Figure 2.60.

Posterior abdominal
wall showing great vessels,
kidneys, and suprarenal glands.
Most of the fascia has been
removed in this view. The ureter
crosses the external iliac artery
just beyond the common iliac
bifurcation. In males, the
testicular vessels cross anterior
to the ureter and join the ductus
deferens to enter the inguinal
canal. The renal arteries are not
seen because they lie posterior to
the renal veins. The left renal
vein is compressed between the
aorta posteriorly and the superior
mesenteric artery anteriorly, the
latter being pulled inferiorly by
the weight of the intestine.

Figure 2.61. Lumbar approach to

kidney and relationships of kidney to
muscles and fascia. A. The external
aspect of the right posterior
abdominal wall is shown. On
dividing the posterior aponeurosis of
the transverse abdominal muscle
between the subcostal and the
iliohypogastric nerves, and lateral to
the oblique lateral border of the
quadratus lumborum, the
retroperitoneal fat surrounding the
kidney is exposed. The renal fascia
is within this fat. The fat inside the
renal fascia is termed the perirenal
fat capsule (perinephric fat); the fat
outside the capsule is the pararenal
fat body (paranephric fat). See
Figure. 2.76A for an earlier stage of
this dissection. B. This transverse
section of the kidney shows the
relationships of the muscles and
fascia. Because the renal fascia
surrounds the kidney as a separate
sheath, it must be incised in any
surgical operation on the kidney,
whether from an anterior or a
posterior approach.
 Figure 2.66. Blood
vessels of suprarenal
glands, kidneys, and
superior part of ureters.
The celiac plexus of
nerves and ganglia that
surrounds the celiac
trunk has been removed.
The IVC has been
transected, and its
superior part has been
elevated from its normal
position to reveal the
arteries that pass
posterior to it. The renal
veins have been cut so
that the kidneys could be
moved laterally. For the
normal relationships of
the kidneys and
suprarenal glands with
the great vessels, see
Figure 2.60. Observe the
gross structure of the
suprarenal glands and
their rich arterial supply.
The cross section of the
suprarenal gland (inset)
shows that it is composed of two distinct parts: the cortex and medulla, which are two separate endocrine glands that
became closely related during embryonic development. Multiple suprarenal arteries arise from the inferior phrenic artery;
one or more inferior suprarenal arteries often arise from the renal artery, and a middle suprarenal artery arises from the
abdominal artery. The number and patterns of arrangement of the suprarenal arteries are very variable. The endocrine
function of the suprarenal glands make their abundant blood supply necessary.