c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

The Anatomy of Colectomy: 1

A D V E R T I S E M E N T

   
 

The posterior view of the peritoneal cavity shows the colonic peritoneal reflections. As the colon rotates counterclockwise on its return to the abdomen in embryonic life, the right and left colon adhere to the posterior parietal peritoneum and one side of the mesocolon fuses with the parietal peritoneum. This fusion fascia is the avascular plane of separation when mobilizing the right and left colon. Cecal attachment is variable and a mobile cecum allows appendiceal mobility and potential cecal volvulus and folding (bascule). The transverse and sigmoid colon retain a narrow junction with the parietal peritoneum. The root of the sigmoid mesocolon crosses the left iliac vessels and ureter. The length of the sigmoid colon and its mesentery determines its mobility and potential for volvulus. A shortened sigmoid mesentery in diverticulitis puts the ureter at risk during sigmoid resection.    

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The Anatomy of Colectomy: 2

A D V E R T I S E M E N T

   
 

The root of the transverse mesocolon crosses the pancreas and second portion of the duodenum. Enzymes from nectotizing pancreatitis can infiltrate the transverse mesocolon and digest and perforate the transverse colon. Mobilization of hepatic flexure exposes the duodenum and head of pancreas for Kocher mobilization of those structures. Mobilization of the splenic flexure includes division of the splenocolic ligament.      

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The Anatomy of Colectomy: 3

A D V E R T I S E M E N T

   
 

The rectosigmoid junction is marked by the splaying of the three teneae to form a continuous outer longitudinal muscle layer. The rectum is about 12cm long including the anal canal surrounded by the sphincter muscles. The pelvic peritoneal reflection crosses the upper third of the rectum forming the rectovesical/rectovaginal Pouch of Douglas. Perforation of the lower 2/3 of the rectum is extraperitoneal between the pelvic peritoneum and levators and can usually be treated non-operatively.      

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This page was last modified on 9/15/2009.