Anatomy of Rectum
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Anatomy of Rectum
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Anatomy of Rectum
- 1. RECTUM Dr Rishi Pokhrel MBBS, MD Maj
- 3. • 3 unique features: Teniae coli – Three bands of longitudinal smooth muscle Haustrations – Pocket like sacs caused by tone of teniae coli Epiploic appendages – Fat-filled pouches of visceral peritoneum Subdivided into Caecum, Appendix, Colon, Rectum & Anal canal LARGE INTESTINE
- 4. Rectum • Intro • Extent • Course & directions • Relations • Mucosal folds • Blood & nerve supply • Supports • Applied anatomy
- 5. Rectum Terminal part of large intestine before anal canal Cardinal features of large intestine – absent Length – 12 cm Diameter – upper part 4 cm, lower part dilated as rectal ampulla Curved in both sagittal and coronal planes Function – temporary storage of fecal matter; distension causes desire to defecate
- 6. Extent Begins at S3, lower end of sigmoid mesocolon – recto-sigmoid junction Ends slightly below and 2- 3 cm in front of tip of coccyx – anorectal junction Males – at level of apex of prostate
- 7. Course and directions Anal canal CURVATURES Sacral flexure Perineal flexure Lat view AP view upper middle lower • Beginning and end lie in median plane • 2 AP curvatures • Sacral flexure – follows curvature of sacrum and coccyx • Perineal flexure – backward bend in anorectal junction • 3 lateral curvatures • Upper – convex to right • Middle – convex to left – most prominent • Lower – convex to right a a
- 8. Peritoneal relations • Upper 1/3 – in front and sides • Middle 1/3 – only in front • Lower 1/3 – devoid of peritoneum – Dilated to form ampulla – Below rectovesical pouch in males – Below recto uterine pouch in females
- 9. Visceral relations • Anteriorly - in males – Upper 2/3 – rectovesical pouch with coils of intestine – Lower 1/3 – base of urinary bladder, ureters, seminal vesicle, vas and prostate
- 10. • Anteriorly in females • Upper 2/3 – recto- uterine pouch with coils of intestine and sigmoid colon, pouch separates the rectum from uterus and upper part of vagina • Lower 1/3 – lower part of vagina
- 11. Visceral relations • Posterior in both sexes – Lower 3 sacrum, coccyx and anococcygeal ligament – Piriformis, coccugeus and levator ani – Median sacral, sup rectal and lower lat sacral vessels – Sympathetic chain with ganglion impar, ant primary rami of S3-5, Co1, and pelvic splanchnic nerves – Lymph nodes, lymphatics and fat
- 12. POST. RELATIONS Symp. chain Piriformis S-4 nerve & Lower lat. Sacral artery Coccygeus S-5 nerve Co-1 nerve Levator ani Median sacral A. Ganglion impar Coccyx Anococcygeal ligament Sacrum Rule of Three • 3 Bones & ligs. • 3 Muscles • 3 Vessels • 3 Sets of nerves • 3 Other structures
- 13. Mucosal folds • 2 types of folds – Longitudinal – temporary, in lower part, disappear on distension – Transverse / Houston’s valves – permanent
- 14. INTERIOR OF RECTUM: MUCOSAL FOLDS Recto-sigmoid junction Valves of HOUSTON Anorectal junction Levator ani Peritoneal reflection Upper fold • At commencement ( S-3) •12 cm from anal orifice •From Rt. Lt. Ant. wall Middle fold • Largest & most constant • Projects from Rt. Wall • At jn. of upper 2/3 with lower 1/3 • 5 cm above anal margin • Forms Neleton’s sphincter Lower fold • Inconstant • Projects from Lt. wall • 2.5 cm below middle fold Fourth fold • May be present • 2.5 cm above M F • From Lt. wall U L M
- 15. TRANSVERSE MUCOSAL FOLDS Midline Upper end Lower end U M L A C B LUMEN Middle Tr. fold Upper Tr. fold Lower Tr. fold Three valves of rectum stop feces from being passed with gas
- 17. Blood supply
- 18. Venous drainage
- 19. Lymphatic drainage • Upper ½ - sup rectal vessels -> para rectal & sigmoid nodes -> inf mesenteric nodes • Lower ½ - middle rectal vessels -> internal iliac nodes
- 20. Nerve supply • Sympathetic – L 1-2 • Parasympathetic – S 2-4 • Distension – Parasympathetic • Pain - both
- 21. DEFECATION • Distension of rectal walls caused by feces – Stimulates contraction of the rectal walls – Relaxes internal anal sphincter • Voluntary signals stimulate relaxation of the external anal sphincter and defecation occurs
- 22. Supports • Pelvic floor by levator ani • Waldeyer’s fascia – lower part of rectal ampulla to sacrum, contain sup rectal vessels and lymphatics • Lateral ligaments – contain middle rectal vessels, nerves • Rectovesical pouch • Pelvic peritoneum • Perineal body
- 23. APPLIED PR EXAM PROCTOSCOPY RADIOLOGICAL STUDIES PROLAPSE AND INTUSUCEPTION POLYP CARCINOMA
- 24. RECTUM: DOUBLE CONTRAST STUDY Applied anatomy
- 25. RECTAL INTUSSUSCEPTION & RECTAL PROLAPSE
- 26. PROLAPSE OF RECTUM COMPLETE PROLAPSE • Complete - consists of full thickness of rectal wall. • Partial prolapse - only mucous membrane of rectal wall.
- 27. RECTAL POLYP • Growth or mass Protruding from the mucous membrane