Properitoneal fat

Last revised by Dr Jeffrey Hocking on 02 Aug 2021

The properitoneal fat, also known as the preperitoneal space, is a fat containing space in the abdomen.

Posteriorly it lies deep to the transversalis fascia, and fills the posterior pararenal space. Laterally it thickens and forms the properitoneal fat pad, which is the anterior extension of posterior pararenal space. It communicates superiorly with the falciform ligament and intersegmental fissure of the liver. Supero-medially it can communicate with extrapleural fat (via Spaces of Larrey)4. Inferiorly it is continuous with the pelvic extension of the posterior pararenal space which terminates as a potential space between the perivesical peritoneal folds5.

Spread of hemorrhage or infection throughout this space can result in the clinical appearances of Cullen's sign and Grey Turner's sign6.

The properitoneal fat pad is known as a plane in surgical anatomy, and as a line or stripe when seen on imaging. It is also referred to frequently as the flank stripe

  • fat
  • ensiform veins

  • epigastric hernia
  • pancreatitis (Cullen's sign, Grey Turner's sign)
  • laparoscopic insufflation

 

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Cases and figures

  • Case 1: x-ray - properitoneal fat
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  • Case 2: red arrows
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  • Case 3: annotated image
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  • Case 4: properitoneal gas
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