Dr Ahmed Fathalla Ibrahim Dr Ahmed Fathalla Ibrahim

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Dr. Ahmed Fathalla Ibrahim Dr Ahmed Fathalla Ibrahim

Dr. Ahmed Fathalla Ibrahim Dr Ahmed Fathalla Ibrahim

RECTUM • BEGINNING: It begins as the continuation of sigmoid colon, opposite S 3

RECTUM • BEGINNING: It begins as the continuation of sigmoid colon, opposite S 3 • TERMINATION: It continues as anal canal, one inch below & in front of the tip of coccyx. Its lower part is dilated to form the rectal ampulla • LENGTH: 5 inches (13 cm) • STRUCTURE: It differs from colon by having no taeniae coli, no appendices epiploicae & no sacculations Dr Ahmed Fathalla Ibrahim

RECTUM Dr Ahmed Fathalla Ibrahim

RECTUM Dr Ahmed Fathalla Ibrahim

RECTUM • CURVES (FLEXURES): 1. Antero-posterior: It follows the concavity of sacrum & coccyx

RECTUM • CURVES (FLEXURES): 1. Antero-posterior: It follows the concavity of sacrum & coccyx 2. Lateral: three in number, the upper & lower are convex to the right & the middle is convex to the left • PERITONEAL COVERING: 1. Upper 1/3: front & sides 2. Middle 1/3: front only 3. Lower 1/3: no peritoneal covering Dr Ahmed Fathalla Ibrahim

RELATIONS OF RECTUM IN MALE PELVIS Dr Ahmed Fathalla Ibrahim

RELATIONS OF RECTUM IN MALE PELVIS Dr Ahmed Fathalla Ibrahim

ANTERIOR RELATIONS OF RECTUM IN MALE PELVIS Dr Ahmed Fathalla Ibrahim

ANTERIOR RELATIONS OF RECTUM IN MALE PELVIS Dr Ahmed Fathalla Ibrahim

RELATIONS OF RECTUM IN FEMALE PELVIS Dr Ahmed Fathalla Ibrahim

RELATIONS OF RECTUM IN FEMALE PELVIS Dr Ahmed Fathalla Ibrahim

RELATIONS OF RECTUM ANTERIOR: 1. Its upper 2/3 is covered by peritoneum & is

RELATIONS OF RECTUM ANTERIOR: 1. Its upper 2/3 is covered by peritoneum & is related to sigmoid colon & ileum 2. Its lower 1/3 is devoid of peritoneum & is related: • In male: to seminal vesicle & vas deferens of both sides, posterior surface (base) of bladder, prostate gland • In female: posterior wall of vagina Dr Ahmed Fathalla Ibrahim

POSTERIOR RELATIONS OF RECTUM Dr Ahmed Fathalla Ibrahim

POSTERIOR RELATIONS OF RECTUM Dr Ahmed Fathalla Ibrahim

RELATIONS OF RECTUM POSTERIOR: 2 BONES: sacrum & coccyx 2 MUSCLES: piriformis & coccygeus

RELATIONS OF RECTUM POSTERIOR: 2 BONES: sacrum & coccyx 2 MUSCLES: piriformis & coccygeus 2 VESSELS: lateral & medial sacral 2 NERVES: sympathetic trunks & sacral plexus Dr Ahmed Fathalla Ibrahim

ARTERIAL SUPPLY OF RECTUM Dr Ahmed Fathalla Ibrahim

ARTERIAL SUPPLY OF RECTUM Dr Ahmed Fathalla Ibrahim

LYMPHATIC DRAINAGE OF RECTUM Dr Ahmed Fathalla Ibrahim

LYMPHATIC DRAINAGE OF RECTUM Dr Ahmed Fathalla Ibrahim

SUPPLY OF RECTUM • ARTERIAL SUPPLY: 1. Superior rectal (continuation of inferior mesenteric): descends

SUPPLY OF RECTUM • ARTERIAL SUPPLY: 1. Superior rectal (continuation of inferior mesenteric): descends in the root of sigmoid mesocolon, divides into right & left branches that supply the mucous membrane of rectum, anastomoses with middle & inferior rectal arteries 2. Middle rectal: branch of internal iliac, supplies the muscular coat of rectum 3. Median sacral: branch of abdominal aorta, supplies a part of the back of rectum Dr Ahmed Fathalla Ibrahim

SUPPLY OF RECTUM • VENOUS DRAINAGE: corresponding veins • LYMPHATIC DRAINAGE: to pararectal lymph

SUPPLY OF RECTUM • VENOUS DRAINAGE: corresponding veins • LYMPHATIC DRAINAGE: to pararectal lymph nodes then to: inferior mesenteric or internal iliac lymph nodes • NERVE SUPPLY: autonomic fibers from inferior hypogastric plexuses Dr Ahmed Fathalla Ibrahim

SUPPORT OF RECTUM The main support are 2 fasciae: 1. Rectovesical fascia (fascia of

SUPPORT OF RECTUM The main support are 2 fasciae: 1. Rectovesical fascia (fascia of Denonvilliers): extends from rectum to bladder & prostate 2. Fascia of Waldeyer: extends from rectum to front of lower part of sacrum & coccyx Dr Ahmed Fathalla Ibrahim