Rutherford Morison pouch

Morison pouch, also known as the posterior right subhepatic space, hepatorenal fossa; or subhepatic recess, is a potential space which separates the liver from the right kidney.

As a potential space, it is not filled with any fluid in normal conditions. However, as one of the lowest dependent spaces in the peritoneal cavity, fluid such as ascites or blood often may fill the potential space. It is also a preferential site for metastases and abscesses.

The posterior right subhepatic space is separated from the anterior right subhepatic space by the transverse mesocolon. The space communicates with the right subphrenic space; right paracolic gutter; and the lesser sac (via the epiploic foramen of Winslow).

History of the Morison pouch

In 1894, the English surgeon James Rutherford Morison (1853 – 1939) published his anatomic description of the posterior right subhepatic space; its role in the surgical treatment of gallbladder disease; and proposed the value of postoperative drainage of that space.

Morison indicated that with the liver retracted upward and the transverse colon downward, one would expose a potential space. The proposed space has an anterior wall bounded right to left by the peritoneal surface of the diaphragm and the undersurface of the right lobe of the liver and gallbladder, extending to the gastrohepatic ligament. The posterior wall formed by the ascending mesocolon over the right kidney and by the duodenum.

…underneath the right lobe of the liver there exists a pouch hitherto undescribed, shut off by natural barriers from the general peritoneal cavity….By the relation of nine cases in which the operation for gall-stone was performed in accordance with the principles I was advocating, I endeavored to show that the secret of success in gall-stone operations was efficient drainage of the pouch demonstrated.

Rutherford Morison 1895

Morison proposed that the drain tract for this space would most advantageously exit in the area of the lower pole of the right kidney. Morison viewed provision for adequate postcholecystectomy drainage of this dependent space as a paramount feature of a successful operation.

Associated Persons

• James Rutherford Morison (1853 – 1939)

Alternative names

• Morison’s pouch; pouch of Morison; pouch of Rutherford Morison
• hepatorenal recess; hepatorenal fossa; hepatorenal space
• subhepatic recess/fossa
• posterior right subhepatic space;

References

• Morison JR. The anatomy of right hypochondrium relating especially to operations for gall stones. Br Med J 1894; 2: 968-971
• Morison R. On Gall-stones. Ann Surg. 1895; 22(2): 181–204.
• Gilliam JW Jr, Schein CJ. The Morison Pouch. Arch Surg. 1976;111(3):227-228
• Hajdu N, de Lacey G. The Rutherford Morison pouch; a characteristic appearance on abdominal radiographs. Br J Radiol. 1970; 43(514): 706-9.
• Sharma R. Posterior right subhepatic space. Radiopaedia