Colon & Rectum - lecture - Loyola University Chicago

[Pages:186]COLON & RECTUM

Vinod A. Winston, M.D Department of Surgery vwinston@lumc.edu

Topics

? Basic Anatomy ? Lower GI bleeding ? Diverticular disease ? Colon & Rectal Carcinoma ? Anal Cancer ? Large Bowel Obstruction ? Inflammatory Bowel Disease ? CD, UC

ARTERIAL SUPPLY OF COLON & RECTUM

? The marginal artery of Drummond brings blood to the left colon if inferior mesenteric artery is ligated

? Arc of Riolan (meandering artery) is another anastomosis between the middle colic & the left colic arteries (not present always)

LYMPHATIC DRAINAGE OF COLON & RECTUM

LYMPHATIC DRAINAGE OF RECTUM & ANAL CANAL

This is IMPORTANT

STUFF

Upper two-third of rectum : Sup Rectal nodes Inferior mesenteric nodes Lower one-third of rectum : Sup Rectal nodes Inferior mesenteric nodes

AND Internal iliac nodes (along middle rectal vessels) Anal canal above dentate line : Sup rectal nodes Inferior mesenteric nodes

AND Internal iliac nodes laterally

Anal canal below dentate line : Inguinal nodes primarily

(can go to internal iliac or superior rectal nodes)

ARTERIAL SUPPLY OF COLON

Cross sectional anatomy

Note: The vasa recta brevia run subserosally in the wall and penetrate the circular muscle and run in the submucosa

Look at the vasa rectae penetrating the muscle

OUR TOOLS

Anoscope

Rigid Proctoscope

Flexible Sigmoidoscope

Anoscope : view the anal canal, about 6-8 cm long Proctoscope : view the rectum and distal sigmoid colon, about 20-22 cm long Flexible Sigmoidoscope : can visualize the left colon, may be upto the splenic flexure Colonoscope : view the entire colon and may be the distal terminal ileum

LOWER GI BLEEDING

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