Right colic artery (from the superior mesenteric artery). The transverse colon is derived from both the midgut and hindgut, and so it is supplied by branches of the superior mesenteric artery and inferior mesenteric artery: The ileocolic artery gives rise to colic, anterior cecal and posterior cecal branches – all of which supply the ascending colon. The ascending colon receives arterial supply from two branches of the superior mesenteric artery the ileocolic and right colic arteries. Distal 1/3 of the transverse colon, descending colon and sigmoid colon – derived from the hindgut.Īs a general rule, midgut-derived structures are supplied by the superior mesenteric artery, and hindgut-derived structures by the inferior mesenteric artery. Ascending colon and proximal 2/3 of the transverse colon – derived from the midgut. The neurovascular supply to the colon is closely linked to its embryological origin: The long length of the mesentery permits this part of the colon to be particularly mobile. The sigmoid colon is attached to the posterior pelvic wall by a mesentery – the sigmoid mesocolon. This journey gives the sigmoid colon its characteristic “S” shape. The 40cm long sigmoid colon is located in the left lower quadrant of the abdomen, extending from the left iliac fossa to the level of the S3 vertebra. When the colon begins to turn medially, it becomes the sigmoid colon. It is retroperitoneal in the majority of individuals, but is located anteriorly to the left kidney, passing over its lateral border. Descending ColonĪfter the left colic flexure, the colon moves inferiorly towards the pelvis – and is called the descending colon. Unlike the ascending and descending colon, the transverse colon is intraperitoneal and is enclosed by the transverse mesocolon. The transverse colon is the least fixed part of the colon, and is variable in position (it can dip into the pelvis in tall, thin individuals). Here, the colon is attached to the diaphragm by the phrenicocolic ligament. This turn is known as the left colic flexure (or splenic flexure). The transverse colon extends from the right colic flexure to the spleen, where it turns another 90 degrees to point inferiorly. This turn is known as the right colic flexure (or hepatic flexure), and marks the start of the transverse colon. When it meets the right lobe of the liver, it turns 90 degrees to move horizontally. The colon begins as the ascending colon, a retroperitoneal structure which ascends superiorly from the cecum. The severity of the disease was extremely high, therefore, early diagnosis based on pathophy-siological features and comprehensive therapies including PMX-DHP were necessary for strategy of treating stercoral perforation of the colon.The colon averages 150cm in length, and can be divided into four parts (proximal to distal): ascending, transverse, descending and sigmoid. Conclusion: Most of the patients with stercoral perforation of the colon had severe postoperative complications. Because the catecholamine index improved within 24 hours, four of 8 cases were rescued. PMX-DHP was performed in 8 cases of severe conditions of stercoral perforation of the colon. APACHE- II and SOFA score were high postoperation and 24 hours after the operation. There were 4 hospital deaths, so the mortality rate was 40%. With regard to the microscopic findings of the perforation site, the intestinal wall showed severe nonspecific inflammatory changes, including an increase of mono-nuclear cells in the lamina propria. There were a lot of severe postoperative complications such as sepsis, disseminated intravascular coagulation, and acute lung injury. Causative bacteria in ascites during the operation were most commonly Escherichia coli. Results: Nine patients had a long history of serious and chronic constipation and 7 patients had hypertension. Clinical features, primary diseases, triggers, causative bacteria in ascites, postoperative complications, pathological features, severity of the disease, and effect of direct hemoperfusion with polymyxin B immobilized fiber (PMX-DHP) were investigated. Method: Ten patients were diagnosed with stercoral perforation. SIGMOIDAL FLEXTURE SERIES
Stercoral Perforation of the Colon APACHE-II Score SOFA Score Polymyxin B Immobilized Fiber (PMX-DHP)ĪBSTRACT: Perpose: In order to establish the pathophysiological features and strategy for stercoral perforation of the colon, we herein analyze a series of stercoral perforation of the colon.
Pathophysiological analysis and strategy for stercoral perforation of the colonĪUTHORS: Koichi Sato, Hiroshi Maekawa, Mutsumi Sakurada, Hajime Orita, Tomoaki Ito, Yoshihiro Komatsu, Fumiko Hirata, Ryo Wada (1894) Dilatation and rupture of sigmoid flexure.
0 kommentar(er)
