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ANATOMI RECTUM

• Panjang ±15-17 cm • Merupakan lanjutan dari usus besar dan pada S3 akan menurun mengikuti lengkungan sacrum dan coccyx • Anorectal ring adalah batas anal kanal dengan rectum yang dapat dipalpasi pada saat DRE. • Tidak ditemui adanya haustra dan rugae pada rectum. • Transverse rectal folds
– Three infoldings of mucosa and submucosa project into lumen – Superior, middle, and inferior – Called rectal valves of Houston

• Rectal ampulla In region of middle and lower curve

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and inferior rectal arteries anastomoses with each other • Venous (Plate 399) – Chief drainage via a rectal venous plexus to the superior rectal vein – Middle and inferior rectal veins also drain the rectum – Superior rectal vein drains to the portal system – Middle and inferior rectal veins drain to the inferior vena cava via the internal iliac vein – Anastomoses between these veins links the portal and system systems . middle.• Blood Supply: Arterial (Plate 398) – Mainly by superior rectal artery (continuation of inferior mesenteric artery) – Also supplied by the middle rectal arteries (from internal iliac arteries) to the middle and inferior parts – Inferior rectal arteries supply the anorectal junctions and anal canal – Superior.

• Lymphatic Drainage – Lymphatic vessels from superior half of rectum drain to para rectal nodes and from there to inferior mesenteric and lumbar nodes – Lymphatic vessels from the inferior half of the rectum Travel with the middle rectal vessels to the internal iliac nodes Anastomose with the lymphatics of the anal canal • Nerve Supply – Sympathetic innervation From lumbar sympathetic fibers via the inferior mesenteric arteries and the superior rectal arteries to the superior rectal plexus to blood vessels of rectum – Parasympathetic innervation Are the main motor fibers to muscles of the rectal wall From the pelvic splanchnic nerves (S2–S4) via the inferior hypogastric (pelvic) plexus to middle rectal plexus – Visceral afferent (sensory) fibers travel via the inferior hypogastric (pelvic) Plexus and pelvic splanchnics back to spinal cord .

Anal canal • Is approximately 3 cm long • Commences anorectal junction and ends at anus • Encircled by internal and external sphincter muscles • Mucosal lining of superior has longitudinal ridges—anal columns – Inferior ends of columns joined by anal valves – Behind valves are small sinuses: anal sinuses – Anal glands (mucus) empty into anal sinuses .

from the inferior portion derived from ectoderm (proctodeum) • Inferior half lined by nonkeratinized squamous epithelium (skin) Vascular. nerve and lymphatic supply of these two regions different as a result of different embryologic origin • Has two sphincters: – external (voluntary) and internal (involuntary) External sphincter • Described as having superficial.• Inferior end of anal valves forms an irregular line: pectinate (or dentate) line • Pectinate line divides the superior portion of the anal canal. and deep parts Parts are not readily distinguishable • Fibers attach to the central perineal tendon (body) anteriorly and anococcygeal ligament posteriorly – Internal sphincter: internal circular muscular layer continuous from rectum around upper two thirds of anal canal . derived from embryonic endoderm (hindgut). subcutaneous.

temperature and touch) . branches of the pudendal nerves (sensitive to pain. sensitive to stretching only) From inferior rectal nerves.Supply Above Pectinate Line Below Pectinate Line Arterial* Superior rectal artery Inferior rectal arteries Venous** Internal plexus drains to superior rectal vein and portal system Internal venous plexus drains to inferior rectal veins and caval system Lymphatic To internal iliac and common iliac and lumbar nodes To superficial inguinal nodes Nerve From inferior hypogastric (pelvic) plexus (both sympathetic and parasympathetic.