Rectum

Rectum begins
as a
continuation of
sigmoid colon at
the level of 3rd
sacral vertebra

rectum
 Rectum ends
by becoming
continous with
the anal canal
at the anorectal
junction.

Anorectal junction
Rectum is 12
cm long
In the upper
part it has
same diameter
of 4cm
In the lower
part it is
dilated to
form rectal
ampulla.
Curvatures of
rectum
Anteroposterior
curves
a.sacral flexure
b.perineal
flexure
Three lateral
curves
a.upper lateral
curve
b.middle lateral
curve
c.lower lateral
curve
Relations
Peritoneal relations
a.upper1/3 –covered with peritoneum
infront and on the sides.
b.middle 1/3 is covered with peritoneum
only in front.
c.lower 1/3 which is dilated to form
ampulla is devoid of peritoneum.
Visceral relations

Anteriorly in males-Upper2/3of the rectum are

related to the rectovesical pouch with coils of
intestine and sigmoid colon.

Rectovesical
pouch
Lower 1/3 of the rectum is related to the base of the
urinary bladder,terminal parts of the ureters,seminal
vesicles ,deferent ducts and the prostate.
Ejaculatory duct

Seminal vesicle
Anterior and posterior relations of the rectum in the
male
Anteriorly in females
Upper2/3 of the rectum is related to
the rectouterine pouch with coils of
intestine and sigmoid colon.Pouch
seperates the rectum from the
uterus,and from the upper part of
vagina
 Rectouterine pouch

Vesicouterine pouch

Lower 1/3 of the rectum is related to the lower part of the vagina.
Posteriorly the relations are same in the male and female.
They are

1.Lower 3 pieces of sacrum and coccyx and

anococcygeal ligament
2.Piriformis,coccygeus and levator ani
3.median sacral,superior rectal and the lower
lateral sacral vessels
4.sympathetic chain ,anterior primary rami of
S3,S4,S5,Co1 and the pelvic splanchnic
nerves,lymph nodes,lymphatics and fat.
Posterior relations of rectum
Mucosal folds
Mucous membrane of the empty
rectum shows 2 types of folds
Longitudinal and transverse
Longitudinal folds are present in the
lower part of an empty rectum
Transverse folds or horizontal folds or
houston’s valves or plicae
transversales are permanent
Longitudinal
folds
Transverse rectal
folds
 Transverse folds of rectum
Superior

Rectosigmoid
middle junction

inferior
Functional parts of rectum
Rectum has 2 functional parts
1.upper part is related to peritoneum –it acts
as a faecal reservoir which can freely
distend anteriorly
Lower part is devoid of peritoneum it is
empty in normal individuals, but may
contain faeces after death or in cases of
chronic constipation.
 Inferior Arterial supply
mesenteric Median sacral
artery artery

Internal
iliac artery

Middle
rectal
Superior
artery
Rectal
artery
Superior rectal artery is a continuation of the inferior
mesenteric artery
It divides into right and left branches
Each branch divides into small branches which pierce the
muscular coats and form anastomoses.
Middle rectal arteries-supply only the superficial coats of
the lower rectum.
They arise from the anterior division of the internal iliac
artery,supply the muscle coats of the lower part of the
rectum
Median sacral artery This is a small branch arising from
the back of the aorta near its lower end.it supplies the
posterior wall of the anorectal junction
 Venous drainage

Median sacral Superior

vein rectal vein

Internal
iliac vein

Middle
rectal vein
Internal rectal
venous
plexus Inferior rectal
vein
Superior rectal vein
Tributaries of this vein begin in the anal
canal,from the internal rectal venous plexus,in
the form of six veins of considerable size
They pass upwards in the rectal
submucosa,pierce the muscular coat above the
anus and unite to form the superior rectal vein
which continues upwards as the inferior
mesenteric vein.
Middle rectal vein- They drain chiefly the
muscular walls of the rectal ampulla and open
into the internal iliac vein
Lymphatic drainage
Upper half of the rectum- inferior
mesentric nodes -pass along the superior
rectal vessels
Lower part of the rectum-internal iliac
nodes –pass along the middle rectal
vessels.
Nerve supply
Both sympathetic and parasympathetic nerves
Sympathetic L1,L2
Parasympathetic S2,S3,S4 through superior rectal or
inferior mesenteric and inferior hypogastric plexuses.
Sympathetic nerves are vasoconstrictor,inhibitory to the
rectal musculature and motor to the internal sphincter.
Parasympathetic nerves are motor to the musculature of
the rectum and inhibitory to the internal sphincter.
Sensations of distension of the rectum pass through the
parasympathetic nerves,
Pain sensations are carried by both sympathetic and
parasympathetic nerves
Supports of rectum
1.Pelvic floor-formed by levator ani muscles
2.fascia of waldayer-inferior fascia of pelvic diaphragm
3.lateral ligaments of the rectum-They are formed by
condensation of pelvic fascia on each side of the
rectum.They enclose the middle rectal vessels ,and
branches of the pelvic plexuses and attach the rectum to
the posterolateral walls of the lesser pelvis.it encloses the
superior rectal vessels and lymphatics.
4.Rectovesical fascia of Denonvilliers-it is a fascia which
seperates the rectum from the prostate.it is formed by
fusion of two layers of peritoneum intervening between
the prostate and rectum.
5.Pelvic peritoneum
6.perineal body with its muscles
Perineal body
Clinical anatomy
Digital per rectum(PR) examination
In PR examination the fingers enters anal canal before
reaching the lower end of the rectum.
In a normal person,the following structures can be
palpated by a finger passed per rectum.
In males-posterior surface of prostate,seminal vesicles,vas
deferens.
In females- perineal body,cervix and occasionally the
ovaries.
Inboth sexes-anorectal ring,coccyx and
sacrum,ischiorectal fossa.
Prolapse of rectum
Incomplete or mucosal prolapse of the rectum through the
anus may occur following violent straining.
This is due to imperfect support of the rectal mucosa by
the submucosa which is made up of loose areolar tissue.
Complete prolapse or procidentia is the condition in which
whole thickness of the rectal wall protrudes through the
anus.
Causes are
Laxity of the pelvic floor.
Excessively deep rectovesical or rectouterine pouch
Inadequate fixation of the rectum in its presacral bed.
Proctoscopy and sigmoidoscopy
The interior of the anal canal and the rectum
can be examined under direct vision with
special instruments like a proctoscope or a
sigmoidoscope.Proctoscopy shows internal
piles and growths in the lower part of the
rectum.
Sigmoidoscopy helps in revealing the
ulcers,growths and diverticula and in taking a
rectal biopsy.
Haemorrhoids also known as emeroids or piles are
a swelling and inflamation of the veins of the
rectum. Hemorroids can develop from two
different places:
Either internal rectal veins which can become
swollen and will form internal hemorrhoids.
External rectal veins can also swell to form
external hemorrhoids.
External hemorrhoids can be seen around the
outside of the anus and, many times, can be felt.
Carcinoma of the rectum
It is common,and is situated in
the rectosigmoid junction
It causes bleeding per rectum
 uterus
Urinary bladder

rectum