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This document provides an overview of the anatomy of the large intestine, including its dimensions, blood supply, lymphatic drainage, peritoneal relations, and positions of the appendix. Key sections include descriptions of the divisions of the large intestine (cecum, ascending colon, transverse colon, descending colon, and sigmoid colon), relationships with surrounding structures like the mesentery and peritoneum, common vascular variations, and lymphatic drainage pathways. References are provided for additional information.

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Clinical Anatomy of the Large Intestine Handout download: http://www.oucom.ohiou.edu/dbms-witmer/gs-rpac.htm 23 January 2007 Lawrence M. Witmer, PhD Professor of Anatomy Department of Biomedical Sciences College of Osteopathic Medicine Ohio University Athens, Ohio 45701 witmerL@ohio.edu
free (anterior) taenia omental taenia ileum mesenteric taenia right colic (hepatic) flexure left colic (splenic) flexure epiploic appendages appendix cecum ascending colon transverse haustra colon descending colon sigmoid colon rectum Moore & Dalley 2005 Anatomical Overview
Skandalakis’ Surgical Anatomy 2004 free taenia omental taenia mesenteric taenia epiploic appendage epiploic appendage mesentery marginal a. short branch long branch Anatomical Overview
www.bondisalud.com.ar/ 1a%20diverticulosis.jpg http://www.pathology.pitt.edu/lectures/gi/colon-b/06.jpg Diverticulosis diverticula (internal view) mucosal herniation Moore & Dalley 2005 diverticula (external view)
Skandalakis’ Surgical Anatomy 2004 mucosa normal epiploic appendage taenia (longitudinal muscularis) fat serosa circular muscularis vasa rectus & branches Diverticulosis antimesenteric anastomosis injury to vasa rectus branch distal ischemia diverticulum into epiploic appendage
Dimensions cecum 5 cm ascending colon 10 cm transverse colon 50 cm descending colon 10 cm sigmoid colon 50 cm anal canal 4 cm rectum 15 cm 5 cm 6 cm 8 cm 5 cm 5 cm 4 cm widest: likely site for perforation narrowest: likely site for obstruction
mesentery of small intestine sigmoid mesocolon greater omentum transverse mesocolon Paraduodenal fossae: 1) Superior & 2) Inferior fossae of Trietz 3)Mesentericoparietal fossa of Waldeyer 4)Intermesocolic fossa of Brooke 5)Paraduodenal fossa of Landzert Skandalakis’ Surgical Anatomy 2004 • Mobility • Vascularization • Compartments • Volvulus IMV • Internal hernias • many more Peritoneal Relations
Paraduodenal fossae: 1) Superior & 2) Inferior fossae of Trietz 3)Mesentericoparietal fossa of Waldeyer 4)Intermesocolic fossa of Brooke 5)Paraduodenal fossa of Landzert Skandalakis’ Surgical Anatomy 2004 SMA Internal Hernia Right Paraduodenal Hernia hernial sac Peritoneal Relations
free taenia cecum Skandalakis’ Surgical Anatomy 2004 appendix mesoappendix superior ileocecal internal hernia (a pericecal hernia; 6-13% of all internal hernias) Peritoneal Relations superior & inferior ileocecal fossa
Position Nonapp- endicitis 1 Appen dicitis 5 Total % A Preileal 6 4 G E C D B A anterior B Postileal 7 3 10 8 F C Subileal 11 8 19 15 D Pelvic 14 11 25 19 E Subcecal 9 5 14 11 F Paracecal 4 9 13 10 G Retrocecal 18 24 42 33 post. Appendix Position Skandalakis’ Surgical Anatomy 2004 data from O’Connor & Reed (1994) Peritoneal Relations
Moore’s Developing Human 1988 • Elongation of gut tube • Herniation into umbilical cord • Counterclockwise rotations Peritoneal Relations
Moore’s Developing Human 1988 • Retraction & return of gut • Final counterclockwise rotation • Descent of cecum • Fixation to posterior abdominal wall Peritoneal Relations
Peritoneal Relations Skandalakis’ Surgical Anatomy 2004 peritoneum cecum appendix ileum peritoneum retroperitoneal tissue paracolic groove para- colic gutter mesentery normal unfixed, mobile
Peritoneal Relations Skandalakis’ Surgical Anatomy 2004 Fixation of cecum asc col mesent ileum cecum pelvic brim Type I 11.2% Ia 8.3% Type Ib 22.7% appendix Type II 9.7% IIa 7.3% III 11.3% III 5.7% areas of fixation shown in black Type IV 17.3% V 4.7% VI 2.7%
stomach aorta umbilicus cecum celiac trunk (foregut) superior mesenteric A. (midgut) inferior mesenteric A. (hindgut) Vasculature Skandalakis’ Surgical Anatomy 2004
Skandalakis’ Surgical Anatomy 2004 m. colic a. r. colic a. marginal a. ileocolic a. cecal a. appendicular a. ileal a. SMA IMA sup. rectal a. RCA-Ileocolic anastomosis absent 5% Vasculature Anastomosis • poor 32% • absent 7% acc. left colic a. (~ 40%) marginal a. l. colic a. sigmoid aa.
Vasculature Skandalakis’ Surgical Anatomy 2004 occluded SMA meandering mesenteric a. (arc of Riolan) dilated marginal a. MCA RCA ileocolic a. Gourley & Gering 2005
Skandalakis’ Surgical Anatomy 2004 Nodes N A Ileocolic 29 B Right colic 11.1 C Midcolic 22.4 D Left colic 25.2 E Sigmoid & rectal 32.8 Lymphatic Drainage mesenteric nodes l. lumbar mesocolic paracolic epicolic nodes B A C D E
Lymphatic Drainage lesion Arterial & lymphatic territory associated with a lesion Skandalakis’ Surgical Anatomy 2004
References • Gourley, E. J. and S. A. Gering. 2005. The meandering mesenteric artery: a historical review and surgical implications. Diseases of the Colon and Rectum 48(5):996-1000. • Mathieu, D. and A. Luciani. 2004. Internal abdominal herniations. American Journal of Roentgenology 183:397-404. • Moore, K. L. 1988. The Developing Human. Clinically Oriented Embryology, 4th Ed. Lippincott, Williams & Wilkins, Baltimore. • Moore, K. L. and A. F. Dalley. 2006. Clinically Oriented Anatomy, 5th Ed. Lippincott, Williams & Wilkins, Baltimore. • O'Connor, C. E. and W. P. Reed 1994. In vivo location of the human vermiform appendix. Clinical Anatomy 7:139-142. • Skandalakis, J. E., G. L. Colborn, T. A. Weidman, R. S. Foster, A. N. Kingsnorth, L. J. Skandalakis, N. P. Skandalakis, P. Mirilas (Editors). 2004. Surgical Anatomy: The Embryologic And Anatomic Basis Of Modern Surgery. McGraw-Hill, New York.