• vermiform [ L.

vermis, wormlike]
• blind intestinal
diverticlum
• 6 - 10 cm long
• arises from
posteromedial
aspect of cecum
below ileocecal
junction
• mesoappendix -
triangular
mesentery
 retrocecal -
most
common

 pelvic
 pre-ileal
 sub-cecal
 post-ileal
• Arterial supply
- appendicular artery
• Venous drainage
- appendicular vein
• Lymphatic drainage
- ileocolic lymph nodes
• Nerve supply
- superior mesenteric plexus
- vagus nerve
Acute Appendicitis
Symptoms: right lower quadrant pain
McBurney’s point
maximal pt of tenderness
oblique line from R ASIS to umbilicus
distal end of outer third
approximates location of appendix
approximates placement of incision
Mc Burney’s Point
PHYSICAL FINDINGS:
1. RLQ tenderness
= visceral referred pain, T10 s.g.
2. Psoas sign
= stretching of psoas by R thigh extension
causes pain
3. Obturator sign
= stretching of obt. internus by internal
rotation causes pain
Cause:
✶ enlarged lymph node

✶ fecalith
Treatment:
✶ Appendectomy

Incision : McBurney’s / Rocky-Davies

Locate appendix: trace taenia coli towards
posteromedial
area of cecum w/c ends as appendix
Ligate appendicular a/v = branch of ILEOCOLIC
a/v
Complication:
PERFORATION
> at midportion [ least blood
supply ]
> spreads infection to parietal
peritoneum
> greater omentum adheres to
appendix to restrict spread of
infection
• Consists of:
• cecum
• ascending
colon
• transverse
colon
• descending
colon
• sigmoid
colon
• Taenia coli
 - 3 thickened band of muscle
• Haustra
- sacculations between taenia
• Appendices
- fatty projections of omentum
• Internal diameter
- larger
• comprise longitudinal
muscle of LI
• 3 taenia: 1] omental 2]
free 3] mesocolic
• none in
-
appendix
 - rectum
• begins at base of
appendix
• ends at rectosigmoid
junction
• 1st part of LI
• continuous w/
ascending colon
• about 7.5 cm
• at right lower
quadrant
• lies in iliac fossa
inferior to terminal
ileum
• palpable at abd wall
if distended w/ gas or
feces
• enveloped by
peritoneum
• can be lifted freely
• has no mesentery
• attached to lateral abdominal wall by
cecal folds
• receives the terminal ileum
obliquely
• folds at ileocecal orifice form the
ileocecal valve - 2 forms
1. Papillary - common
2. Labial
• folds meet laterally to form ridges -
frenulum
 CECUM
1. Arterial supply - ileocolic art [ br of
SMA]
2. Venous drainage
- ileocolic vein

3. Lymphatic drainage
- ileocolic lymph nodes

Note: same for appendix &

cecum
4. Nerve supply
- sup. mesenteric plexus
- vagus nerve
• circular muscle
poorly developed
around orifice
• not a true sphincter

- ICV does not control

passage of intestinal
contents from ileum
into the cecum
 - ICV does not prevent
reflux of intestinal
contents from cecum
back to ileum
4 parts
forms an arch
1] Ascending
2] Transverse
3] Descending
4] Sigmoid
- passes superiorly on right side
- turns to left below liver as R colic
flexure or
hepatic flexure
- narrower than cecum
-lies retroperitoneally on the R side of
posterior abdominal wall
-covered by peritoneum anteriorly and
on its sides
- 45 cm long
- largest, most mobile
- crosses abdomen from R colic flexure to L colic
flexure
- L colic flexure [splenic flexure]= more superior,
more acute, less mobile compared to R,
below spleen
- transverse mesocolon [mesentery]= loops down
to pelvis
- variable in position
- from left colic flexure to
sigmoid
- on left side
- retroperitoneal
- has a short mesentery
- has a paracolic gutter on its
side
- S shaped loop
- 40 cm
- connects desc colon and rectum
- has long mesentery
- thus, has considerable degree of freedom
- termination of taenia coli = indicates
rectosigmoid jxn
- omental appendices = long
- root of sigmoid mesocolon = inverted V
shaped attachment

- various positions
- twisting of root = cause obstruction
-Structures near sigmoid
> may be injured during surgery on
sigmoid
> commonly involved by diseases from
sigmoid
> structures: 1] Ur. Bladder [male] /
uterus [female]
1. Arterial supply

-Ileocolic art and R colic art [ br of

SMA]
2. Venous drainage

-Ileocolic v and R colic v [ trib of

SMV]
3. Lymphatic drainage
- Superior mesenteric LN
4. Nerve supply
- Superior mesenteric nerve plexus
1. Arterial supply - Middle colic art
[ fr SMA]
- R and L colic
art
2. Venous drainage - SMV
3. Lymphatic drainage - Sup.
Mesenteric LN
4. Innervation - Sup mesenteric
nerve plexus
1. Arterial supply
- Left colic and sigmoid art [ br of IMA]
2. Venous drainage
- Left colic and sigmoid vein [ trib of IMV]
3. Lymphatic drainage
- Inferior mesenteric LN
4. Nerve supply =
a.Sympathetic - Sup.hypogastric pl.
b. Parasym = Pelvic splanchnic n.
1. Blood supply and venous drainage:
R sided colon, appendix and transverse
colon - SMA
L sided colon and sigmoid colon - IMA
2. Ileocecal valve permits 2-way passage
3. 3 taenia coli : none in appendix and
rectum
4. Lymph nodes grouping follow blood
vessels
5. McBurney’s pt is very useful for clinicians
COLON CANCER

- may involve any segment

Diagnostic tests:
1] Barium enema = xray of colon

2] Colonoscopy = direct visualization

3] CT Scan with Oral and IV contrast

COLON CANCER

Symptoms:
1] decreased size of stools

2] constipation
3] blood in stools
Treatment:
- colon containing the cancerous mass is
resected including its arterial and venous
drainage
- lymph nodes dissected also
Ascending colon cancer = R hemicolectomy

- ligate ileocolic, R colic and middle colic

vessels
Transverse colon cancer = Transverse
colectomy
- ligate middle colic, R and L colic vessels

Descending colon cancer = L hemicolectomy

- ligate left colic vessels

Sigmoid colon cancer = Sigmoidectomy
- long mesentery
- very mobile

- can be visualized w/ sigmoidoscope

- 25 cm from anus
- common site of large
intestinal obstruction as: 1] Volvulus -
twisting of mesosigmoid
2] Cancer - most
common site
3] Diverticulitis- connects to UB form
fistula
Familial Adenomatous Polyposis Coli
Familial Adenomatous Polyposis Coli
Carcinoma of the Colon (annular type)
Crohn’s Colitis
Perforated Diverticle
Tuberculosis
Pseudomembranous Colitis