The large intestine
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Right hemicolectomy Carcinoma of the caecum or ascending colon (Figure70.8) is treated by right hemicolectomy (Figure70.9). At open surgery the peritoneum lateral to the ascending colon is incised, and the incision is carried around the hepatic flexure. The right colon and mesentery are elevated, taking care not to injure the ureter, gonadal vessels or the duodenum. The ileocolic artery is ligated close to its origin from the superior mesenteric artery (‘high-tie') and divided. Where the right colic artery has a separate origin from the superior mesenteric artery (around 10% of patients) this is separately ligated. The mesentery of the distal 20 cm of ileum and the mesocolon as far as the proximal third of the transverse colon is divided. The greater omentum is divided up to the point of intended division of the transverse colon. When it is clear that there is an adequate blood supply at the resection margins, the right colon is resected, and an anastomosis is fashioned between the ileum and the transverse colon. If the tumour is at the hepatic flexure the resection must be extended further along the transverse colon and will involve dividing the right branch of the middle colic artery.
Mesenteric and renal angiography
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
The SMA usually originates 1 cm lower than the celiac trunk and anterior to the L1 vertebral body.[1] The SMA travels inferiorly and slightly rightward to supply the duodenum and pancreas. In its course, the SMA passes beneath the pancreas and divides into the inferior pancreaticoduodenal, middle colic, right colic, ileocolic, and intestinal branches (Figure 24.2). In general, the middle colic artery provides blood supply to the proximal and midtransverse colon. In some individuals, the middle colic may provide the main source of blood to the splenic flexure. The right colic artery provides the blood supply to the middle and distal ascending colon, while the ileocolic artery supplies the distal ileum, cecum, and proximal ascending colon. The middle, right, and ileocecal branches join together with the left colic artery (from the inferior mesenteric) forming the marginal artery or artery of Drummond that courses along the inside border of the colon. Multiple anatomic variations of the colic arteries exist.
Intestinal atresia and stenosis
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
From the list of options above, choose which is the most appropriate for each of the following scenarios regarding the pathological findings and classification of jejunoileal atresia. Each option may be used once, more than once, or not at all. A newborn is found to have a bowel obstruction and intraoperative findings include intestinal atresia with atretic blind ends connected by a fibrous cord with an intact mesentery.A diffuse inflammatory process has been proposed as a contributing factor.A premature infant of low birthweight is found to have malrotation as well as a proximal jejunal atresia. The blood supply to the distal bowel is perilously supplied in a retrograde fashion by arcades from the ileocolic artery.An infant is taken to the operating room and found to have jejunal atresia that consists of a septum with an intact bowel wall and mesentery.
Routine CT scan one year after surgery can be used to estimate the level of central ligation in colon cancer surgery
Published in Acta Oncologica, 2019
Ditte Louise E. Munkedal, Mona Rosenkilde, Nicholas P. West, Soren Laurberg
The available images included scans undertaken prior to surgery, 2 days after surgery and approximately 1 year after surgery. The study radiologist first assessed the images taken 1 year after surgery in order to identify the residual arterial stump and measure its length. If this was not possible, the preoperative CT-scan was used for identification. Afterwards, the CT-scan performed 2 days after surgery was used as a control. On the right side only, the ileocolic artery was measured from its origin at the superior mesenteric artery to the ligation. On the left side only, the inferior mesenteric artery was measured from its origin at the aorta to the ligation. The arterial stumps were classified as: a normal vessel (Figure 1(a)), thrombosed (visible thrombosis within the vessel, Figure 1(b)), a fibrotic line (mostly degenerated, Figure 1(c)) and not visible.
Transmesenteric hernia: a rare case of acute abdominal pain in children: a case report and review of the literature
Published in Acta Chirurgica Belgica, 2018
Edward Willems, Bart Willaert, Sam Van Slycke
Rokitansky first reported a transmesenteric herniation in 1836. He described the herniation of the caecum alone through a hole in the mesentery near the ileocolic junction at a post-mortem examination [5,8]. In 1885, Treves described an area in the mesentery near the ileocaecal angle circumscribed by the ileocolic artery and its anastomosis with the terminal branch of the ileal artery. This area was later named Treves’ field correspondingly. He noted that this mesenterial area contained no blood vessels, no fat and no mesenterial glands, hypothesizing that it is therefore very prone to injury during fetal development. Subsequently, a congenital defect in the mesentery can develop through which the intestine might herniate. Treves described these defects to be round to oval-shaped with a diameter of 2–3 cm and a thickened margin [2,9,10]. Congenital defects in the mesentery have also been found in other areas of the mesentery, yet they occur most commonly in parts of the mesentery that are thin and avascular, such as in the mesentery of the terminal ileum and the sigmoid and transverse mesocolon [4,6,11].
The mesentery: an ADME perspective on a ‘new’ organ
Published in Drug Metabolism Reviews, 2018
Aneesh A. Argikar, Upendra A. Argikar
From a vascularization point of view, the abdominal aorta (aorta in the abdominal cavity) divides in to superior and inferior mesenteric arteries. The superior and inferior mesenteric arteries supply oxygenated blood to the intestines. These arteries pass through the mesentery and branch several times until they reach the intestines. The superior mesenteric artery branches into colic arteries, intestinal arteries, and ileocolic artery. The inferior mesenteric artery branches into colic artery, sigmoidal arteries, and rectal artery (Marieb and Hoehn 2012). A detailed representation of the mesenteric vascular flow is shown in Figure 2.
Related Knowledge Centers
- Ascending Colon
- Peritoneum
- Superior Mesenteric Artery
- Iliac Fossa
- Appendicular Artery
- Right Colic Artery
- Ileocecal Valve
- Colic Branch of Ileocolic Artery
- Anterior Cecal Artery
- Posterior Cecal Artery