COLON, RECTUM &

ANAL CANAL ANATOMY

MOHAMED ELADL
29/10/2014

Learning objectives
1.

2.

3.

Understanding the development of the hindgut, cloaca

partitioning and derivatives and possible abnormalities
occurring during development; (Congenital megacolon, and
imperforate anus).
Understanding the surgical anatomy (location, peritoneal
covering, blood supply, innervation, lymphatic drainage)
including recognition of expected anatomic variations of
colon, rectum & anal canal
Understanding the anatomy of portal vein and portosystemic
anastomosis (esophageal varices, piles, caput medusa).

DEVELOPMET OF Hindgut
The derivatives of the hindgut are:
1.
2.
3.
4.
5.
6.

The left one-third of the transverse colon.

Descending colon.
Sigmoid colon.
Rectum.
The upper part of the anal canal.
The epithelium of the urinary bladder and most of
the urethra.

DEVELOPMET OF Hindgut
The Hindgut elongates to form of 2 parts:
1. Colic loop.
2. Cloaca (dilated terminal part).

The colic loop

The colic loop gives the following parts:
1.Remaining part of transverse colon.
2.Left Colic flexure.
3.Descending Colon.
4.Pelvic colon.
These structures lie on the Left Side of the abdominal Cavity
& supplied by inferior mesenteric artery.

DEVELOPMET OF CLOACA
Definition:
It is the expanded terminal part of the hindgut.
It is an endodermal lined cavity

DEVELOPMET OF CLOACA
Ducts

opening

into

the

cloaca:
Laterally:
Receives
the
openings of the mesonephric
duct.
Ventrally:
Receives
the
allantois (urachus), which is a
diverticulum of the yolk sac
passes through the substance
of the connecting stalk.

PARTITIONING OF THE CLOACA

A wedge of mesoderm (the urorectal septum) is developed

in the angle between the alllantois and the hindgut. This

septum will divide the cavity of the cloaca into dorsal and
ventral parts.

PARTITIONING OF THE CLOACA

The

urorectal septum grows towards the cloacal

membrane.
By the 7th week, the septum reaches as the cloacal
membrane and fuse with it.
This result in:

PARTITIONING OF THE CLOACA

1. The cavity of the cloaca
become completely divided
into:
Dorsal part: Which give
rise to the rectum and upper
part of anal canal.

Ventral

part:

(primitive
urogenital sinus): Which give
rise to the urinary bladder &
urethra.

PARTITIONING OF THE CLOACA

2. The cloacal membrane is
divided into:
Dorsal part:
The anal
membrane.

Ventral part: The urogenital

membrane.

THE PERINEAL BODY

represents the area of fusion of
the urorectal septum with the
cloacal membrane in the adult.

PARTITIONING OF THE CLOACA

3. The urorectal septum, also,
divides the cloacal sphincter
into:
Ventral part: becomes the
perineal muscles.

Dorsal part: becomes the

external anal sphincter.

PARTITIONING OF THE CLOACA

PARTITIONING OF THE CLOACA

PARTITIONING OF THE CLOACA

PARTITIONING OF THE CLOACA

PARTITIONING OF THE CLOACA

DEVELOPMET OF the anal canal

The upper 2/3 of anal canal: is derived from the

posterior part of the cloaca (which is lined by

endoderm).
The lower 1/3 of the anal canal: is derived from
proctodeum, which is a depression from the
surface ectoderm.

The 2 parts are separated by anal membrane:

Rupture of the anal membrane the proctodeum

becomes continuous with the anal canal & forms
its lower ectodermal part.

DEVELOPMET OF the anal canal

The pectineal line is the site of fusion between the

2 parts of the anal canal.

The mesoderm of the upper 2/3: forms the internal

anal sphincter (plain muscle).

The mesoderm of the lower 1/3: forms the external

anal sphincter (striated muscle).

DEVELOPMET OF the anal canal

Congenital Megacolon
(Hirschsprung disease)

IT IS THE MOST COMMON

CAUSE
OF
NEONATAL
OBSTRUCTION OF THE COLON.

Due to Failure of neural crest

cells to migrate into the wall of
the colon during the 5th to 7th
weeks.
Feature:
The absence of autonomic
ganglion
cells
in
the
myenteric plexus distal to
the dilated segment of colon.
Only the rectum and sigmoid
colon are involved.

IMPERFORATE ANUS
Abnormal development
urorectal septum:

of

the

Types:
1.Anal agenesis, with or without a
fistula:
The anal canal may end blindly or
there may be an ectopic opening
(ectopic anus) or an anoperineal fistula
that opens into the perineum.
There may be a fistula to:
Bladder (recto-vesical fistula)
Urethra (recto-urethral fistula)
Vagina (recto-vaginal fistula
Passage of meconium in urine is
diagnostic.

IMPERFORATE ANUS
2.Anal stenosis:
Due to slight dorsal deviation of the
urorectal septum.
The anus and anal canal are narrow.

3.Membranous atresia of the anus:

Due to failure of the anal membrane to
rupture at the end of the 8th week.
There is a thin layer of tissue separates the
anal canal from the exterior.

The large intestine

Length: 1.5m
Parts:

Characters of large intestine

Taenia coli.
Sacculations
Appendicis
epiploicae.

Peritoneal Relations
Completely
covered:
Caecum, appendix,
transverse colon,
sigmoid colon

Partially covered:
Ascending colon,
descending colon,
right & left colic
flexures.

