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Fundamentals of Rectal Cancer SurgeryFundamentals of Rectal Cancer Surgery

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Rectal Anatomy

Rectal Anatomy is a topic covered in the Fundamentals of Rectal Cancer Surgery.

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Rectum

The rectum as measured by rigid proctoscopy extends approximately 15 cm in length from the anal verge. It occupies the pelvis and angulates at the level of the coccyx to pass through the levator plate. The rectum is posterior to the uterus, cervix, and posterior vaginal wall in women and the bladder, vas deferens, seminal vesicles, and prostate in men (Figure 1.1). The proximal limit of the rectum is controversial and for most surgeons is best defined by the pelvic inlet, which is defined by a line between the sacral promontory and the pubic symphysis. The critical endoscopically identified anatomic landmarks are the three convex curves that correspond to the folds or valves of Houston. The left-sided valves are found at 7 cm to 8 cm and 12 cm to 13 cm, respectively, and the right valve is found from 9 cm to 11 cm from the anal verge. The middle valve (Kohlrausch’s plica) corresponds to the anterior peritoneal reflection. Below this peritoneal reflection the rectum is entirely extraperitoneal and loses its serosal surface.[1] The middle rectal valve’s relationship to the anterior peritoneal reflection makes it an important landmark in the pre-treatment assessment of a rectal cancer.

Figure 1.1
Descriptive text is not available for this image

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Rectum

The rectum as measured by rigid proctoscopy extends approximately 15 cm in length from the anal verge. It occupies the pelvis and angulates at the level of the coccyx to pass through the levator plate. The rectum is posterior to the uterus, cervix, and posterior vaginal wall in women and the bladder, vas deferens, seminal vesicles, and prostate in men (Figure 1.1). The proximal limit of the rectum is controversial and for most surgeons is best defined by the pelvic inlet, which is defined by a line between the sacral promontory and the pubic symphysis. The critical endoscopically identified anatomic landmarks are the three convex curves that correspond to the folds or valves of Houston. The left-sided valves are found at 7 cm to 8 cm and 12 cm to 13 cm, respectively, and the right valve is found from 9 cm to 11 cm from the anal verge. The middle valve (Kohlrausch’s plica) corresponds to the anterior peritoneal reflection. Below this peritoneal reflection the rectum is entirely extraperitoneal and loses its serosal surface.[1] The middle rectal valve’s relationship to the anterior peritoneal reflection makes it an important landmark in the pre-treatment assessment of a rectal cancer.

Figure 1.1
Descriptive text is not available for this image

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Last updated: October 13, 2021

Citation

"Rectal Anatomy." Fundamentals of Rectal Cancer Surgery, 2021. ASCRS U, www.ascrsu.com/ascrs/view/Fundamentals_of_Rectal_Cancer_Surgery/2831000/all/Rectal_Anatomy.
Rectal Anatomy. Fundamentals of Rectal Cancer Surgery. 2021. https://www.ascrsu.com/ascrs/view/Fundamentals_of_Rectal_Cancer_Surgery/2831000/all/Rectal_Anatomy. Accessed March 21, 2023.
Rectal Anatomy. (2021). In Fundamentals of Rectal Cancer Surgery https://www.ascrsu.com/ascrs/view/Fundamentals_of_Rectal_Cancer_Surgery/2831000/all/Rectal_Anatomy
Rectal Anatomy [Internet]. In: Fundamentals of Rectal Cancer Surgery. ; 2021. [cited 2023 March 21]. Available from: https://www.ascrsu.com/ascrs/view/Fundamentals_of_Rectal_Cancer_Surgery/2831000/all/Rectal_Anatomy.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Rectal Anatomy ID - 2831000 Y1 - 2021/10/13/ BT - Fundamentals of Rectal Cancer Surgery UR - https://www.ascrsu.com/ascrs/view/Fundamentals_of_Rectal_Cancer_Surgery/2831000/all/Rectal_Anatomy DB - ASCRS U DP - Unbound Medicine ER -
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Grapherence® [↑12]
    • Fundamentals of Rectal Cancer Surgery
    • Background
    • Rectal Anatomy
    • Rectal Cancer Biology and Hereditary Cancer Syndromes
    • Rationale for Multi-Modality Therapy
    • Preoperative Issues
    • Preoperative Staging
    • Role of Tumor Board
    • Indications for Preoperative Neoadjuvant Therapy
    • Local Excision
    • Indications for LAR Versus Intersphincteric Resection Versus APR
    • Indications for Extended Resection
    • Preoperative Preparation
    • Interoperative
    • Patient Positioning and Equipment for Rectal Cancer Surgery
    • Inferior Mesenteric Artery
    • Inferior Mesenteric Vein (IMV)
    • Splenic Flexure Mobilization
    • Surgical Techniques for Length
    • Technique of Total Mesorectal Excision (TME)
    • Tailored Mesorectal Excision (TME)
    • Bowel Transection and Anastomosis
    • Indications for Fecal Diversion
    • Abdominoperineal Resection
    • Standardized Operative Report
    • Management of Intraoperative Vascular and Urinary Complications
    • Postoperative Issues
    • Rectal Cancer Pathology Assessment
    • Adjuvant Therapy for Rectal Adenocarcinoma
    • Surveillance After Rectal Cancer Treatment
    • Management of Local Recurrences
    • Short-Term Complications - Anastomotic
    • Short-Term Complications - Urinary
    • Ostomy Complications and Management
    • Long-Term Complications – Bowel Dysfunction
    • Long-Term Complications - Sexual Dysfunction and Its Management
    • Parastomal and Perineal Hernias
    • Impact of Postoperative Complications On Oncologic Outcomes
    • Course Complete
    • Final Assessment
Grapherence® [↑12]
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  • Anatomy and Embryology of the Colon, Rectum, and Anus
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