). When phlegmon or abscess forms, their opening and drainage are indicated. As a result of a purulent-inflammatory process in the retroperitoneal space, retroperitoneal fibrosis can develop.
Tumors:
Tumors of the retroperitoneal space arise from the tissues of the organs located in it (duodenum, ureter, kidney, etc.) and non-organ tissues (adipose tissue, muscles, fascia, blood vessels, nerves, sympathetic nerve nodes, lymph nodes and vessels). According to histogenesis, tumors of mesenchymal origin (mesenchymomas, lipomas, liposarcomas, lymphosarcomas, fibromas, fibrosarcomas, etc.), neurogenic (neurilemmomas, neurofibromas, paragangliomas, neuroblastomas, etc.), teratomas, etc. are distinguished. There are benign and malignant, single and multiple retroperitoneal tumors.Early symptoms for retroperitoneal tumors are usually absent. Gradually, the tumor reaches large sizes, displacing neighboring organs. Patients feel discomfort in the abdominal cavity, aching pain in the abdomen and lower back. Sometimes a tumor is discovered by chance during palpation of the abdomen, a feeling of heaviness in the abdomen caused by the tumor, or in case of dysfunction of the intestines, kidneys (intestinal obstruction, renal failure), etc.
With extensive retroperitoneal tumors, venous and lymphatic outflow is disrupted, which is accompanied by edema and venous stagnation in the lower extremities, as well as ascites, dilation of the saphenous veins of the abdomen. Unlike malignant ones, benign tumors of the retroperitoneal space, even large ones, have little effect on the general condition of the patient, but with continued growth they can disrupt the function of neighboring organs.
To clarify the diagnosis, X-ray, ultrasound examination and puncture biopsy are performed. Differential diagnosis is carried out with retroperitoneal organ tumors (kidneys, adrenal glands), some intra-abdominal tumors (intestinal mesentery, ovary), with retroperitoneal abscess or hematoma, leak, aneurysm of the abdominal aorta.
Treatment in most cases is surgical. Some types of sarcomas are amenable to chemotherapy, radiation, or combination treatment. The prognosis is unsatisfactory. Retroperitoneal tumors, especially sarcomas, are characterized by frequent recurrence.
Operations:
The main surgical access to the retroperitoneal space is lumbotomy - extraperitoneal penetration into the retroperitoneal space through an incision in the lumbar region. In some cases, for example, during operations on the abdominal aorta, a transperitoneal approach is used, in which the retroperitoneal space is opened after laparotomy by dissecting the posterior layer of the parietal peritoneum. Operations performed on organs in the retroperitoneal space.11308 0
The peritoneum, lining the abdominal cavity, is adjacent to the intra-abdominal fascia. Between the peritoneum and the fascia there is a small amount of fatty tissue in the anterior parts of the abdomen - preperitoneal tissue. The posterior wall of the peritoneal sac does not adjoin directly to the intra-abdominal fascia; between them a space is formed filled with fatty tissue, called retroperitoneal, or retroperitoneal.
1 - t. errector spinae; 2 - quadratus lumborum muscle; 3 - lumboiliac muscle; 4 - retroperitoneal cellular space; 5 - pericolonic fiber space; 6 - perinephric cellular space; 7 - retrorenal fascia; 8 - deep layer of the lumbodorsal fascia; 9 - anterior renal fascia
The posterior surface of the retroperitoneal space consists of the lumbar and lower costal parts of the diaphragm, the quadratus lumborum muscle and the iliopsoas muscle with the same fascia.
In the retroperitoneal space, there is a middle section - the “mediastinum of the abdomen” (according to N.I. Pirogov) and two lateral ones, located outside the spine. The retroperitoneal space is conventionally divided into three floors: subphrenic, lumbar and retroperitoneal spaces of the large pelvis (the area of the iliac fossae).
Localization of abscesses in the retroperitoneal space. Sagittal (a) and transverse (b) sections through the lumbar region:
1 - abscess of the anterior retroperitoneal space; 2 - abscess of the posterior retroperitoneal space; 3 - retroperitoneal subphrenic abscess; 4 - retrofascial lumbar abscess
The “abdominal mediastinum” contains the aorta, the inferior vena cava and their branches, lymph nodes, part of the body of the pancreas and the horizontal part of the duodenum. The fiber that fills the median retroperitoneal space in the upper section passes into the mediastinal fiber through the hole in the diaphragm. Anteriorly, the fiber passes into the fiber of the mesentery of the small intestine and transverse colon, and downwards into the pararectal fiber space.
