Which gland is intraperitoneal

Upon arrival to our facility, we were faced with an evolving abdominal compartment syndrome in addition to acute hemorrhage of unclear etiology. In the course of the second laparotomy, hemodynamic instability, the need to address the sequelae of abdominal hypertension, and worsening coagulopathy precluded further exploration of the LUQ for the continued source of hemorrhage.

Therefore the decision was made to proceed with angiographic embolization in the setting of continued bleeding. TAE as a therapeutic option for pheochromocytoma was first described in by Bunuan [ 62 ] and collegues.

Their effort to use gel foam TAE was met with significant hemodynamic instability resulting in emergent laparotomy for excision of the necrotic tumor. Since this initial experience, TAE has been reported in the literature as a palliative option in the management of malignant pheochromocytoma when surgical extirpation is not feasible [ 63 , 64 ].

More germane to the present case, the use of TAE for management of acute spontaneous intraperitoneal hemorrhage from a pheochromocytoma has not been previously reported, although its use in retroperitoneal hemorrhage as been described by two separate groups [ 17 , 50 ].

In the present case any further effort to explore the LUQ for the source of hemorrhage may very well have resulted in the patient's demise. We therefore elected to salvage the situation by employing damage control techniques to quickly get the patient out of the operating room to facilitate TAE of the suspected hemorrhaging pheochromocytoma. Interestingly, in addition to embolization of a left adrenal artery in this case, a bleeding left intercostal artery was also identified.

In an effort to better define the anatomy of the suprarenal arteries, Toni and colleagues reviewed aortography performed on patients without known suprarenal disease [ 65 ]. As described in all of these reports, post-TAE hypertension can present a formidable challenge. In this case, malignant hypertension was successfully managed with infusion of sodium nitroprusside in the acute setting, followed by administration of phenoxybenzamine. Spontaneous intraperitoneal hemorrhage remains a rare complication of pheochromocytoma, though the physiologic consequences present considerable medical and surgical challenges.

The present case has demonstrated the importance of multi-modal therapy including the need for emergent surgical intervention and the availability of interventional radiology for control of the hemorrhage.

Most importantly, a high index of suspicion must be maintained in similar cases so that the highly lethal hemodynamic sequelae may be anticipated and managed with the appropriate pharmacologic agents to ensure optimal outcomes.

Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Sipple J: The association of pheochromocytoma with carcinoma of the thyroid gland. American Journal of Medicine. Article Google Scholar. A distinct genetic entity. Ann Intern Med.

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Privacy Policy. Skip to main content. Digestive System. Search for:. The Peritoneum. The Peritoneum The peritoneum, the serous membrane that forms the lining of the abdominal cavity, covers most of the intra-abdominal organs. Learning Objectives Differentiate among the digestive organs and their location relative to the peritoneum. Key Takeaways Key Points The peritoneum supports the abdominal organs and serves as a conduit for their blood and lymph vessels and nerves.

There are two layers of the peritoneum: the outer layer, called the parietal peritoneum, is attached to the abdominal wall; the inner layer, the visceral peritoneum, is wrapped around the internal organs that are located inside the intraperitoneal cavity. The mesentery is the double layer of visceral peritoneum. The potential space between these two layers, the peritoneal cavity, is filled with a small amount of slippery serous fluid that allows the two layers to slide freely over each other.

The structures in the abdomen are classified as intraperitoneal, retroperitoneal, or infraperitoneal, depending on whether they are covered with visceral peritoneum and are attached by mesenteries. There are two main regions of the peritoneum connected by the epiploic foramen: the greater sac or general cavity of the abdomen, and the lesser sac or omental bursa. Intraperitoneal organs and retroperitoneal organs weave in and out of these membranes, and serve varying functions.

Retroperitoneal structures tend to be more static than intraperitoneal ones. Key Terms greater omentum : A large fold of visceral peritoneum that hangs down from the stomach. Examples In one form of dialysis, called peritoneal dialysis, a glucose solution is sent through a tube into the peritoneal cavity.