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Anatomy and Physiology of the Colon, Rectum, and Anus

Colon The colon is approximately five feet (1.5 meters) in length, begins at the ileocecal valve, and ends at the rectosigmoid junction. Arterial blood supply to the colon from cecum to splenic flexure is through the superior mesenteric artery which gives rise to the ileocolic, right colic, and middle colic arteries. The left and sigmoid colon is supplied by the inferior mesenteric artery which gives rise to the left colic and sigmoidal arteries. There can be several anatomic variations in the colic arteries including absent middle colic artery, absent right colic artery, common trunk for right and ileocolic artery, and the presence of an Arc of Riolan between the middle and left colic artery. The colonic wall histologically from lumen outward consists of: (1) a simple columnar epithelium which forms crypts, (2) lamina propria, (3) muscularis mucosa, (4) submucosa, (5) muscularis propria formed by an inner circular and outer longitudinal layer of smooth muscle, and (6) serosa. The outer longitudinal smooth muscle of the colon thickens in three locations called tenia coli. The rectosigmoid junction is the point at which the three tenia fan out and form a complete outer longitudinal layer. The colon is also called the large intestine. The ileum (last part of the small intestine) connects to the cecum (first part of the colon) in the lower right abdomen. The rest of the colon is divided into four parts: The ascending colon travels up the right side of the abdomen. The transverse colon runs across the abdomen. The descending colon travels down the left abdomen. The sigmoid colon is a short curving of the colon, just before the rectum.

The function of the colon is (1) absorption of water and electrolytes, and (2) propulsion and storage of unabsorbed fecal waste for evacuation. Approximately one liter of fluid chyme enters the cecum each day with an average of only 100cc excreted in the feces. Parasympathetc innervation by preganglionic vagal fibers and pelvic fibers result in colonic motility. Sympathetic innervation by the superior mesenteric plexus, inferior mesenteric plexus, and the hypogastric plexus inhibits colonic motility Rectum The rectum is the terminal portion of the large intestine beginning at the confluence of the three tenia coli of the sigmoid colon and ending at the anal canal. Generally the rectum is 15 cm in length, is intraperitoneal at its proximal and anterior end, and is extraperitoneal at its distal and posterior end. The epithelial lining or mucosa of the rectum is of a simple columnar mucous secreting variety.
Anal Canal The anal canal begins a few centimeters proximal to the classic and well visualized dentate line and it ends at the anal verge. The anal canal is about 5 cm in length. Histologically the proximal end of the anal canal is the point at

which the columnar epithelium of the rectum becomes a transitional epithelium. This epithelium transitions to a stratified squamous variety at the dentate line. The distal most end of the anal canal is the anal verge which is the point where the stratified squamous epithelium becomes true skin marked by the presence of hair follicles and sweat glands. The anal verge is readily identified by noting the point at which hair shafts are seen. The anoderm is a term used to describe the zone between the dentate line and the anal verge. Perianal skin then describes the anatomic area beyond the anal verge