Download 11-Rectum

Dr. Ahmed Fathalla Ibrahim
Dr Ahmed Fathalla Ibrahim
RECTUM
• BEGINNING: It begins as the
continuation of sigmoid colon,
opposite S3
• TERMINATION: It continues as anal
canal, one inch below & in front of the
tip of coccyx. Its lower part is dilated to
form the rectal ampulla
• LENGTH: 5 inches (13 cm)
• STRUCTURE: It differs from colon by
having no taeniae coli, no appendices
epiploicae & no
sacculations
Dr Ahmed Fathalla Ibrahim
RECTUM
Dr Ahmed Fathalla Ibrahim
RECTUM
• CURVES (FLEXURES):
1. Antero-posterior: It follows the
concavity of sacrum & coccyx
2. Lateral: three in number, the upper &
lower are convex to the right & the
middle is convex to the left
• PERITONEAL COVERING:
1. Upper 1/3: front & sides
2. Middle 1/3: front only
3. Lower 1/3: no peritoneal covering
Dr Ahmed Fathalla Ibrahim
RELATIONS OF RECTUM
IN MALE PELVIS
Dr Ahmed Fathalla Ibrahim
ANTERIOR RELATIONS OF
RECTUM IN MALE PELVIS
Dr Ahmed Fathalla Ibrahim
RELATIONS OF RECTUM
IN FEMALE PELVIS
Dr Ahmed Fathalla Ibrahim
RELATIONS OF RECTUM
ANTERIOR:
1. Its upper 2/3 is covered by peritoneum & is
related to sigmoid colon & ileum
2. Its lower 1/3 is devoid of peritoneum & is
related:
• In male: to seminal vesicle & vas deferens
of both sides, posterior surface (base) of
bladder, prostate gland
• In female: posterior wall of vagina
Dr Ahmed Fathalla Ibrahim
POSTERIOR RELATIONS OF
RECTUM
Dr Ahmed Fathalla Ibrahim
RELATIONS OF RECTUM
POSTERIOR:
2 BONES: sacrum & coccyx
2 MUSCLES: piriformis & coccygeus
2 VESSELS: lateral & medial sacral
2 NERVES: sympathetic trunks &
sacral plexus
Dr Ahmed Fathalla Ibrahim
ARTERIAL SUPPLY OF RECTUM
Dr Ahmed Fathalla Ibrahim
LYMPHATIC DRAINAGE OF
RECTUM
Dr Ahmed Fathalla Ibrahim
SUPPLY OF RECTUM
• ARTERIAL SUPPLY:
1. Superior rectal (continuation of inferior
mesenteric): descends in the root of
sigmoid mesocolon, divides into right & left
branches that supply the mucous
membrane of rectum, anastomoses with
middle & inferior rectal arteries
2. Middle rectal: branch of internal iliac,
supplies the muscular coat of rectum
3. Median sacral: branch of abdominal aorta,
supplies a part of the back of rectum
Dr Ahmed Fathalla Ibrahim
SUPPLY OF RECTUM
• VENOUS DRAINAGE: corresponding
veins
• LYMPHATIC DRAINAGE: to pararectal
lymph nodes then to: inferior
mesenteric or internal iliac lymph
nodes
• NERVE SUPPLY: autonomic fibers
from inferior hypogastric plexuses
Dr Ahmed Fathalla Ibrahim
SUPPORT OF RECTUM
The main support are 2 fasciae:
1.Rectovesical fascia (fascia of
Denonvilliers): extends from
rectum to bladder & prostate
2.Fascia of Waldeyer: extends from
rectum to front of lower part of
sacrum & coccyx
Dr Ahmed Fathalla Ibrahim