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Anatomy of the Rectum and Anus
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
A. P. Meagher, W. J. Adams, D. Z. Lubowski, D. W. King
The rectum is supplied by superior, middle, and inferior rectal arteries and veins, with additional small median sacral and pelvic floor vessels. The middle rectal artery is variable in its origin and inserts low into the rectum, 1 to 2 cm from the pelvic floor.1 The veins from each vascular leash anastomose freely in the submucosal plane. The lymphatic drainage follows the course of the arteries.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The blood supply of the rectum is supplied by the superior rectal artery (first two-thirds of rectum) and the middle rectal artery (last third of rectum). The venous drainage is the superior and middle rectal veins. The nerve supply comprises the inferior anal nerves and inferior mesenteric ganglia. The lymphatic drainage comprises the inferior mesenteric, pararectal, and internal iliac lymph nodes. In males, the anterior border of the rectum comprises the rectovesical pouch, small bowel, Denonvillier’s fascia, bladder, vas, seminal vesicles, and prostate.
The rectum
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The superior rectal artery is the direct continuation of the inferior mesenteric artery and is the main arterial supply of the rectum (Figure73.1). The arteries and their accompanying lymphatics lie within the loose fatty tissue in the mesorectum, surrounded by a sheath of connective tissue (the mesorectal fascia). The middle rectal artery arises on each side from the internal iliac artery and passes to the rectum in the lateral ligaments. It is usually small and often only present on one side, and divides into several branches. The inferior rectal artery arises on each side from the internal pudendal artery as it enters Alcock's canal. It hugs the inferior surface of the levator ani muscle as it crosses the roof of the ischiorectal fossa to enter the anal muscles.
A Modification of Laparoscopic Type C1 Hysterectomy to Reduce Postoperative Bladder Dysfunction: A Retrospective Study
Published in Journal of Investigative Surgery, 2019
Wei Jiang, Meirong Liang, Douxing Han, Hui Liu, Ling Li, Meiling Zhong, Lin Luo, Siyuan Zeng
Currently, there are two schools of thought regarding NSRHs: One of these favors a traditional approach, and the other favors a modified approach. The traditional school insists on the visualized preservation of the nerve by meticulous separation of the nerve, despite the prolonged and complicated nature of the procedure.6,7,12 To cope with the complex anatomy of the nerve plexus, numerous researchers have invented multiple instruments.6,7,12 In contrast, the modified approach spares the inferior hypogastric plexus as a whole without separating the autonomic nerve by direction of defined anatomical landmarks. The inferior hypogastric plexus is formed by the hypogastric nerve, pelvic splanchnic nerve, innervating bladder, uterus and rectum. A range of anatomical landmarks has been put forward to enable the preservation of the plexus. Fujii5 and Kato13 recommended separation of the inferior vesical vein to identify and preserve the bladder branch from the inferior hypogastric plexus, however, the preservation is difficult due to the rich anatomical variation. Ditto et al.14 and Bin Li et al.15 reported that the middle rectal artery demarcated the boundary between the nervous portion and vesicular portion of the CL. However, the middle rectal artery is subjected to rich anatomical variation and is more commonly single sided than double sided.16