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Techniques of adrenalectomy
Published in Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner, Endocrine Surgery, 2017
Minerva Angelica Romero Arenas, Ashley Stewart, Nancy D. Perrier
The adrenal glands are highly vascularized (Figure 35.1); they receive small arterial blood from branches of the inferior phrenic arteries and renal artery and directly from the aorta. Nutrient arteries form a capsular arterial plexus that sends capillaries coursing through the cortex. These capillaries then form a venous portal system that drains into the adrenal medulla. There the vessels reach confluence with the central adrenal vein. The right adrenal vein is short and wide; it exits the gland and immediately enters the posterolateral aspect of the IVC. There can be smaller accessory veins that drain directly into the right renal vein inferiorly or into the inferior phrenic vein superiorly as well. The left adrenal vein exits anteriorly and usually drains into the left renal vein, although it occasionally enters the IVC directly.
The Kidney (KI)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
This sickle-shaped ligament attaches the liver to the ventral body wall. An embryologic remnant of the ventral mesentery, the falciform ligament denotes the separation of the most caudal portion of the left liver lobe into medial and lateral segments. The ligament attaches to the deep surface of the rectus abdominis as far down as the umbilicus. This explains the appearance of the ligament at KI 17 but not KI 16 caudal. It comprises two mesothelial layers of peritoneum filled with extra-peritoneal fat; the free edge houses the embryonic remnant of the ligamentum teres hepatis (obliterated left umbilical vein), muscular fibers, and paraumbilical veins. These vessels may re-open in patients with portal hypertension, as the congestion in the liver purses venous blood toward the abdominal wall and into previously dormant vascular pathways. The falciform ligament receives its blood supply from the left phrenic artery and a branch of the middle segment artery of the liver.5 Venous blood from the falciform drains into the left inferior phrenic vein. The paraumbilical veins together with the umbilical vein create an accessory portal system in communication with the systemic venous system. The inferior epigastric veins connect to the paraumbilical veins (of Burrow).
Bilateral adrenal haemorrhage after a high energetic trauma: a case report and review of current literature
Published in Acta Chirurgica Belgica, 2020
N. Jimidar, D. Ysebaert, M. Twickler, M. Spinhoven, K. Dams, P. G. Jorens
In trauma, unilateral adrenal injury occurs 5 times more on the right side than on the left (77% vs. 15%), while bilateral adrenal injury occurs in 8% of cases [5]. The difference between right and left adrenal gland could be explained by the different drainage of the adrenal veins. While the left adrenal vein drains into the left renal or inferior phrenic vein, the right adrenal vein drains directly into the vena cava inferior. Severe compression of the inferior vena cava might increase the adrenal venous pressure, leading to intraglandular haemorrhage. Rupture of the vessels in the medulla due to sudden deceleration can also cause haemorrhage. Another theory to explain adrenal haemorrhage involves compression of the glands between the spine and surrounding organs [6]. Other mechanisms have also been proposed: stress-induced ACTH release in trauma increases the energy demand of the adrenals and increases the blood supply – making the glands more susceptible for ischemia and bleeding. Finally, hypovolemic shock in severe trauma could lead to hypoperfusion, hypoxaemia and clotting disorders, all affecting adrenal function [7].