Viewer. Disease from the pancreas, such as pancreatic cancer and pancreatitis, can spread via the subperitoneal route along the transverse mesocolon anteriorly to the colon, the gastrocolic ligament, and the omentum (,Figs 6–,,,,,11, Movie 2 ). The inferior mesenteric vein usually drains into the confluence of the SMV and portal vein. Although hemangioblastoma may be associated with the von Hippel-Lindau syndrome, this … Retroperitoneal sarcomas most commonly present as an abdominal mass, often without other symptoms. Axial-oblique maximum intensity projection images at different levels from a contrast-enhanced CT scan.The plane is that of the transverse mesocolon. 64, No. Tumor mass is malignant and spreads in retroperitoneal space. Actinomycosis is an uncommon intra-abdominal infection and its association with chronic pancreatitis has … The proximal left gastric artery, originating from the celiac axis, courses in a cephalad direction in the retroperitoneum before branching into the gastrohepatic ligament to anastomose with the right gastric artery. The left colic vein (arrow) drains into the inferior mesenteric vein (arrowhead). The left gastroepiploic vessels can be identified as they arise from the distal splenic artery and vein and course from the splenic hilum in the gastrosplenic ligament. Pseudocyst formation in the small bowel mesentery in a 38-year-old man. 2, American Journal of Roentgenology, Vol. Viewer. Secondary retroperitoneal fibrosis is associated with malignant disease, drugs, exposure to radiation and surgery. Figure 20. Figure 24. Pancreatitis has spread to the left transverse colon (white arrow). The distinction between the body and tail is poorly defined. Disease processes commonly spread either by the transperitoneal route or the subperitoneal route. In contrast to intraperitoneal organs, the organs in this space are fixed to a particular location. The neck, which is between the head and the body of the pancreas, corresponds anatomically to that part of the pancreas lying anterior to the SMA and vein and the beginning of the portal vein. Viewer Pancreatitis in a 61-year-old woman. Figure 11. The gastrohepatic and hepatoduodenal ligaments are derivatives of the primitive ventral mesogastrium. Fluid is seen in the small bowel mesentery and the retroperitoneum around the right kidney (r). The gastropancreatic fold divides the lesser sac into a smaller medial compartment and a larger lateral compartment. Colonic involvement is caused by direct spread of pancreatic enzymes through the extraperitoneal fat planes along the mesocolon, causing pericolitis (,Fig 9). The gastrosplenic ligament usually contains adipose tissue around the vessel, which in this patient has been replaced by tumor infiltration. Over the uncinate process of the pancreas, it becomes confluent with the root of the small bowel mesentery. Recognition of colonic involvement in pancreatitis is important, as such involvement is associated with a poor prognosis, with mortality rates of 40% and higher. The gastrohepatic ligament is attached to the lesser curve of the stomach and to the fissure of the ligamentum venosum anterior to the caudate lobe. The disease extends to the gastrosplenic ligament (black arrow) via its direct contiguity with the splenorenal ligament at the splenic hilum. Figure 8. (Primary) retroperitoneal structures in reality. The left gastroepiploic vessels anastamose with the right gastroepiploic vessels. Arterial structures around the pancreas. The jejunal arteries are the branches of the SMA that course in the jejunal mesentery to the left of the SMA to supply the jejunum. The left middle colic vein drains into the inferior mesenteric vein or the splenic vein (,Fig 13). See Movie 5.Download as PowerPointOpen in Image Figure 5. In a typical patient, the marginal vessels from the right transverse colon forming the middle colic vein join the right gastroepiploic vein to become the gastrocolic trunk, draining into the SMV anterior to the head of the pancreas (,Fig 12). The right gastroepiploic artery is a branch of the anterior gastroduodenal artery, which runs in the transverse mesocolon and then in the gastrocolic ligament. The small bowel mesentery can be identified by the jejunal artery and vein (arrows). \"Retro\" is a prefix referring to the state of being prior to, located behind or in back of something. The branches of the SMA include the inferior pancreaticoduodenal artery, jejunal and ileal arteries, middle colic arteries, and ileocolic artery. The jejunal artery and vein (long arrow) serve as vascular landmarks to identify this structure. Venous structures around the pancreas. Fat necrosis (arrows) in the greater omentum in a 49-year-old man with pancreatitis.See Movie 4.Download as PowerPointOpen in Image The right and left gastroepiploic arteries traverse the gastrocolic ligament, forming an anastomotic arcade along the greater curvature of the stomach. The hepatoduodenal ligament carries the proper hepatic artery (long white arrow), the portal vein (short black arrow), and the common bile duct. The pancreas is supplied by the branches from the celiac trunk and the SMA (,Figs 3, ,4). The epiploic artery and vein originate from the gastroepiploic arcade and course in the greater omentum. Viewer Organs in this space include the: 1. It is composed of fatty extraperitoneal connective tissue, the SMA and SMV and their branches, nerves, lymphatics, and an investment of the peritoneum that reflects from the posterior parietal peritoneum. The first part of the small intestine is called the duodenum, which begins the process of chemical digestion. Pericolonic inflammation and thickening of the transverse colon (arrows) in a 57-year-old man with pancreatitis. Figure 1. Viewer. The mechanism of spread along the mesenteric planes was first described by Meyers and Evans in 1973 in the radiology literature (,1). The splenorenal ligament inserts in the splenic hilum and contains the distal splenic artery and vein. Disease from the pancreas, such as pancreatitis and peritoneal metastases from pancreatic carcinoma, can spread to the gastrocolic ligament and the greater omentum by traversing anteriorly through the transverse mesocolon ( Movie 2, ,Fig 11).
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