Is there a precise correlation between the lengths of the peritoneal reflection and the middle rectal valve?

Introduction: Pelvic anatomy remains a challenge, and thorough knowledge of its intricate landmarks has major clinical and surgical implications in several medical specialties. The peritoneal reflection is an important landmark in intraluminal surgery, rectal trauma, impalement, and rectal adenocarcinoma. Objectives: To investigate the correlation between the lengths of the middle rectal valve and of the peritoneal reflection determined with rigid sigmoidoscopy and to determine whether there are any differences in the location of the peritoneal reflection between the genders and in relation to body mass index (BMI) and parity. Design: We prospectively investigated the location of the middle rectal valve and of the peritoneal reflection via intraoperative rigid sigmoidoscopy in colorectal cancer patients undergoing elective colorectal surgery. Results: We evaluated 38 patients with a mean age of 55.5 years old (57.5% males) who underwent colorectal surgery at the coloproctology service of the Hospital Santa Marcelina, São Paulo, state of São Paulo, Brazil. There was substantial agreement between the lengths of the middle rectal valve and of the peritoneal reflection (Kappa = 0.66). In addition, the peritoneal reflection was significantly lower in overweight patients (p = 0.013 for women and p < 0.005 for men) and in women with > 2 vaginal deliveries (p = 0.009), but there was no significant difference in the length of the peritoneal reflection between genders (p = 0.32). Conclusion: There was substantial agreement between the lengths of the peritoneal reflection and of the middle rectal valve, and the peritoneal reflection was significantly lower in overweight patients and in women with more than two vaginal deliveries. (AU)

Peritoneal spaces: measurements of peritoneal surfaces / Espacios peritoneales: mediciones de las superficies peritoneales

In this work the quantitative data of the surfaces that limit the sub-spaces that constitute the peritoneal space are shown. The methodology of measurement of the two sheets (parietal and visceral) of the peritoneal serosa applied in our previous paper (Albanese et al., 2009), in non-eviscerated corpses, allowed us to know for the first time, the surface or total extension of the peritoneum "in situ". This methodology was useful to determine the surface or area of the two sheets of the peritoneum, which limit the peritoneal space. Our objective in this study was to determine the total peritoneal areas (visceral + parietal) in human corpses that are not eviscerated, which limit the different sub-spaces that make up the peritoneal space. Ten female cadavers fixed in 5 % formaldehyde solution were used. Small cellophane films were placed directly on the peritoneal sheets. The digital images were obtained by scanning these models. The surface was determined by the "Scion image for Windows" program. The results were expressed as mean +/- SE. The analysis of variance (ANOVA) was used for the statistical study. The results obtained showed that the peritoneal sub-space of greater surface area was retro-omental (mean +/- SE 7767.81 +/- 646.70 cm2 p <0.01 ANOVA), due to the large extension of its visceral surface ( mean +/- SE 7401.82 +/- 640.99 cm2). More than 50 % of the surface of the entire peritoneum corresponds to said sub-space. The smallest peritoneal sub-space (3 % of the total peritoneal surface) was the pelvic sub-space (mean +/- SE 431.30 +/- 41.62 cm2). We believe that this information may be useful in case of peritoneal pathological processes or those affected by prolonged peritoneal dialysis, and that knowledge of the surface and extension of the peritoneal space involved may contribute to the estimation of the peritoneal surface involved and help to plan the treatment.

En este trabajo se muestran los datos cuantitativos de las superficies que limitan el espacio peritoneal y los sub-espacios que lo componen. La metodología de medición de las dos hojas (parietal y visceral) de la serosa peritoneal empleada en cadáveres no eviscerados, permitió conocer por primera vez, la superficie o extensión total del peritoneo in situ. El objetivo en este trabajo fue determinar -en cadáveres humanos no evisceradoslas áreas peritoneales totales (visceral + parietal) que limitan los distintos sub-espacios que conforman el espacio peritoneal. Se han utilizado diez cadáveres femeninos no eviscerados fijados en solución de formaldehido al 5 %. Pequeñas películas de celofán se colocaron directamente sobre las hojas peritoneales. La obtención de imágenes digitales se realizó escaneando estos modelos. La superficie fue determinada por el programa "Scion image for Windows". Los resultados se expresaron como media +/- SE. Para el estudio estadístico se utilizó el análisis de varianza (ANOVA). Los resultados obtenidos demostraron que el sub-espacio peritoneal de mayor superficie fue el retro-omental (media +/- SE 7767,81 +/ - 646,70 cm2 p<0.01 ANOVA), debido a la gran extensión de su superficie visceral (media +/- SE 7401,82 +/- 640,99 cm2). Más del 50 % de la superficie de todo el peritoneo corresponde a dicho sub-espacio. El sub-espacio peritoneal más pequeño (3 % de la superficie peritoneal total) fue el sub-espacio pélvico (media +/SE 431,30 +/- 41,62 cm2). Esta información podrá ser de utilidad en el caso de procesos patológicos peritoneales o áreas afectadas por diálisis peritoneal prolongada. De esta manera el conocimiento de la extensión del espacio peritoneal involucrado, puede contribuir a la estimación de la magnitud y gravedad de la superficie peritoneal comprometida. Además puede ayudar a planificar el tratamiento.

Diagnóstico del conducto peritoneo vaginal persistente contralateral en pacientes con hernia inguinal / Diagnosis of persistent contralateral vagino-peritoneal duct in patients with inguinal hernia

Actualmente la exploración laparoscópica del orificio inguinal profundo es la mejor forma de diagnosticar la persistencia del conducto peritoneo vaginal coantralateral en pacientes con hernia inguinal unilateral. Se realizó dicha exploración en 20 pacientes examinando quirúrgicamente el trayecto inguinal contralateral luego de la evaluación endoscópica. En 15 casos (75 por ciento) la visión endoscópica no reveló signos sugerentes de persistencia del conducto, lo cual fue corroborado quirúrgicamente. En cinco pacientes (25 por ciento) se encontraron signos anatómicos sugerentes de persistencia, confirmándose dicha observación en todos ellos al explorar en forman quirúrgica el trayecto inguinal. En esta serie no hubo falsos (+) ni falsos (-). La exploración laparoscópica del orificio inguinal profundo es una técnica simple, rápida, segura y sensible en el diagnóstico de la persistencia del conducto peritoneo vaginal contralateral en pacientes con hernia inguinal unilateral

Topografia estrutural do baço acessório / Topographic anatomy of accessory spleen

Com o intuito de apreciar a topografia estrutural do baço acessório no homem, foi examinada a cavidade abdominal em 949 cadáveres. O estudo histológico, de nódulos suspeitos, permitiu considerar nódulos que efetivamente representassem baços acessórios. Estes nódulos foram considerados e avaliados conforme relaçöes sintópicas, dimensöes, peso. Em 42 (4,43%) dos 949 indivíduos analisados foram encontrados 59 baços acessórios, sendo que em cinco casos foram observados mais de um baço acessório. A distribuiçäo dos baços acessórios quanto ao sexo e cor näo mostrou preferências, entretanto quanto às faixas etárias, verificamos que na primeira década estes nódulos ocorreram mais freqüentemente (8,7%). A sintopia dos baços acessórios mostoru nítida predominância junto ao omento pancreático-esplênico (77,6%) do que na porçäo retroperitoneal (22,4%). Estes resultados poderäo contribuir para o estadiamento de tecido esplênico funcionante na cavidade abdominal, com especial atençäo para as intervençöes cirúrgicas onde a manutençäo incidental de baços acessórios pode vir a se constituir em causa de recidiva tardia da afecçäo