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General Surgery
Large Intestine and Anorectum Surgical Anatomy of the Colon
Built from Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
What’s inside
20 sections · 196 slides
Overview
- Scope of this topic
- Anatomic and Surgical History of the Large Intestine and Anorectum
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
- Anatomic and Surgical History of the Large Intestine and Anorectum (continued)
Embryology of the colon and anorectum
- Herniation of the midgut into the umbilical cord
- Midgut and hindgut contributions to the large intestine
- Midgut and hindgut segments in detail
- Partition of the cloaca into rectum and urogenital sinus
- Timetable of anorectal development
- Formation of the external anal sphincter
- Development of the taeniae coli
- Lymphoid follicles of the large intestine
Congenital anomalies of the colon
- Colonic stenoses and atresias
- Distribution of intestinal atresia and stenosis
- Hirschsprung's disease: pathogenesis
- Distribution of aganglionic segment length
- Line of resection in aganglionic megacolon
- Causes of megacolon to consider in diagnosis
- Megacolon versus massive faecal impaction
Congenital anomalies of the anorectum
- Classifying anorectal malformations
- Anatomic Classification of Anorectal Malformations
- Anatomic Classification of Anorectal Malformations (continued)
- Classification of anorectal malformations
- Anal (low) defects
- Anorectal (high) defects
- High rectal atresia
- Rare combinations of developmental arrest, atresia and fistula
- Embryogenesis of anal and anorectal defects
- Germ Layer Origin of Developmental Cysts
Topography and dimensions of the large intestine
- Right and left colon as surgical units
- Average lengths and diameters of the colonic segments
Arterial supply of the colon
- Arterial supply of the large intestine
- Superior mesenteric artery branches to the colon
- Collaterals of the superior mesenteric artery
- Long and short vasa recta
- Vasa recta and the epiploic appendages
- Inferior mesenteric artery: origin and branches
- Level of division of the inferior mesenteric artery
- Variations of the arteries to the right and left colon
- Marginal artery of Drummond
- Quality of anastomosis at the splenic flexure
- Terminal arterial supply and the surface features of the colon
- Collateral flow through a dilated marginal artery
- Critical point of Sudeck
- Reappraisal of Sudeck's critical point
Venous and lymphatic drainage
- Venous drainage of the colon and rectum
- Venous drainage of the colon
- Venous drainage of the rectum and anus
- Nodal groups of the large intestine
- Lymphatic drainage of the large intestine
- Number of Lymph Nodes in the Mesentery of the Large Intestine by Regions
- Extent of resection for lesions in each colonic segment
- Vascular anatomy and nodal metastasis: Yada's findings
- Lymphatic drainage of the sigmoid colon, rectum and anus
Innervation of the large intestine
- Intrinsic innervation: the enteric nervous system
- Neural control of the gut wall
- Sympathetic innervation of the colon
- Parasympathetic innervation of the colon
Caecum and ileocaecal valve
- Position and peritoneal covering of the caecum
- Degrees of fusion of the caecum to the peritoneum
- Types of caecal and ileal attachment to the dorsal body wall
- Ileocaecal folds and fossae
- Posterior relations to protect during right colon mobilisation
- How each specialty describes the ileocaecal valve
- Function of the ileocaecal valve
- Branches of the ileocolic artery
- Lymphatics of the ileocaecal region, ventral view
- Lymphatics of the ileocaecal region, dorsal view
- Benign Cecal Lesions
Ascending colon
- Fusion of the ascending colon and its variations
- Degrees of attachment of the right colon
- Mobile caecum
- Conditions required for right colon volvulus
- Percent Frequency of Persistent Right and Left Mesocolon
- Colonic volvulus: distribution and mortality
- Jackson's veil across the ascending colon
Hepatic flexure, transverse colon and splenic flexure
- Transverse colon and its mesocolon
- Developmental relation of the transverse colon to the omentum
- Splenic flexure: position and relations
- Arterial supply of the transverse colon
- Nomenclature of the colic arteries
Descending and sigmoid colon
- Sigmoid colon: iliac and pelvic portions
- The lambda-shaped root of the sigmoid mesocolon
- Sigmoid mesocolon and the left ureter
Rectum: boundaries, peritoneum and pelvic floor
- The surgical anal canal
- Line of peritoneal reflection on the rectum
- The pelvic diaphragm from below
- Puborectalis and the anorectal ring
- Fasciae of the pelvis in coronal section
- The spaces of the anus and rectum
- Ischioanal (ischiorectal) fossa
- Pelvirectal spaces and the lateral ligaments
- Waldeyer's fascia and the presacral space
- Denonvilliers' fascia
The mesorectum and total mesorectal excision
- What the mesorectum is
- The holy plane of rectal surgery
- Relationships of the mesorectum in the male
- Oncological rationale for total mesorectal excision
Blood supply, lymphatics and spread in the rectum and anal canal
- Arteries of the rectum and anal canal
- Arterial supply of the rectum and anus
- The middle rectal artery: how constant is it?
- Lymph drainage of the anus and rectum and its two watersheds
- The two, four, eight mnemonic
- Routes of spread from a primary carcinoma of the colon
Innervation of the anorectum, defecation and continence
- Autonomic innervation of the anorectum
- Dissection planes in front of and behind the normal rectum
- Pelvic nerve plexus with a normal rectum and anal canal
- Pelvic nerve plexus in anorectal agenesis with rectovesical fistula
- Neural pathways in continence
- Neural pathways in defecation
- Sequence of the defecation reflex
- Causes of faecal incontinence
Histology of the colonic wall and rectum
- How the colonic wall differs from the small intestinal wall
- The five layers of the colonic wall
- The taeniae coli
- Appendices epiploicae
- Valves of Houston
The anal canal: musculature, lining and glands
- The internal anal sphincter
- The conjoined longitudinal coat
- The external anal sphincter
- The three loops of the external anal sphincter
- Extrinsic muscles of the surgical anal canal
- The three histologic zones of the anal canal
- Interior of the anal canal
- The pectinate line as a landmark
- The Pectinate Line and Changes in the Surgical Anal Canal
- The Pectinate Line and Changes in the Surgical Anal Canal (continued)
- Anal glands, ducts and papillae
- Pathogenesis of anal fistula
- Common locations of anal abscesses and fistulous openings
- Perianal lymphatic drainage and Goodsall's rule
- Innervation of the anal canal and perianal skin
Operative anatomy of the colon and anorectum
- Abdominoperineal resection: the abdominal phase
- Presacral bleeding
- Nerve planes of the retrorectal space
- Malignant Retrorectal Tumors
- Malignant Retrorectal Tumors (continued)
- Malignant Retrorectal Tumors (continued)
- Standard right colectomy: four reasons to prefer it
- Managing a short last sigmoid artery
- Tube caecostomy
- Tube caecostomy: indications and evidence
- Loop colostomy
- Loop colostomy: anatomical cautions
- End colostomy
- End colostomy: siting and technique
- Laparoscopic colectomy: the case for and against
- The colon as a reconstructive organ
Summary and sources
- Embryology: the points that matter
- Vascular anatomy: the points that matter
- Anorectal anatomy: the points that matter
- Sources cited in the text
- Sources cited in the text (continued)
- Sources cited in the text (continued)
- Sources cited in the text (continued)
- Sources cited in the text (continued)
- Sources cited in the text (continued)
- Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
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