The document provides an overview of the surgical anatomy of the retroperitoneal and pelvic extraperitoneal space, detailing its divisions, contents, and associated structures such as the kidneys, aorta, and suprarenal glands. It highlights the anatomy relevant to potential surgical procedures, including notable features like lymphatic vessels and the impacts of retroperitoneal tumors. Contact information for further inquiry and references for additional information are also included.

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)

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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.

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• 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