Anatomic considerations Peritoneum is a thin, translucent serosal membrane of mesodermal origin, covers the surface of the peritoneal cavity, mesenteries and intraperitoneal viscera. Peritoneum is divided into visceral and parietal components. The visceral peritoneum covers the intraperitoneal organs, omenta and mesenteries. The parietal peritoneum lines the abdominal walls; undersurface of the diaphragm; anterior surface of the retroperitoneal viscera and the pelvis .12The peritoneum subdivided into interconnected compartments by the peritoneal ligaments and mesenteries  which determine the location and routes of spread of primary and secondary malignancies and infection within the peritoneal cavity. Normally a very small volume of sterile fluid is present in the peritoneal cavity. This fluid continuously circulates upwards to the subdiaphragmatic spaces where the subphrenic submesothelial lymphatics provide most of the lymphatic clearance from the peritoneal cavity. The cephalic movement of peritoneal fluid is augmented by the negative intra-abdominal pressure during exhalation and bowel peristaltic motion. 260px|Fig. 3. Peritoneal fluid preferentially flows into the gravity-dependent areas and then ascends through the paracolic gutters reaching the subphrenic spaces. In case of ascites fluid collects in well defined areas of stasis or arrested flow (asterisks). Initially, peritoneal fluid accumulates in gravity-dependent spaces, the deep recesses of the pelvis and the lateral paravesical spaces and then ascends cephalad through the paracolic gutters reaches the subdiaphragmatic spaces. As the left paracolic gutter is shallow and discontinuous with left subdiaphragmatic space at the phrenicocolic ligament, most of the fluid takes path through the right paracolic gutter. Completion of the circulatory pathway takes place caudally by redirection of fluid into the pelvis through the inframesocolic compartment13 (Fig. 3). In pathologic conditions the excessive fluid collects in well-defined areas of stasis or arrested flow including the peritoneal recesses of the pelvis (pouch of Douglas in women and retrovesical space in men), the right lower quadrant (near the termination of the small bowel mesentery at the ileocaecal junction), the superior aspect of the sigmoid mesocolon and the right paracolic gutter. In the cases of primary and secondary peritoneal malignancies, careful evaluation of the peritoneal recesses is necessary to locate occult disease for proper staging and planning for debulking procedures.
Anatomic considerations Peritoneum is a thin, translucent serosal membrane of mesodermal origin, covers the surface of the peritoneal cavity, mesenteries and intraperitoneal viscera. Peritoneum is divided into visceral and parietal components. The visceral peritoneum covers the intraperitoneal organs, omenta and mesenteries. The parietal peritoneum lines the abdominal walls; undersurface of the diaphragm; anterior surface of the retroperitoneal viscera and the pelvis . The peritoneum is subdivided into interconnected compartments by the peritoneal ligaments and mesenteries , which determine the location and routes of spread of primary and secondary malignancies and infection within the peritoneal cavity. Normally a very small volume of sterile fluid is present in the peritoneal cavity. This fluid continuously circulates upwards to the subdiaphragmatic spaces where the subphrenic submesothelial lymphatics provide most of the lymphatic clearance from the peritoneal cavity. The cephalic movement of peritoneal fluid is augmented by the negative intra-abdominal pressure during exhalation and bowel peristaltic motion. 260px|Fig. 3. Peritoneal fluid preferentially flows into the gravity-dependent areas and then ascends through the paracolic gutters reaching the subphrenic spaces. In case of ascites fluid collects in well defined areas of stasis or arrested flow (asterisks). Initially, peritoneal fluid accumulates in gravity-dependent spaces, the deep recesses of the pelvis and the lateral paravesical spaces and then ascends cephalad through the paracolic gutters reaches the subdiaphragmatic spaces. As the left paracolic gutter is shallow and discontinuous with left subdiaphragmatic space at the phrenicocolic ligament, most of the fluid takes path through the right paracolic gutter. Completion of the circulatory pathway takes place caudally by redirection of fluid into the pelvis through the inframesocolic compartment (Fig. 3). In pathologic conditions the excessive fluid collects in well-defined areas of stasis or arrested flow including the peritoneal recesses of the pelvis (pouch of Douglas in women and retrovesical space in men), the right lower quadrant (near the termination of the small bowel mesentery at the ileocaecal junction), the superior aspect of the sigmoid mesocolon and the right paracolic gutter. In the cases of primary and secondary peritoneal malignancies, careful evaluation of the peritoneal recesses is necessary to locate occult disease for proper staging and planning for debulking procedures.
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