Large Intestine

The large intestine begins in the RLQ, just lateral to the ileocecal valve. The large intestine consists of
four major parts: cecum, c l n, rectum, and anal canal (Fig. 13.8). The nal segment of the large intestine
is the rectum. The distal rectum contains the anal canal, which ends at the anus.

Colon Versus Large Intestine

Large intestine and colon are not synonyms, although many technologists use these terms
interchangeably. The c l n consists of ur secti ns and t exures and does not include the cecum and
rectum. The four sections of the colon are (1) the ascending c l n, (2) the transverse c l n, (3) the
descending c l n, and (4) the sigm id c l n. The right (hepatic) and le t (splenic) c lic exures also are
included as part of the colon. The transverse colon has a wide range of motion and normally loops down
farther than is shown on this drawing.

Cecum

At the proximal end of the large intestine is the cecum, a large blind pouch located inferior to the level
of the ileocecal valve. The vermiform appendix (commonly referred to as just the appendix) is attached
to the cecum. The internal appearance of the cecum and terminal ileum is shown in Fig. 13.9. The most
distal part of the small intestine, the ileum, joins the cecum at the ile cecal valve. The ileocecal valve
consists of two lips that extend into the large bowel. The ileocecal valve acts as a sphincter to prevent
the contents of the ileum from passing too quickly into the cecum. A second function of the ileocecal
valve is to prevent re ux, or a backward ow of large-intestine contents, into the ileum. The ileocecal
valve does only a fair job of preventing re ux because some barium can almost always be re uxed into
the terminal ileum when a barium enema is performed. The cecum, the widest portion of the large
intestine, is fairly free to move about in the RLQ.

Appendix

The vermi form appendix (appendix) is a long (2 to 20 cm), narrow, worm-shaped tube that extends
from the cecum. The term vermi orm means “wormlike.” The appendix usually is attached to the
posteromedial aspect of the cecum and commonly extends toward the pelvis. However, it may pass
posterior to the cecum. Because the appendix has a blind ending, infectious agents may enter the
appendix, which cannot empty itself. Also, obstruction of the opening into the vermiform appendix
caused by a small fecal mass may lead to narrowing of the blood vessels that feed it. The result is an in
amed appendix, or appendicitis. Appendicitis may require surgical removal, which is termed an
appendect m , before the diseased structure ruptures, causing peritonitis. Acute appendicitis accounts
for about 50% of all emergency abdominal surgeries and is 1.5 times more common in men than in
women. Occasionally, fecal matter or barium sulfate from a gastrointestinal tract study may ll the
appendix and remain there indefinitely.

Large Intestine- barium Filled

The radiograph shown in Fig. 13.10 demonstrates the four parts of the colon—ascending, transverse,
descending, and sigm id; and the two exures—the right c lic (hepatic) exure and the le t c lic (splenic)
exure. The remaining three parts of the large intestine—cecum, rectum, and anal canal—are also
shown. As is shown by this radiograph, these various parts are not as neatly arranged around the
periphery of the abdomen as they are on drawings. There is a wide range of structural locations and
relative sizes for these various portions of the large intestine, depending on the individual body habitus
and contents of the intestine.

Rectum and Anal Canal

The rectum extends from the sigmoid colon to the anus. The rectum begins at the level of S3 (third
sacral segment) and is about 12 cm (4 12 inches) long. The nal 2.5 to 4 cm (1 to 112 inches) of large
intestine is constricted to form the anal canal. The anal canal terminates as an opening to the exterior,
the anus. The rectum closely follows the sacrococcygeal curve, as demonstrated in the lateral view in
Fig. 13.11. The rectal ampulla is a dilated portion of the rectum located anterior to the coccyx. The initial
direction of the rectum along the sacrum is inferior and posterior. However, in the region of the rectal
ampulla, the direction changes to inferior and anterior. A second abrupt change in direction occurs in
the region of the anal canal, which is directed again inferiorly and posteriorly. Therefore, the rectum
presents t anter p steri r curves. This fact must be remembered when the technologist inserts a rectal
tube or enema tip into the lower gastrointestinal tract for a barium enema procedure. Serious injury can
occur if the enema tip is forced at the wrong angle into the anus and anal canal.

Large Versus Small Intestine

Three characteristics readily differentiate the large intestine from the small intestine. 1. The internal
diameter of the large intestine is usually greater than the diameter of the small bowel. 2. The muscular
portion of the intestinal wall contains three external bands of longitudinal muscle bers of the large
bowel that form three bands of muscle called taeniae c li, which tend to pull the large intestine into
pouches. Each of these pouches, or sacculations, is termed a haustrum. st the large intestine except
r the rectum p ssesses haustra. Therefore, a second primary identifying characteristic of the large bowel
is the presence of multiple haustra. This characteristic can be seen in the enlarged drawing of the
proximal large intestine in Fig. 13.12. 3. The third differentiation is the relative p siti ns of the two
structures. The large intestine extends around the peripher of the abdominal cavity, whereas the small
intestine is more centrall located.

Relative Location Of Air and Barium in Large Intestine

The distribution of air and barium is in uenced most often by the location of each portion of the large
intestine in relation to the peritoneum. Aspects of the large intestine are more anterior or more
posterior in relation to the peritoneum. The cecum, transverse colon, and sigmoid colon are more
anterior than other aspects of the large intestine. The simpli ed drawings in Fig. 13.13 represent the
large intestine in supine and pr ne positions. If the large intestine contained both air and barium sulfate,
the air would tend to rise and the barium would tend to sink because of gravity. Displacement and the
ultimate location of air are shown as black, and displacement and the ultimate location of the barium
are shown as hite. When a person is supine, air rises to ll the structures that are most anterior—that is,
the transverse colon and loops of the sigmoid colon. The barium sinks to ll primarily the ascending and
descending colon and aspects of the sigmoid colon. When a patient is pr ne, barium and air reverse
positions. The drawing on the right illustrates the prone position—air has risen to ll the rectum,
ascending colon, and descending colon. Recognizing these spatial relationships is important during
uoroscopy and during radiography when barium enema examinations are performed. See Table 13.1 for
differences in peritoneal location of the large intestine structures.
Anatomy Review