Right Sided Sigmoid Colon and Redundant Loop of Descending Colon with Its Embryological Correlation and Clinical Significance

Abstract

CASE REPORTAs a part of routine dissection, we found right sided sigmoid colon with redundant loop of colon in two cadavers of age ranging from 40-65 years in the anatomy department. As per the instructions given in Cunningham's manual of practical anatomy [1] the midline incision was given extending from xiphoid process to the pubic symphysis to explore the peritoneal cavity without any damage to the peritoneum and structures covered by it. After exposing the abdominal cavity and removing peritoneal fat, the viscera were carefully separated and cleared from the field of view. In situ placement of small and large intestines and their peritoneal relations were studied in detail. The small intestine and its mesentery was reflected to the right, to study extent and location of parts of colon along with their peritoneal relations. The blood vessels supplying the small and large intestine were carefully dissected and studied.The right sided sigmoid colon and long loop of descending colon was observed in two cadavers. The mesentery of ascending and descending colon was retained. This mesentery along with the mesentery of transverse colon was continuous with the mesentery of small intestine [Table/ Fig-1,2]. In case one, the vertical segment of descending colon extended upto L4-L5 vertebral level and the horizontal segment crossed in front of the left gonadal vessels, left genitofemoral nerve, left ureter, abdominal aorta, common iliac vessels and superior rectal artery, right ureter, right genitofemoral nerve and right gonadal vessels [Table/ Fig-3] to reach to right lumbar region and at this point it ascended one vertebral level higher and then turned downwards to become sigmoid colon at the right pelvic brim. The sigmoid colon occupied right iliac fossa and caecum was in the right lumbar region. The right limb of mesentery of sigmoid colon was attached to the right pelvic wall and left limb extended from right pelvic brim to third sacral vertebra. The inferior mesenteric artery turned towards right side so as to supply the right sided sigmoid colon. The left colic branch of inferior mesenteric artery divided into, left colic1 and left colic2, to supply the long segment of descending colon. The left colic1 divided into ascending and descending branch. The descending branch ended by anastomosing with the left colic2. The ascending branch ended by anastomosing with the left branch of middle colic [Table /Fig-3 ABSTRACTAnatomical variations of colon are mostly developmental and can lead to variety of acute and chronic pathological conditions. So it becomes important to recognize and understand the importance of clinical implications of such anomalies to benefit surgeons, clinical geneticists and research community. We describe two cases of right sided sigmoid colon and long descending colon which had two segments: vertical and horizontal. The mesentery of ascending and descending colon was retained. This mesentery along with the mesentery of transverse colon was continuous with the mesentery of small intestine. There w...

Mechanotechnical faults and particular issues of anastomotic complications following robot‐assisted anterior resection in 968 rectal cancer patients

“…AS was associated with short mesocolon, IFI findings of defective perfusion, transient diversion, lower level of anastomosis, manual coloanal anastomosis (CAA), prolonged total or console time, and poorly‐differentiated or mucinous cancers ( P < .001‐.05). The short mesocolon, identified and documented during operation, refers to an anatomical trait rather than to a numerical measurement, that is, an unusually short mesocolon that was under tension during anastomosis or was short in length and sometimes accompanied by thickening of the mesenteric base with dense fibrosis or by a right‐sided sigmoid colon . Multivariate analysis of factors associated with AC is shown in Table .…”

“…The short mesocolon, identified and documented during operation, refers to an anatomical trait rather than to a numerical measurement, that is, an unusually short mesocolon that was under tension during anastomosis or was short in length and sometimes accompanied by thickening of the mesenteric base with dense fibrosis or by a right-sided sigmoid colon. 11,12 Multivariate analysis of factors associated with AC is shown in Table 3. AS, male sex, narrow pelvis, and defective stapling configurations were independently associated with AL (P < .001-.05), whereas manual CAA and AL were independently associated with AS (P < .05).…”

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“…Inferior mesenteric artery arose from right side of aorta. 5 Jacob et al also described a case of short and high ascending colon with redundant descending colon on right side. 6 Nayak et al described a case of coiled descending colon and straight sigmoid colon.…”

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