Peritoneal Relations

SkandalakisSurgical Anatomy 2004

Peritoneal Relations

SkandalakisSurgical Anatomy 2004

Surface anatomy of the caecum

Right inguinal ligament

Transtubercular

Surface anatomy of the Appendix

Mc Burney point

BLOOD SUPPLY OF THE COLON

SkandalakisSurgical Anatomy 2004

LYMPH DRAINAGE OF THE COLON

SkandalakisSurgical Anatomy 2004

PORTAL VEIN
Formation:
Splenic & sup. mesentric v.

Site:
L1, behind neck of pancreas.

Course: ascends upward

Behind 1st part of duodenum.
Free border of lesser
omentum.
In porta hepatis.

Termination:
Enter liver & divide into right &
left terminal branches.

PORTAL VEIN
Tributaries:
1.
2.
3.
4.
5.
6.

Splenic v
Superior mesentric v
Left gastric v
Right gastric v
Para-umbilical v
Cystic v

PORTOSYSTEMIC ANASTOMOSIS
Def.:
Communication between portal &
systemic circulations

Sites:
1.

Esophagus (lower end):

Left gastric (Portal) &
Esophageal tributaries (Azygos).
Pathology: Esophageal varices.
Complication: Haematemsis

PORTOSYSTEMIC ANASTOMOSIS
Sites:
2.

Anal canal:
Sup. Rectal (portal)
Mid. & inf. Rectal (internal iliac)
Pathology: hemorrhoids
Complication: bleeding

PORTOSYSTEMIC ANASTOMOSIS
3. Liver
Portal vein (portal)
Hepatic veins (IVC)
Pathology: Hepatomegaly
Complication: liver failure
4. Bare area of liver
Portal v (portal)
Phrenic vs (IVC)
Pathology: ascites

PORTOSYSTEMIC ANASTOMOSIS
5. Umblicus
Paraumbilical veins
(Portal)
Epigastric veins
(ext. iliac &
brachiocephalic)
Pathology: Caput
Medusae.

PORTOSYSTEMIC ANASTOMOSIS

6. Retroperitoneal
Veins of gut (portal)
Veins of post. Abdominal wall (IVC)
Pathology: congestion

RECTUM

Begins at the 3rd sacral

Ends about 1 inch in

piece, as the continuation

of the pelvic colon.

front and below the tip of

the coccyx, where it
becomes continuous with
the anal canal.

RECTUM

Sacral curvature:
It is curved following the
concavity of the sacrum and
coccyx.

RECTUM

Lateral curvatures:
The upper part: forms 3 lateral
flexures, the upper and lower
flexures are concave to the left,
while the middle one is concave
to the right. However, the
beginning &termination of the
rectum lie in the median plane.

The lower part:

Is dilated to form the rectal
ampulla.

RECTUM

Perineal curvature:
At the junction of rectum and anal
canal it is directed forwards.

It doesn't show appendices epiploica,

taenia coli and sacculations (unlike the
other parts of the large intestine).

Peritoneal relations
The upper 1/3: front and
sides.
Middle 1/3: front only.
Lower 1/3: no peritoneal
covering.

Anterior Relations

In male:
Above, Rectovesical pouch.
Below, Base of the bladder,
seminal vesicles, ampullae of
vas, terminal parts of the
ureter and prostate.

Anterior relations

In female:

Above, rectovaginal
pouch.
Below, posterior wall of
vagina.

posterior relations
1. Sacrum and coccyx.
2. Piriformis, coccygeus & levator ani
muscles.
3. Median sacral vessels.
4. Branches of superior rectal vessels.
5. Sympathetic trunks, lower sacral
and coccgeal nerves.
6. Ganglion impare.

On each side:
Pararectal fossa.

Hemorrhoids

The internal hemorrhoids are above the dentate line and covered with
insensitive mucosa
The externals are below the dentate line and covered by sensitive squamous
epithelium.
There are no pain fibers above the dentate line but lots below the dentate line.

Blood supply of RECTUM

The superior rectal artery is a branch of the Inferior Mesenteric Artery,

middle rectal artery is a branch of internal iliac artery, and the inferior
rectal artery is a branch of the internal pudendal artery.
The superior rectal vein drains to the IMV and portal vein and can be
involved with rectal varices from portal hypertension.

ANAL CAnAl
Site:

Begins 1 inch below and

in front of the tip of the

coccyx as a continuation of
the rectum.
It passes downwards and
backwards for 1.5 inch to
end at the anal orifice.

ANAL CAnAl

Anterior relations:

Perineal body, separating it

from
the
membranous
urethra and bulb of the
penis in male and the lower
end of the vagina in female.

Posterior relations:

Anococcygeal
body,
separating it from the tip of
the coccyx.

ANAL CAnAl

Lateral relations:

Upper part: related to

levator ani.
Lower part: ischiorectal
fossa.

External ANAL sphincters

Voluntary Striated muscle fibers.

Surrounds the lower 2/3 of the canal,
thus overlapping the internal sphincter
in the middle third.

It consists of 3 parts:
1.Subcutaneous: no bony attachment.
2.Superficial: between the perineal and
anococcygeal body and tip of coccyx.
3.Deep part: around the middle 1/3 of
the anal canal.

Nerve supply: Inferior rectal nerve

and perineal branch of the 4th sacral

nerve.

Internal ANAL sphincters

Smooth muscle fibers.

Acting involuntary.
It is a thickening of the smooth
circular muscle layer of the gut,
which surrounds the upper 2/3 of the
canal.
Nerve supply: sympathetic fibres via
the superior and inferior hypogastric
plexuses.

ANAL Mucosa

It shows longitudinal folds called

anal columns.
The lower ends of these columns
are connected with each other by
semilunar valves called anal
valves.
The line along the anal valves
situated is called white line of
Hilton.
This line during fetal life gives
attachment to anal membrane,
which
separate
the
upper
endodermal part from the lower
ectodermal part.

Thank You