DISTRIBUTION OF INTRA-ABDOMINAL MALIGNANT SEEDING: DEPENDENCY ON DYNAMICS OF FLOW OF ASCITIC FLUID

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Abstract
The distribution of intraperitoneal malignant seeding clearly correlates with the pathways of flow of ascitic fluid. Four predominant sites of seeded metastases are identified: (1) the pouch of Douglas at the rectosigmoid level; (2) the right lower quadrant at the lower end of the small bowel mesentery; (3) the left lower quadrant along the superior border of the sigmoid mesocolon and colon; and (4) the right paracolic gutter lateral to the cecum and ascending colon. It is at these sites that the preferential, repeated or arrested flow of intraperitoneal fluid occurs. It is concluded that deposition and growth of secondarily seeded neoplasms in the abdomen are dependent upon the natural flow of ascites within the peritoneal recesses.