From the Guidelines
The Morrison pouch, also known as the hepatorenal recess or pouch of Morison, is located in the right upper quadrant of the abdomen between the liver and the right kidney. This anatomical space is bounded anteriorly by the posterior surface of the right lobe of the liver, posteriorly by the anterior surface of the right kidney, and medially by the inferior vena cava 1. The location of Morrison's pouch is critical in clinical practice, particularly in the evaluation of trauma patients, as it is the deepest part of the peritoneal cavity when a person is in a supine position, making it a common site for fluid collection in patients with intra-abdominal bleeding or ascites.
Some key points to consider when examining Morrison's pouch include:
- The use of ultrasound to detect free fluid in the hepatorenal recess, as demonstrated in Fig. 4 of the study by the European Society of Intensive Care Medicine 1
- The importance of adjusting gain settings to optimize visualization of the diaphragm and renal sinus fat, as well as known hypoechoic structures such as the inferior vena cava, gallbladder, or renal vein 1
- The need to accumulate approximately 200-250 mL of fluid in the peritoneal cavity before it becomes detectable in Morrison's pouch on ultrasound examination, highlighting the importance of careful examination and consideration of clinical context.
In terms of clinical implications, the location of Morrison's pouch is crucial in guiding the evaluation and management of patients with suspected intra-abdominal bleeding or ascites, and ultrasound examination of this region is a key component of the Focused Assessment with Sonography for Trauma (FAST) scan.
From the Research
Location of Morrison's Pouch
- Morrison's pouch, also known as the hepatorenal recess, is located between the right liver lobe and the right kidney 2.
- It is situated in the supramesocolic compartment, which is a dependent location that can accumulate fluid 2.
- The pouch is in close proximity to the adjacent organs and has communication with the inframesocolic compartment, making it a common site for fluid accumulation 2.
- The location of Morrison's pouch is described as the space between the inferior aspect of the liver and the anterior aspect of the right kidney, where fluid thickness can be measured on CT scans 3.
- This anatomical location is significant in the detection of free intraperitoneal fluid, as it is a common site for fluid accumulation in cases of intraperitoneal hemorrhage or other pathological conditions 4, 5, 6.