RECTUM & ANAL CANAL

RECTUM & ANAL CANAL

RECTUM is continuous above with

the sigmoid colon at the level of S.3

vertebra and below with the anal

canal at about 2.5 cm in front of the

tip of the coccyx.***

Length of the rectum:12 to 15 cm

long.
How will you look for the junction

between the sigmoid colon and

rectum?***

it is the place where sigmoid

mesocolone ends.
RECTUM
CURVATURES OF THE RECTUM***

Rectum means straight; but in human,

it has 2 curvatures:

Antero-posterior curvature and

lateral curvatures.

1 Antero-posterior curvature

The rectum follows the curvature

of the sacrum and coccyx and is

called “sacral flexure”.

 CURVATURES OF THE RECTUM***

2. Lateral curvatures

There are 3 lateral

curvatures.

TWO convex on the right and

ONE convex on the left.

The upper & lower ones are

convex to the right and

the middle one is convex

to the left.
INTERIOR OF THE RECTUM

There are three rectal folds called

rectal valves of Houston.
TWO on the left and
ONE on the right.***
[Do not confuse with the
curvatures]

The valves are semilunar-shaped,

transverse folds, formed by:
mucosa, submucosa and circular
muscle of the rectal wall.***
They are permanent folds.***
[Not like mucosa folds of the small
intestine] (Why?)
INTERIOR OF THE RECTUM
The lower end of the rectum is dilated and called “rectal ampulla” which is
very distensible.

The feces are stored temporary in the rectum before they are expelled.
 Peritoneal relations of the rectum*****

The peritoneum covering of the

rectum:

Superior 1/3 of the rectum, the

peritoneum covers on its anterior

and two lateral surfaces.

Middle 1/3 has peritoneum only on

its anterior surface and

Lower 1/3 has NO peritoneal

covering on any side.
Peritoneal relations on the anterior surface of rectum*****
In male, the peritoneum is reflected from the anterior surface of rectum to the
posterior wall of the bladder, where it forms the recto-vesical pouch.***
In female, the peritoneum is reflected from the rectum to the posterior part of the

vagina fornyx, where it forms the pouch of Douglas (recto-uterine pouch).***

2. Anterior relations of the rectum (different in 2 sexes)

{A} In the male

[1] Fundus of urinary bladder
[2] Recto-vesical pouch
[3] Terminal parts of ureters
[4] Vas deferens
[5] Seminal vesicles &
[6] Prostate.

{B} In the female

[1] Vagina.
[2] Pouch of Douglas
[3] Cervix of the uterus.
Posterior relations of the rectum***
(same in both sexes)

[1] Lower 3 sacral vertebrae

[S3, S4, S5]

[2] Coccyx

[3] Ano-coccygeal ligament

[4] Median sacral vessels

(continuation of aorta / IVC)

[5] Branches of superior rectal artery

[6] Sympathetic trunks

[7] Sacral plexuses.

 THE ANAL CANAL
The anal canal is the terminal part of the GI tract. It is about 3.8 cm long.
It begins where the rectum ends at the level of tip of the coccyx and it ends at the
anus.
U-shaped sling formed by pubo-rectalis muscle slings around the ano-rectal junction.
Below the junction with the rectum, the anal canal passes downward and
backward.
 The anal sphincters**
The anal canal is surrounded by anal sphincters.

1. Internal sphincter is the thickened circular smooth muscle layer of the GIT.

2. External anal sphincters is the striated muscles. Consists of three parts:

subcutaneous, superficial and deep.*** They surround the internal sphincter.
Interior of the anal canal*****

In upper 1.5 cm, the mucous

membrane forms 6 to 10 longitudinal
ridges called “anal columns of Morgani”.

[Deep to these columns contain the

terminal branches of superior rectal
vessels (artery & vein)].***

Transverse fold of mucosa unites the

lower ends of the columns called the
“anal valves of Ball”. These valves have
a small recess called “anal sinuses”
The “pectinate line” is the transverse
line along the lower limit of the anal
valves.

It is the lower limit of the hindgut;***

Branches of the hindgut artery reached

up to this line.*****

The part below the pectinate line is

called the “transitional zone” or
“pecten” (about 1.5 cm wide). Inferiorly,
it ends at the “Hilton white line”.

Below the Hilton’s line is “anal verge”

(8 mm wide) lined by true skin, consists

of hair and sebaceous glands.
 Arterial Supply of the Rectum & Anal canal*****

The rectum and upper part of the anal canal [above the pectinate line]
derived from hindgut. They are therefore, supplied mainly by:

1. Superior rectal artery (from inferior mesenetric artery);

In addition, they also received branches from:

2. Middle rectal artery (from internal iliac artery);

3. Median sacral artery (from abdominal aorta)

The lower part of the anal canal [below the pectinate line] is developed
from the anal pit, [the ectoderm] and thus it is supplied by:

4. Inferior rectal artery (from internal pudendal artery, a branch of

internal iliac artery).

Venous Drainage of Rectum & Anal canal*****

The venous drainage of the rectum

and anal canal follows the arterial
supply.

It begins from the “internal rectal

venous plexus” which lies between
the epithelium and muscle wall.

Through the muscle wall, the

internal rectal venous plexus
communicates freely with the
external rectal venous plexus
which is outside the muscle wall.
The external rectal venous plexus unites with:
1. superior rectal vein above, which continues upwards as inferior mesenteric vein and drains
to the portal system.
2. middle rectal vein on each side drain into the internal iliac vein. (The systemic vein)
3. below the pectinate line, inferior rectal veins drains into the internal pudendal vein and thence
into the internal iliac vein(The systemic vein).
IniiInferiori
Differences between above and below the Pectinate line:*****
1. Pectinate line forms the junction between endodermal and ectodermal origins.

2. Above the line is supplied by autonomic nervous system (ANS), insensitive;

below the line by somatic nervous system & is sensitive to pain.

3. Above the line, veins drain into the portal system; below it, drains into the
systemic veins

4. Above the line, the artery is superior rectal artery from the inferior mesenteric
artery and below the line is by inferior rectal artery from internal pudendal
branch of internal iliac artery.

5. Above the line the lymphatic drain into aortic lymph nodes;

below the line, it drains into the superficial inguinal nodes.

 Applied Anatomy***

1. Internal haemorrhoids (Piles) are varicosities of the deep rectal venous plexus and covered by mucosa. (At the area supplied by ANS and thus,
painless)***

2. External haemorrhoids are varicosities of inferior rectal veins covered by skin.

(At the area supplied by the somatic nervous system thus, have pain sensation).**
PRACTICE QUESTIONS

State the vertebral level of the beginning and end of the rectum.
How will you look for the junction between the sigmoid colon and rectum?
Briefly describe the curvatures and valves of the rectum.
Describe the peritoneal relation of the rectum.
List the anterior relations of rectum in male and female.
Describe the sphincters of the anal canal.
Describe each part of the anal canal.
Describe in brief: anal columns of “Morgani”,. anal valves of “Ball”, anal sinuses, pectinate line, transitional zone (pecten) and
Hilton’s white line.
Where does the hindgut end?
State the differences between above and below the Pectinate line.
State the arterial supply and venous drainage of the rectum and anal canal.
State the sensory supply of the internal and external haemorrhoids.
Thank you.
Best of luck.