379.The 65-year-old with pancreatic adenocarcinoma in the head of pan-
creas was taken to surgery. A PET CT suggested some metastasis to both
liver and multiple posterior lymph nodes. It was explained to the patient
and his family that the surgery would likely notbe curative, but rather pal-
liative in that the cancer was already too far advanced for removal. During
the surgery ablation of the autonomic innervation that carries pain in this
region is also performed to provide pain relief. The surgeon will inject 50%
ethanol to kill nerve cells at which of the following locations?
a. At each subcostal nerve under ribs 6–8
b. Around the celiac trunk
c. Around each lateral epigastric fold
d. Around the coronary ligament
e. Around the lateral arcuate ligament
380.An 11-year-old girl is brought into your pediatric office by her
mother. She recently learned to do back flips on the balance beam, when
her foot slipped off and she landed with her perineum striking the beam.
She developed a massive subcutaneous hematoma filling her perineum that
posteriorly formed a straight horizontal line just anterior to her anus, and
anteriorly extended onto the anterior abdominal wall about half way up to
her umbilicus and above the inguinal ligament. No blood entered her
thighs. She could still urinate and there was no blood in her urine. The
hematoma was contained by what space?
a. Ischioanal fossa
b. Superficial perineal space
c. Deep perineal space
d. Femoral sheath
e. Inguinal canal
Abdomen 497