Christine Te, MD

Dept. of Anatomy
San Beda College of Medicine
 Fixed terminal part of
large intestine
 Begins anterior to level
of S3 vertebra
 12 - 15 cm long
 Follows curve of sacrum
and coccyx
 Ends to become anal
canal
 Puborectalis muscle
forms a sling at junction
of rectum and anal canal
producing 90 deg
anorectal angle
Rectal ampulla
-terminal dilated
part w/c is very
distensible
-where feces is held
before it is
expelled
 Superior/3
- covered w/
peritoneum
 Middle/3
- on anterior surface
only
 Inferior /3
– no covering
 sacral vertebrae
 coccyx
 Anococcygeal lig.
 Median sacral
vessels
 Br of sup.rectal
art
 Male
› Fundus of urinary bladder
› Seminal vesicles, vas
deferens, ureter
› Prostate
Rectovesical pouch –space bet
rectum and UB
 Female
› Vagina
Rectouterine pouch- space bet
rectum and uterus
 it pierces the levator
ani to become the anal
canal where a part of
the levator ani called
the puborectalis sling
pulls the anorectal
junction anteriorly
 Segment :
 Superior
 Superior rectal art [fr
IMA]
 Middle
 middle rectal art [fr int
iliac art]
 Inferior
 inferior rectal art [ fr int
pudendal]
 fr median sacral art
1. SUPERIOR
SUPERIOR RECTAL VEINS
› TO INFERIOR MESENTERIC V.

2. INFERIOR
INFERIOR RECTAL VEINS
› TO INTERNAL PUDENDAL V.

3. MIDDLE
MIDDLE RECTAL VEINS
› DRAINS THE MUSCULAR
COAT OF THE UPPER
PART OF THE ANAL
CANAL
 Superior part of
rectum
› Pararectal LN
› Inf mesnteric LN
› Aortic LN
 Inferior part of
rectum
› Internal iliac LN
 Sympathetic
› Inferior hypogastric
plexus
 Parasympathetic
› S2-3 nerves
 ANAL COLUMNS
› VERTICAL FOLDS OF
THE MUCOUS
MEMBRANE
 ANAL VALVES
› HORIZONTAL FOLDS
THAT JOINS OR
LINKS ADJOINING
ANAL COLUMNS
 ANAL SINUSES
› RECESSES
FOUND
BETWEEN THE
ANAL COLUMNS
AND VALVES
› ANAL GLANDS
OPENS INTO THE
ANAL SINUSES
 PECTINATE LINE
› LINE FORMED BY
THE ANAL
VALVES AROUND
THE
CIRCUMFERENCE
OF THE ANAL
CANAL
 EPITHELIUM IS
TRANSITIONAL
CUBOIDAL
 FOUND BELOW
THE PECTINATE
LINE AND ABOVE
THE ANOCUTA-
NEOUS LINE
 FOUND BELOW
THE ANOCUTA-
NEOUS LINE
 LINING OF THE
CANAL IS TRUE
SKIN
 CONTINUATION OF
THE CIRCULAR
SMOOTH MUSCLE
OF THE RECTUM
 SURROUNDS THE
UPPER ¾ OF THE
ANAL CANAL UP TO
THE ANOCU-
TANEOUS LINE
 SUBCUTANEOUS
› SUBCUTANEOUS AND
SURROUNDS THE ANAL
OPENING ITSELF
› FIBROUS SEPTA DERIVED
FROM THE LONGITUDINAL
MUSCLE LAYER OF THE
RECTUM PASSES THROUGH
IT ON ITS WAY TO THE SKIN
AROUND THE ANUS
 SUPERFICIAL
› ATTACHED
POSTERIORLY TO THE
ANOCOCCYGEAL
LIGAMENT AND
ANTERIORLY TO THE
PERINEAL BODY
 DEEP
› FUSED WITH THE
PUBORECTALIS SLING
 SUPERIOR RECTAL
ARTERY
› Superior to pectinate line
 MIDDLE RECTAL ARTERY
-Form anastomosis
w/superior and inferior
rectal art
 INFERIOR RECTAL ARTERY
› Inferior to pectinate line
 INTERNAL VENOUS PLEXUS
› FOUND IN THE SUBMUCOSA
› DRAINS MAINLY INTO THE SUPERIOR
RECTAL VEINS BUT ALSO INTO INFERIOR
RECTAL VEINS
› SITE FOR PORTOCAVAL SHUNTING
 EXTERNAL VENOUS PLEXUS
› FOUND OUTSIDE THE MUSCULAR COAT
› DRAINS INTO THE INFERIOR RECTAL
VEINS
 Superior to pectinate
line
-Internal iliac LN

 Inferior to pectinate
line
-Superficial inguinal LN
 Superior to pectinate line
-Inf hypogastric plexus [symp]
- Pelvic splanchnic n.[parasym]

 Inferior to pectinate line

-Inferior rectal nerves
-Sensitive to pain,touch,temp
Rectal Adenocarcinoma