QuestionSBA
QuestionChoice
Incorrect - The lesser sac is located behind the stomach and lesser omentum, the only entrance and exit being through the epiploic foramen. In cases of pancreatitis and certain perforated gastric ulcers, fluid can collect in the lesser sac. However, it would not typically cause pain in the right hypochondrium.
10008257
c
Lesser Sac
QuestionChoice
Incorrect - The vesico-uterine pouch is located between the uterus and the bladder. It is rarely a site of fluid collection in supine patients, and would not cause right upper quadrant pain.
10008259
e
Vesico-uterine pouch
QuestionChoice
Incorrect -  The subphrenic space is a peritoneal space between the anterior part of the liver and the diaphragm. It is separated into the right and left sides by the falciform ligament. The subphrenic spaces can be sites of fluid collection following procedures. However, the presence of an abscess here would not cause pain to radiate to the right back and shoulder.
10008256
b
Left Subphrenic Space
QuestionChoice
Correct - The hepatorenal recess is a common site of fluid collection in unwell or postoperative patients who are supine. Fluid collection and subsequent abscess formation would cause pain in the right hypochondrium which radiates to the back and shoulder.
10008255
a
Hepatorenal recess
QuestionChoice
Incorrect - Fluid in the pouch of Douglas can accumulate due to menstrual blood refluxing through the fallopian tubes, or from the release of fluids from ruptured cysts. The pouch of Douglas is located posteriorly to the uterus and anteriorly to the rectum. Fluid can collect here following surgical procedures, however, it would not cause pain in the right hypochondrium.
10008258
d
Pouch of Douglas
Concept
Chapter
2693
4656
Ascites
Topic
136
Gastroenterology
14198
A 68-year-old female patient suffered a peritoneal infection following abdominal surgery. She later complains of pain in her right hypochondrium, which radiates to the right side of her back and shoulder.

The patient was primarily supine both during and in the days following the operation.

In which of the following anatomical sites is the infected fluid most likely to have collected?
a