The pararectal fossae are peritoneal depressions on either side of the rectum formed by the pararectal folds of peritoneum, bounded medially by the mesorectum and laterally by the lateral pelvic wall. They are the primary route of access in total mesorectal excision and pelvic lymph node dissection.
The pararectal fossa is the surgical corridor for total mesorectal excision (TME) in rectal cancer surgery, where sharp dissection along the holy plane between the mesorectal fascia and the parietal pelvic fascia preserves the autonomic nerves. Lateral pelvic lymph node dissection (LPND) is performed within the pararectal fossa in advanced rectal cancer. Haematoma or abscess in the pararectal fossa is a recognised complication of pelvic surgery.
Post-operative blood collection in the pararectal fossa following pelvic surgery producing pelvic pain, fever, and urinary retention from adjacent bladder compression, requiring CT characterisation and possible drainage.
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