Segmental colonic length and mobility

Abstract

INTRODUCTION Locoregional variation in the human colon is important in surgical practice; the length and mobility of different colonic regions impacts on laparoscopic and endoscopic colorectal procedures. The aim of this study was to refine anatomical understanding of the colon in terms of segmental length and mobility. METHODS The colons of 35 cadavers were examined to determine lengths of caecum as well as ascending, transverse, descending and rectosigmoid colon, and to characterise colonic mobility at each location in terms of the mesenteric attachments. The presence of Jackson's membrane (a congenital peritoneal band of the right colon) was also documented. RESULTS The mean total colonic length was 131.2cm (standard deviation [SD]: 13.4cm). There was no correlation with height, age or sex; the best predictor of total colonic length was the length of the rectosigmoid segment. The mean height of the transverse mesocolon was 7.4cm (SD: 3.6cm) and that of the sigmoid mesocolon was 6.3cm (SD: 2.6cm). Two-thirds of the subjects had a mobile portion of the ascending colon and nearly one-third had a mobile descending colon. A mobile ascending colon was significantly more common in females. Jackson's membrane was present in 66% of the subjects. CONCLUSIONS This cadaveric study suggests that rectosigmoid length accounts for most of the variability in total colonic length. The significant proportion of colons with mobility of the ascending and descending segments prompts revision of the traditional anatomical teaching of these segments as fixed and retroperitoneal. Mobility of the ascending colon may account for the anecdotal finding that colonoscopy is more challenging in female patients. Jackson's membrane was identified in most colons.

The Relation between Red Meat and Whole-Grain Intake and the Colonic Mucosal Barrier: A Cross-Sectional Study

“…As expected, gender and age seemed to have an effect on the colonic mucus thickness. Previous studies have suggested differences in the length of the rectosigmoid colon in humans, where women were observed to have a longer rectosigmoid colon, and thus a larger mucosal surface, which may support the results [56,57]. Age was also previously reported as a factor contributing to thinner mucus in mice [58].…”

Dolichocolon revisited: An inborn anatomic variant with redundancies causing constipation and volvulus

“…Phillips et al[ 8 ] reported colon length from several studies of cadavers, using laparotomy, barium enema or CT-colonography, between 1955 and 2015. The mean length of the colon varied between 109.0 cm and 169.0 cm.…”

How to perform gastrointestinal ultrasound: Anatomy and normal findings

“…Towards the end of the first trimester, the peritoneum of the newly forming ascending colon and the hind-gut derived left colonic segments, begin to fuse with the posterior abdominal wall. Although traditionally described as retroperitoneal structures, modern post-mortem studies have found that two thirds of the ascending and a third of the descending colonic segments have mobile portions of elongated mesentery[ 7 ]. Nonetheless, peritoneal attachments have significance for the flow of free fluid within the abdomen as fluid tends to flow caudally, medial to the ascending colon towards the ileocaecal junction and thus metastatic deposits may become lodged in the mesenteric ruffles en route.…”

“…Relative thickenings of the mesocolon provide ligamental support to the colonic flexures; the nephrocolic ligament runs from the inferior aspect of the right kidney to the hepatic flexure which then becomes intimately related to the descending duodenum before the transverse mesocolon begins; the splenic flexure is suspended by (1) the phrenicocolic ligament which runs from the diaphragm and also supports the spleen; (2) the splenocolic; and (3) the pancreaticocolic ligaments which are essentially extensions of the transverse mesocolon[ 5 , 7 ]. These attachments provide fixed points for ultrasound evaluation of the colon, which can at times, be highly mobile within the abdomen.…”