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





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The Anatomy of Colectomy: 7

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The configuration of the colon is shown three-dimensionally. The colic gutters are mistakenly thought of as being a deep part of the abdominal cavity, but the psoas and quadratus muscles keep these parts of the colon relatively anterior. The subphrenic spaces, Morrisonís pouch, and the Pouch of Douglas are the deepest recesses of the peritoneal cavity and the sites of poorly accessible abscess formation following perforation. The cecum, sigmoid and transverse colon are the most mobile segments, with the sigmoid being the most variable in length.   

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The Anatomy of Colectomy: 8

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The relationship of the colon to the retroperitoneal structures is shown. Exposure of the aorta can be obtained by opening along the white line of the left colon and performing medial visceral rotation. The transverse colon assumes a dependent position when a person is upright, draping the transverse mesocolon over the small bowel. Elevating the transverse colon exposes the emergence of the first part of the jejunum to the left of the root of the small bowel mesentery.      

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The Anatomy of Colectomy: 9

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The right and transverse colon are supplied by branches of the superior mesenteric artery (SMA). The acute takeoff of the SMA predisposes it to receiving emboli by virtue of flow dynamics.     

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