2009, Number 3
Rev Mex Coloproctol 2009; 15 (3)
Surgical anatomy of the rectum: Its importance
Reis NJA, Reis JJA
Full text
Language: Spanish
References: 15
Page: 65-70
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ABSTRACT
Objective: Nowadays there’s a big confusion to classify the tumor. Because the mistake in the knowledge of the rectum anatomy. We will demonstrate the main points of the discord: A) Is there middle rectum anatomically? B) Does the mesorectum exist? C). In which case most be made the total excision of the perirrectal fat? Material and methods: Review of many anatomy treaties: Proctologic anatomy by Lippincott editorial, illustrated anatomosurgery practice, surgical anatomy of the colon and rectum, surgical anatomy of the anal canal (by one of the authors of this work), surgery of rectum and descriptive anatomy compendium. Results: The rectal internal morphology studies recognize the formation of thick folds of transversal mucosa thick folds named valves: a low valve to 7 cm from anus. Another is to 2 cm upper with a half moon form, a third one to 11 cm from anus. As this valves are mucosal folds without a clear localization they can’t be consider as anatomical points to the rectum segment. The mesorectum doesn’t exist in the rectum, because this is located in the sacral concavity. There’s a pelvic fascia and for removing total of fat perirectal tissue it is necessary to respect the fascia integrity, and the third question in which case must be taken off the totality of perirectal fat tissue, that is in low rectum tumor cases. Therefore the rectal segmentation as the limit between up and low rectum, is located in the peritoneal reflection. In the rectal tumors diagnosis definition of it’s anatomic situation is important for the therapeutic behavior, because the low rectum has it’s embryologic origin in the Proctodeum (ectoblastic). It can be more sensitive to the radiation the up rectum tumors are originated from the formation entoblast tissue (endoblast) the radiations cause peritoneal injuries and other pelvic cavity organs. Conclusion: The rectal segmentation is important for the locate-regional tumor stadium and for the appropriate treatment definition. In first place, establish the anatomic concept of the low rectal tumor localization. In second place defines which are the complementary for the new adjuvant indication: Rd; Rd + Ox. Concluding: A) The rectum is not an abdominal organ. B) The rectum is perineal or pelvic. C) Mesorectum doesn’t exist. D) Rectum is not intraperitoneal, only there’s peritoneum in your anterior face. E) It is define a strategy for pelvic and perineal dissection for the identification of the pelvic fascia. F) Middle anatomic rectum doesn’t exist.REFERENCES