This is the 1st chapter of Prof. Cheng-Hua Luo's book on Retroperitoneal Tumors (Clinical Management) 2018.

1. Surgical Anatomy of the
Retroperitoneal & Pelvic
Extraperitoneal Space
Dr. Shahbaz Hanif, MS
Peking University International Hospital,
Beijing, China.

2. Surgical Anatomy of the
Retroperitoneal Space
Diaphragm
Sacral promontory + Arcuate line
Parietal peritoneum
Fascia of post. abdominal wall
Communicates with:
• Mediastinal connective tissue (superiorly)
• Extraperitoneal fat (bilaterally)
• Pelvic extraperitoneal space (inferiorly)

3. Continue…
The retroperitoneal space can be divided into:
1. Left lumbar region (left flank)
2. Right lumbar region (right flank)
3. Pre-vertebral region
4. Left iliac fossa (LIF)
5. Right iliac fossa (RIF)

4. Continue…
Contents:
SAD PUCKER
S = Suprarenal glands
A = Aorta / Inferior Vena Cava (IVC)
D = Duodenum (2nd – 4th parts)
P = Pancreas (head, neck & body)
U = Ureters
C = Colon (ascending & descending)
K = Kidneys
E = Esophagus
R = Rectum

5. Kidney
Left kidney (T11 - L2)
Right kidney (T12 - L3)
Structures at the renal hilus:
Front to backward:
Renal vein, Artery & Pelvis
Above to downward:
Renal artery, Vein & Pelvis
• Kidneys move with respiratory movements of the diaphragm within the range
of no more than 1 vertebra (Rohen et al. 1998)

6. Capsules of the Kidneys
3-layers:
• Renal fascia
• Adipose capsule
• Fibrous capsule
• Each kidney weighs about 120-150 g.

7. Or
Adipose
tissue

8. Renal Vasculature
• Renal artery
 Abd. Aorta, (L1-L2 intervertebral disks)
 Rt. Renal artery is normally longer.
 Average diameter = 0.77 cm
 Accessory renal arteries are common.
Close attention should be paid, when a
resection of kidney is required.

9. Continue…
• Renal vein
 Left renal vein is normally 2 or even more than 3 times longer.
 It houses blood from left kidney, left suprarenal gland, and testicles
(ovaries)
• Lymphatic vessels & Nerves
 Testicular varicose veins (constriction of Lt. renal V. by enlarged RP lymph
nodes)

10. Suprarenal (Adrenal) Gland
• Location
• Shape
 Right (pyramidal)
 Lest (half moon)
• Size
 Length=5cm, Width=3cm,
Thickness=0.5-1cm, Weight=5-7g
• Tumors
 Retroperitoneal tumors
 Neural tumors
 pheochoromocytomas

11. Ureter
• Size
 25-30 cm in length
 4-7mm in diameter
• Parts
 Abdominal part
 Pelvic part
 Intramural part
Retroperitoneal tumors frequently
Compress, distort & even invade,
eventually leading to obstruction.

12. Abdominal Aorta
• Length
 12th thoracic – 4th lumbar
vertebrae = (13.4 cm)
• Branches
 Unpaired visceral
 Paired visceral
 Parietal
 Terminal

13. Common Iliac Artery
 Diameter = 10.3-10.4 mm
 Length = 4.3-4.6 cm
 Vessel wall is thinner at the
terminal bifurcation
• External Iliac Artery
 Diameter = 5.9-6 mm
 Length = 10.4-11.8 cm
• Acute abd. Aortic occlusion may be fatal or leads to lower limb gangrene

15. Retroperitoneal Lymph Nodes &
Lymphatic Vessels

16. Lumbar Sympathetic Trunk

17. Celiac Plexus

18. Pelvis
 Greater sciatic foramen
 Lesser sciatic foramen
 Obturator canal
 Extraperitoneal tumors

19. Muscles of Pelvis Wall & Diaphragm
Pelvic Wall Muscles:
 Internal Obturator Muscle
 Piriformis Muscle
Pelvic Diaphragm Muscles
 Levator Ani Muscle
• Puboprostatic
(Pubic vaginal muscle)
• Puborectalis
• Pubococcygeus
• Iliococcygeus
 Coccygeal Muscle

20. Rectum & Anal Canal

21. Bladder

22. Pelvic Blood vessels, Lymph nodes &
Nerves

24. Cross Section of Extra-peritoneal
Pelvis

25. References
 Cheng-Hua Luo, Retroperitoneal Tumors (Clinical Management), Springer
(2018). https://doi.org/10.1007/978-94-024-1167-6
 For better understanding of retroperitonal
and pelvic anatomy, pictures, illustrations or
images are downloaded from Google.
 For further information regarding
Retroperitoneal Tumors, you can contact me
at: dr.shahbazhanif@foxmail.com;
dr.shahbazhanif@qqmail.com