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Anatomy of the retroperitoneum

Department of Radiology, Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK

Summary

• The retroperitoneum is a complex compartment, the anatomy of which has yet to be fully validated.
  
• The retroperitoneum lies between the posterior parietal peritoneum in front and the transversalis fascia behind.
  
• It is nominally divided into three spaces by the perirenal fascia: the anterior pararenal space, the perirenal space and the posterior pararenal space.
  
• The anterior pararenal space communicates across the midline. Superiorly it extends to the dome of the diaphragm and hence to the mediastinum. Inferiorly it communicates with the pelvis and below the inferior renal cone with the posterior pararenal space.
  
• The perirenal space extends across the midline. It abuts the bare area of the liver on the right and the subphrenic space on the left, with mediastinal communication via the diaphragmatic hiatae. In disease the perirenal space is usually closed inferiorly, preventing pelvic spread.
  
• Within the fat surrounding the kidney in the perirenal space there is a network of thin septae that contain and direct the spread of fluid.
  
• The posterior pararenal space is potentially in continuity anteriorly with the properitoneal fat of the anterior abdominal wall. It is open towards the pelvis inferiorly but limited superiorly by fusion of the posterior perirenal fascia with the fascia of the quadratus lumborum and psoas muscles.