JEJUNUM and ILEUM

Dr. Aldwin A. Yaneza

Dept. of Anatomy
 Jejunum and Ileum
 Jejunum starts at
duodenojejunal flexure
 6-7 m long
 2/5 jejunum, 3/5 ileum
 Coiled
 Covered by greater omentum
 No clear line of demarcation
 Localization is of surgical
importance
 No clear line of distinction between the two
parts. But important to recognize either
segment, especially in performing
gastrojejunostomy or tube jejunostomy for
feeding.
 Jejunum
 Latin jejunus = EMPTY
 Often empty
 Thicker
 More vascular
 Redder
 Lies in umbilical region
 Circular folds [ plica circulares or
valves of Kerckring] of mucous
membranes are large and well
developed
 Ileum
 Thin
 Less vascular
 Less red
 Lies in hypogastric and right inguinal
region
 Plicae circulares are small in superior
ileum and absent in terminal ileum
 Lymph follicles are aggregated as
Peyer patches located at the anti-
mesenteric side
 Site of an outpouching called Meckel’s
diverticulum
 Ends at ileocecal junction
 Meckel’s Diverticulum
 Most common malformation of GIT
 In 1 -2 % of popln
 Fingerlike pouch
 Remnant of embryonic yolk stalk
 Same layers as wall of ileum
 May contain gastric epithelium and
secrete acid cause ulcer
 3 -6 cm long
 Fr antimesenteric border of ileum
 Within 50 cm of ileocecal junction
 When inflammed , mimics acute
appendicitis
 MESENTERY
 Double layer of peritoneum w/c encloses an organ and
connects it to abdominal wall
 Contains fat, lymph nodes, BV, nerves going to viscus
 Named after viscus it attaches
 Stomach – mesogastrium
 Transverse colon – transverse mesocolon
 Sigmoid colon – mesosigmoid
 Ovary - mesovarium
 Most mobile parts of intestine
 Transverse colon, small intestine
 None in retroperitoneal viscus
 Ascending colon , kidney, parts of duodenum
 Mesentery
 Suspends jejunum & ileum
 Fan shaped
 Root [ 15 cm long ] is
directed obliquely,
inferiorly, and to the right
 Root crosses the ff struc
 Duodenum,3rd part
 Aorta
 IVC
 Psoas major
 Right ureter
 R gonadal vessels
 Mesentery
 Consists of 2 layers of
peritoneum
 Bet are jejunal and ileal bld
vessels,lymphatics, nerves
 Less fat in mesentery of
jejunum
 Prominent arterial arcades
in jejunum
 Arterial supply
 Superior Mesenteric Art or
SMA
 Branches: Jejunal artery
Ileal artery
 Arterial arcades
 Arteries in mesentery unite
 Shorter/more complex in ileum
 Vasa recta
 Straight vessels w/c arise fr
arterial arcades
 Longer in jejunum
 Shorter in ileum
 Venous drainage
 Superior Mesenteric Vein or
SMV
 Accomp SMA

 Crosses duod/ horiz.part

and unicinate process
 Terminates by uniting with
splenic vein to become
portal vein
 Lymphatic Drainage
 Mesenteric Lymph nodes
3 locations:
1.Close to the wall of the
intestine
2.Amongst arterial arcades
3.Along proximal part of SMA
Nerve Supply
 Parasympathetic
 Vagus
 Stimulate:
 increase motility of the bowel,
 increase secretion of intestinal
gland
 vasodilation of blood vessels

 Sympathetic
 Superior mesenteric ganglion
 Stimulate:
 reduce motility of the bowel
 reduce secretion of intestinal
gland
 vasconstriction of blood vessels
Jejunum- Histology
Ileum- Histology

Peyers patches
 Comparison
Criteria Jejunum Ileum
 Diam large small
 Wall thick thin
 Plicae many few
 Art arc 1-2 many
 V recta long short
 Fat/mes less more
 Xray feathery smooth
 Code
Jej Ileum
 Denzel Diameter *
 Washington Wall *
 Plays Plicae *
 A Arterial arcade *
 Villain in Vasa recta *
 X-rated Xray *
 FilM Fat in mesentery *
Training Day
Breast of Eva Mendez
Future Cars
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Dodge Zeos
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 Segment?
 No plicae circulares
 Near appendix
 Thin walled
 Answer: ILEUM
 Segment?
 Smaller diameter
 With diverticulum[arrow]
 Answer: ILEUM
 Segment?
 Larger diameter
 Thick wall
 Redder
 Answer: JEJUNUM
 Segment?
 Thick wall
 Prominent plicae circ
 Answer: Jejunum
 Segment?
 Encroaching fat
 Ans: ILEUM
 Segment
 Large diameter
 More on upper abdomen
 Thick walled
 Ans: JEJUNUM
 Clinical Correlation
 A 34 yo,male, was rushed to the ER for stab wound
at right lower quadrant. He had eviscerated
intestine [which has numerous arcades and short
vasa recta] from the SW site [ 4 cm]. What is this
segment?
 ILEUM
 A 34 yo M was admitted for anal bleeding
Endoscopy [inserted into anus]was immediately
performed which saw the bleeding segment about 4
cms distally from the cecum and where the mucosa
is smooth and not thrown into folds. Diagnosis?
What is the bleeding segment?
 Lower GI Bleeding
 Ileum
 Lower GI Bleeding 2 to ileitis
 A 18 F will undergo surgery for bleeding
diverticulitis. Where is the location?
Where[quadrant] will you place the incision? What
structures will be encountered?
 Ileum
 Right lower quadrant
 Structures
 Skin
 Subcutaneous, Fascia
 EO, IO, TA
 Parietal peritoneum
 A 86 F with stroke and unable to swallow is
scheduled for insertion of a feeding tube
jejunostomy. Where will the surgeon make the
incision? How will he know if the segment he
grasped is the JEJUNUM?
 Left upper quadrant
 Thick walled
 Larger diameter
 Few arterial arcade
 Long vasa recta
 Less fat in the mesentery
ILEOSTOMY
Dilated jejunum

Sutures after resection and

anastomosis
Gastrojejunostomy- connect the
jejunum to the body of stomach

jejunum

Body of stomach
GI TB
 Segment?
 Clue 1: The small intestine
was adherent to the uterus
 Clue 2: My incision was
below the umbilicus
 Answer:
 ILEUM
Prepare for Quiz
Set A first
 Quiz Set A
 Tabulate the 7 differences between jejunum
and ileum.
 Quiz Set B
 1. What is the arterial supply of small
intestines?
 2. What is the venous drainage?
 3. What are the nerve supplies?
 4. What are the actions of No 3?
 5. Where are the lymph nodes located?
 6. How do you call the mucosa of the jejunum
thrown into folds?
 7. What is a Meckels diverticulum?