The blood-supply of the distal segment of the rectum in anterior resection

Boxall, T. A.; Smart, Philip; Griffiths, John

doi:10.1002/bjs.18005022209

Cited by 53 publications

(40 citation statements)

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“…The middle rectal artery has been reported to show great variability in its origin and number and when present, lies anterolateral to the rectum anterior to the seminal vesicle and the prostate in male or to the upper part of the vagina in female. 4,[13][14][15][16] The lateral ligaments in our study were posterolateral to the rectum. That the middle rectal artery does not pass to the rectum in the lateral ligament but distal to it has been noted by many investigators.…”

Section: Discussionmentioning

confidence: 98%

The Location and Contents of the Lateral Ligaments of the Rectum: A Study in Human Soft Cadavers

Pak‐art

Tansatit

Mingmalairaks

et al. 2005

Diseases of the Colon &Amp; Rectum

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Section: Discussionmentioning

confidence: 98%

The Location and Contents of the Lateral Ligaments of the Rectum: A Study in Human Soft Cadavers

Pak‐art

Tansatit

Mingmalairaks

et al. 2005

Diseases of the Colon &Amp; Rectum

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“…Anastomosis exists between the middle and superior rectal arteries; there are no anastomoses with the inferior rectal arteries. The middle and inferior rectal arteries provide the blood supply to the rectal stump after division of the superior hemorrhoidal artery during sphincter saving procedures for rectal carcinoma (Boxall et al 1963;Goligher 1967). Preservation of the middle rectal arteries is necessary to maintain viability of the rectal stump after high ligation of the inferior mesenteric artery (Boxall et al 1963).…”

Section: Arterial Supplymentioning

confidence: 99%

Surgical Anatomy of the Colon, Rectum and Anus

Birnbaum¹

2015

Coloproctology

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Knowledge of the embryologic origins of the gastrointestinal tract is useful for the understanding of the anatomic relationships and surgical tissue planes used in abdominal surgery. The colon begins in the right lower quadrant where the terminal ileum enters the cecum and ends at the sacral promontory. The rectum follows the sacrum ending at the anal canal. The blood supply to the right colon comes from the superior mesenteric artery and to the left from the inferior mesenteric artery. Branches of the internal iliac artery supply the rectum. The veins and lymphatics run parallel to the arteries. Innervation comes from the parasympathetic and sympathetic fibers of the lower thoracic and lumbosacral region of the spinal cord. EmbryologyKnowledge of the embryologic origins of the gastrointestinal tract is useful for the understanding of the anatomic relationships and surgical tissue planes used in abdominal surgery and congenital abnormalities. The primitive foregut structures end at the second portion of the duodenum and are supplied by the celiac artery. The midgut starts at the duodenal ampulla and ends at the distal transverse colon. The small intestine, cecum, appendix, ascending colon, and proximal transverse colon are derivatives of the midgut and are supplied by the superior mesenteric artery. The hindgut begins at the distal third of the transverse colon and includes the descending colon, sigmoid colon, rectum, and the upper portion of the anal canal. The hindgut and part of the lower urogenital tract are supplied by the inferior mesenteric artery. The anal canal is formed at the end of the rectum where the endodermal tissues fuse with the ectoderm and is supplied by branches of the internal pudendal artery (Rowe et al. 1974;Dujovny et al. 2004). The dentate line is the approximate location of the transition from endoderm to ectoderm at the junction of the upper two thirds of the anal canal with the lower one third. The veins and lymphatics follow the same embryologic divisions as the arterial supply.These structures develop during the fourth week in utero (Fig. 1). During the sixth week, the midgut lengthens, herniates out of the abdominal cavity, and rotates 90 counterclockwise around the superior mesenteric artery. The cloaca is the caudal part of the hindgut and begins to separate into two sections at the end of the sixth week of gestation. The ventral portion develops into the urogenital sinus and the dorsal portion develops into the anorectum (Rowe et al. 1974). This separation occurs as a result of either a cranially oriented septum growing down to reach the cloacal membrane or from lateral folds fusing in the middle (Stephens 1961). By the tenth week the midgut rotates an additional 180 counterclockwise as it returns to the abdominal cavity. The cecum descends to the right iliac fossa where it becomes fixed. The base of the small bowel mesentery is fixed from the ligament of Treitz in the left upper quadrant to the ileocecal valve in the right lower quadrant (Moore 1988).

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“…The existence of the middle rectal artery is also controversial and has been reported to occupy the lateral ligament with a wide incidence, ranging from 22% to 100%. [8][9][10][11] These variations are due in part to the differences in the caliber of the artery that is defined as the middle rectal artery. If one counts every vessel inside the lateral ligament, regardless of its diameter, the incidence approaches 100%.…”

Section: Coronal Anatomymentioning

confidence: 99%