presacral space
The
anatomical compartments and their connections as demonstrated by ectopic air. The same patient as in Fig. 13b. Fournier gangrene in a 67-year-old diabetic man, with extensive arteriosclerosis, already submitted to aortic bifemoral bypass years ago, still permeable (red circles – patent common femoral bypass grafts located anteriorly to native arteries, occluded on the left). Contrast-enhanced CT scan at level of acetabular dome shows endopelvic fascia and extraperitoneal pelvic spaces. Endopelvic fascia and its two layers are illustrated. The parietal layer covers the elevator muscle of anus and coccygeus (pelvic diaphragm) and the intrapelvic portions of the internal obturator and the piriformis muscles. The visceral layer covers inferior segments of the urinary bladder, lower third of the ureters, uterus, vagina and seminal vesicles; it forms a continuous line enveloping the perirectal fat, the mesorectal fascia. Pelvic spaces. Prevesical space is bordered by transversalis fascia anteriorly and umbilicovesical fascia posteriorly. Paravesical and presacral spaces are limited by parietal and visceral sleeves of the endopelvic fascia. Perivesical space is surrounded by umbilicovesical fascia and rectovesical septum. Perirectal space is involved by the rectal fascia and separated from the perivesical space by the rectovesical septum
The presacral space is located between the rectum and the sacrococcygeal part of the spine.
Gross anatomy
Contents
The presacral space contains a variety of tissue:
- fat
- mesenchymal tissue
- lymph nodes
- nerve plexuses
- blood vessels
Boundaries
- superior - peritoneal reflections
- inferior - levator ani and coccygeus muscles
- laterally - ureter, iliac vessels
Radiographic appearance
An increase in the width of the presacral space measurement is considered indicative of pathology in the rectum or other structures in the pelvis. This alteration is usually seen in barium enema studies and on plain film.
The upper limits of normal for the presacral space width is 15 mm in patients younger than 45 years old . However, some patients have measurements over 15 mm with no apparent reason (fewer still have 'normal' measurements above 20 mm), which increases with older age. Factors such as sex and weight of the patient should also be taken into consideration .
Related pathology
Siehe auch:
Assoziationen und Differentialdiagnosen zu presacral space: