Distribution of fluid within the peritoneal cavity: a cadaveric study

This study assesses the distribution of varying volumes of fluid within the peritoneal cavity of cadavers of different sizes (small < or =60 kg; medium = 60-100 kg; large > or =100 kg). The results help to predict the volumes of therapeutic solutions (e.g., adhesiolysis solutions used in the prevention of post-operative adhesion formation) that would be required to reach all the relevant spaces within the greater sac of the peritoneal cavity. Twenty-one cadavers (9 male, 12 female) were selected randomly. Midline laparotomy and bilateral subcostal incisions were made to visualize the distribution of 500 ml of water into the pelvic cavity, paracolic gutters, right subhepatic, and subphrenic spaces. A further 500 ml of water was then added and the distribution was again recorded. The results showed that 500 ml of water was found to distribute to all areas in 47.8% of cadavers, and 1,000 ml distributed to all areas in 81.0% of cadavers. One hundred percent of small cadavers achieved maximum distribution with 500 ml irrespective of gender. Seventy percent of medium cadavers achieved maximum distribution with 1,000 ml, and 75% of large cadavers achieved maximum distribution with 1,000 ml. Anatomical variation in the size of the phrenicocolic ligament was found to be an important limiting factor in the distribution of fluid to the space inferior to the left lobe of the liver and the left subphrenic space. Pre-existing intra-abdominal pathology and previous abdominal surgery also influenced the distribution of fluid within the peritoneal cavity.