The anatomical role of Scarpa's fascia in the manifestation of clinical signs associated with retroperitoneal haemorrhage and bile leakage

Shahnoor Ullah, University of Western Ontario

Abstract

While the aetiology of eponymous surface signs of retroperitoneal haemorrhage and bile leakage is known, it is unclear what causes their appearance. The location of Scarpa's fascia makes it a potential candidate in understanding the pattern of these signs. In this study, dissections were performed on seven embalmed cadavers and the Visible Human Project was examined to determine Scarpa’s fasica’s role in these clinical signs. Scarpa's fascia attaches where the umbilicus emerges from the external oblique aponeurosis providing a deficiency that may cause the bruising in Cullen's sign. As the membranous layer continues into the flanks, it creates a pocket which may account for Turner's sign. The continuation of the membranous layer into the axilla and chest forms another pocket where bile may accumulate in Icterus Marginatus. The anatomical characteristics of Scarpa's fascia described by this study suggest that it plays a role in the development of these clinical signs.