The pre- and retrorenal fascia form the perirenal cellular space (paranephron), which is open medially towards the spine and the “abdominal mediastinum”. Infection of the paranephron is possible hematogenously and lymphogenously, with penetrating wounds, but more often contact infection occurs from the kidney (renal carbuncle, pyonephrosis), with destructive appendicitis, when the appendix is located retrocecally and retroperitoneally.
An abscess from the paranephron can spread downwards into the iliac fossa, small pelvis, and through cracks in the fascia or when the fascia is destroyed by the inflammatory process - into the paracolon.
The pericolic cellular space (paracolon) is limited anteriorly by the posterior surface of the ascending or descending colon and the parietal peritoneum and posteriorly by the anterior renal, retroperitoneal and preureteral fascia.
Infection of the paracolon most often occurs with inflammation of the retroperitoneally located vermiform appendix, perforation of an ulcer of the posterior wall of the duodenum, perforation of an ulcer or tumor of the posterior wall of the ascending or descending colon, with pancreatic necrosis, purulent pancreatitis. In case of destructive pancreatitis with localization of the process in the head of the pancreas, pus can spread into the right paraintestinal space to the cecum; if the body and tail of the pancreas are affected, it can spread to the left space.
Purulent leaks into the paracolon extend from the right to the hepatic flexure of the ascending rim of the intestine, downwards to the cecum, from the outside to the junction of the parietal peritoneum with the fascia along the posterior axillary line and from the inside to the “abdominal mediastinum”. On the left, purulent leaks can spread upward to the splenic flexure of the colon and pancreas, downward to the peri-vesical and perirectal tissue.
The internal and external boundaries of the spread of purulent leaks are the same as in the right peri-intestinal space. In purulent paracolitis, in cases of spread of the purulent process from the retroperitoneally located vermiform appendix, pus can penetrate the subcutaneous tissue in the area of the lumbar triangle (Petit's triangle) above the wing of the ilium.
The fascial sheets that form the retroperitoneal cellular spaces (paracolon, paraurethral and retroperitoneal spaces) gradually disappear downwards. These spaces merge with each other and in the pelvis they turn into one cellular space, limited by the intrapelvic fascia and the pelvic peritoneum.
The main cellular spaces (the retroperitoneal tissue itself, the paranephron and paracolon), although limited by the fascia, do not provide complete delimitation of the purulent processes localized in them. Through natural gaps in the fascia, as well as when they are destroyed, the purulent-inflammatory process can spread from one space to another.
In surgical practice, in addition to the three retroperitoneal tissue spaces, the fascial-muscular sheath of the iliopsoas muscle is distinguished.
Abscesses in osteomyelitis and tuberculosis of the lumbar spine can descend along the so called psoas into the iliac fossa and spread through the lacuna musculorum to the thigh. Under the t. psoas is the lumbar nerve plexus, from which the femoral nerve is formed. It passes under the muscle and exits through the muscle lacuna to the thigh. The nerve is surrounded by fatty tissue, which is enclosed in the fascial sheath of the nerve. Paraneural tissue can serve as a conductor for the purulent process.
In the iliac fossa there are three cellular spaces. One of them is represented by retroperitoneal tissue, located under the parietal peritoneum, and is limited posteriorly by the iliopsoas fascia. Under the iliopsoas muscle there is a deep cellular fissure of the iliac fossa, which is limited by the muscle and the wing of the ilium.
Between the anterior surface of the muscle and its own fascia there is an iliac fissure, in which the nerves of the lumbar plexus pass. The purulent process rarely involves the iliopsoas muscle directly, but in case of paranephritis, paracolitis, pus along the anterior surface of the muscle can spread into the iliac fossa and along the muscle through the muscle lacuna under the Poupartian ligament and onto the thigh with the development of an abscess, phlegmon of the anterior and anterior inner surface of the thigh.
Most inflammatory processes called “paranephritis”, “paracolitis”, “psoitis” or simply “retroperitoneal abscess” are secondary. A rare exception is inflammation after penetrating wounds. In approximately 40% of patients, the primary lesion remains unclear.
If the range of etiological moments of paranephritis and paracolitis is relatively narrow (paranephritis and paracolitis almost always arise as a result of the sequential spread of purulent processes from the kidney, colon and appendix, to which the corresponding sections of the retroperitoneal tissue are directly adjacent), then the etiological moments of acute purulent processes in the retroperitoneal tissue itself there is a lot of fiber (pancreatic necrosis, destructive cholecystitis, etc.).
The most common cause of retroperitoneal phlegmon is acute purulent paranephritis. Cellulitis of the iliac fossa most often develops as a complication of destructive appendicitis when the appendix is located retroperitoneally.
More rare causes are phlegmon of the hernial sac with a sliding inguinal hernia, sepsis, osteomyelitis of the ilium and a gunshot wound to the pelvis.
VC. Gostishchev
