What is the anatomy relevant to abdominal abscess?

Updated: Mar 27, 2020
  • Author: Alan A Saber, MD, MS, FACS, FASMBS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

The eight functional compartments in the peritoneal cavity include the following:

  • Pelvis
  • Right paracolic gutter
  • Left paracolic gutter
  • Right infradiaphragmatic space
  • Left infradiaphragmatic space
  • Lesser sac
  • Hepatorenal space (Morrison space)
  • Interloop spaces between small intestine loops

The paracolic gutters slope into the subhepatic and subdiaphragmatic spaces superiorly and over the pelvic brim inferiorly. In a supine patient, the peritoneal fluid tends to collect under the diaphragm, under the liver, and in the pelvis.

More localized abscesses tend to develop anatomically in relation to the affected viscus. For example, abscesses in the lesser sac may develop secondary to severe pancreatitis, or periappendiceal abscesses from a perforated appendix may develop in the right lower quadrant. Small bowel interloop abscesses may develop anywhere from the ligament of Treitz to the ileum. An understanding of these anatomic considerations is important for the recognition and drainage of these abscesses.


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