Barberini Fabrizio, Zani Augusto, Ripani Maurizio, Di Nitto Valentina, Brunone Francesca
Department of Human Anatomy, University of Rome "La Sapienza", Via Alfonso Borelli, 50, I-00161 Rome, Italy.
Ann Anat. 2007;189(3):299-303. doi: 10.1016/j.aanat.2006.12.005.
Peritoneal fossae derive from normal or anomalous coalescence of the peritoneum during fetal development, or from the course of retroperitoneal vessels. Clinically, internal abdominal hernias may be housed inside these fossae. In this report from an autopsy, a singular peritoneal fossa was delimited superiorly by an arcuate serous fold, raised up by the inferior mesenteric vein, and infero-posteriorly by two (right and left) avascular folds, extending from the abdominal aorta to the jejunum. The right fold reached the duodeno-jejunal flexure, which was located on the right side of the aorta. The left fold subdivided into two, anterior and posterior, secondary folds. The anterior fold reached the superior edge of the first jejunal loop, and the posterior fold turned medially to connect with the inferior edge of the proximal limb of the same loop. This fossa consisted of three recesses: superior, Located behind the subserous vascular arch, antero-inferior and postero-inferior, separated by interposition of the left posterior secondary fold, between the jejunum and aorta. The complex arrangement of this fossa suggests that it might have originated from a coalescence arising beyond the duodeno-jejunal flexure and including the first jejunal loop, and from the subserous course of the inferior mesenteric vein. Because of displacement to the right of the flexure, processes of coalescence in a location normally occupied by the ascending duodenum might have occurred in a similar pattern for the jejunum, involving the mesoduodenum and the proximal part of the mesentery. Labyrinthine fossae like this might cause strangulation of internal abdominal hernias and hinder intraoperative maneuvers.
腹膜隐窝源于胎儿发育过程中腹膜的正常或异常融合，或源于腹膜后血管的走行。临床上，腹内疝可能存在于这些隐窝内。在这份尸检报告中，一个独特的腹膜隐窝上方由一条弓形浆膜皱襞界定，该皱襞由肠系膜下静脉抬起，后下方由两条（右侧和左侧）无血管皱襞界定，从腹主动脉延伸至空肠。右侧皱襞到达位于主动脉右侧的十二指肠空肠曲。左侧皱襞分为前后两条次级皱襞。前皱襞到达第一空肠袢的上缘，后皱襞向内转向与同一袢近端的下缘相连。这个隐窝由三个隐窝组成：上方的，位于浆膜下血管弓后方；前下方的和后下方的，由左后次级皱襞在空肠和主动脉之间插入而分隔。这个隐窝的复杂结构表明它可能起源于十二指肠空肠曲后方并包括第一空肠袢的融合，以及肠系膜下静脉的浆膜下走行。由于十二指肠空肠曲向右移位，在通常由升部十二指肠占据的位置上的融合过程可能以类似的方式发生在空肠，涉及十二指肠系膜和肠系膜近端部分。这样的迷宫样隐窝可能导致腹内疝绞窄并阻碍术中操作。
