GROSS ANATOMY OF THE

RECTUM AND ANAL CANAL

BY

DR KELECHI DURUH
DEPT. OF HUMAN ANATOMY
FBMS COLLEGE OF MEDICINE UNEC
JAN 11,2022
 RECTUM
Part of large intestine
Pelvic part of the digestive system
Continuous proximally with the sigmoid
colon and distally with the anal canal
Begins at the rectosigmoid junction (anterior
to S3 vetebrae)
Ends at the anorectal junction (2-3cm in
front and below the tip of the coccyx)
2
 FEATURES OF LARGE INTESTINE
• Special Features

– Omental appendices (fatty

omentum-like projections)

– Taeniea coli –
› Longitudinal bands of smooth
muscle-
› Begin at the base of the
appendix and run the length
of the LI to become a
continuous layer over the
rectum

– Haustra- sacculations of the wall

between the taeniae
3
 RECTUM

LATERAL VIEW
ANTERIOR VIEW
 RECTUM
• Follows the curve of the sacrum
and coccyx

• About 12 cm in length

• Has no mesocolon, epiploic

appendices, sacculations or taenia
coli

• The lower part of the rectum is

dilated to form an ampulla (convex
to the left)

5
 RECTUM
Features
• 2 Anteroposterior Curves
– Sacral flexures (concave
anteriorly)
– Perineal flexure (convex
anteriorly

• 3 Lateral Flexures
– Superior (LT)
– Intermediate (RT)
– Inferior (LT)

6
 RECTUM
Lateral flexures

• Formed in relation to three

internal infoldings of mucosa,
submucosa and circular muscle
fibres called transverse rectal
folds or rectal valves of Houston

• Rectal valves have variable

positions but are always present

7
 RECTUM
 RELATIONSHIPS
• Peritoneal Relationships
› Superior third (anterior and lateral
surfaces)
› Middle third (anterior surface)
› No surface in the inferior third
› Reflected from rectum to posterior
wall of the bladder to form the
rectovesical pouch in males and to
the posterior wall of the fornix of
the vagina to form the rectouterine
pouch
> Lateral reflections of peritoneum
from superior 3rd of rectum form
the pararectal fossae 8
 RECTUM
 RELATIONSHIPS CONTD.
• FASCIAE
> Rectovesical septum lies between the fundus of the bladder and the ampulla of
the rectum in male

>Rectovaginal septum lies between the rectum and posterior wall of the vagina in
female

9
 RECTUM
RELATIONSHIPS CONTD
>The fascia of Waldeyer

• Also called pre sacral fascia

• Avascular
• From the lower part of the
sacrum to the posterior
aspect of the rectum
• Encloses sacral vessels and
nerves
• Continues anteriorly as the
pelvic fascia

10
 RECTUM
RELATIONSHIPS CONTD
>The fascia of Denoviller’s
• Also called the rectoprostatic
fascia
• Membranous partition at the
lowest part of the
rectovescical pouch
• Separates the rectum from the
prostate and urinary bladder
• Encloses the middle rectal
vessels and branches from the
hypogastric plexus

11
 RECTUM 12

RELATIONSHIPS CONTD
>OTHER STRUCTURES
Anterior:
In males:
– Sigmoid colon
– Coils of ileum that occupy the
rectovesical pouch
– Posterior surface of bladder
– Prostate, seminal vessicles

In females:
– Sigmoid colon
– Coils of ileum that occupy the
rectouterine pouch (Douglas’ pouch)
– Posterior surface of vagina
 RECTUM 13

RELATIONSHIPS CONTD
>OTHER STRUCTURES
Posterior
– Lower 3 sacral vertebrae
– Coccyx
– Median sacral vessels
– Ganglion impar and branches of
the superior rectal vessel
– Sacral plexus

Laterally
– Pararectal fossa
– Fat and fascia of the levator ani
and coccygeus
 ARTERIAL SUPPLY TO RECTUM
 Superior rectal artery
(continuation of inferior
mesenteric artery)

› Superior part of the rectum

› Mucous membrane,
mucocutaneous junction at the
anal canal

 Right and left middle rectal

arteries (from anterior divisions
of internal iliac)

 Middle and inferior parts of the

rectum
14
 15
ARTERIAL SUPPLY TO RECTUM
 Inferior rectal artery (branch of
the internal pudendal artery)
– Inferior part of the rectum
– Anorectal junction

 Median sacral artery

(attenuated continuation of the
abdominal aorta)

– Posterior Surface of the

rectum
 VENOUS DRAINAGE OF THE RECTUM
Veins
 Accompany the arteries
› Submucous venous plexus (in the
rectum)  external rectal plexus 
superior rectal vein or  middle and
inferior rectal veins)

› Superior rectal vein  portal venous

system

› Inferior and middle rectal veins 

systemic venous system via the
internal iliac vein

16
LYMPHATIC DRAINAGE

Lymph – follows arterial supply to para-aortic nodes

INNERVATION OF THE RECTUM

• sympathetic supply from
– Hypogastric plexus
– Branches of the coeliac plexus

•Parasympathetic supply from Lumbar and pelvic splanchnic nerves S2 –

S4

17
 ANAL CANAL

• Terminal part of the large

intestine
• Begins at the anorectal
junction and ends at the
rectal ampulla
• Extends from the superior
aspect of the pelvic
diaphragm to the anus
• About 2.5cm to 3.5cm long
18
 ANAL CANAL
• Descends posteroinferiorly between the
anococcygeal ligament and the perineal body
• Surrounded by internal and external anal
sphincters
 ANAL CANAL
MUCOSAL SURFACE
• Superior ½ is characterized
by series of longitudinal ridges
termed anal columns
• contains superior rectal
vessels
• Upper ends of these columns
mark the anorectal junction

20
 ANAL CANAL
MUCOSAL SURFACE CONTD
• The inferior ½ is characterised
by anal valves
• The inferior limit of the anal
valves form a pectinate line.
• Pectinate line indicates the
junction of the superior and
inferior parts of the anal canal
• The part above the pectinate
line differ from that below in
blood supply, innervation and
lymphatic drainage

21
 ANAL CANAL
INTERNAL ANAL SPHINCTER

– Involuntary sphincter
– Formed by thickening of the
circular muscle
– Surrounds the upper 2/3rd of
the anal canal
– Tonically contracted most of
the time but relaxes in
response to distension at the
rectal ampulla
– Tone is maintained by
sympathetic fibres and
inhibited by parasympathetic
fibres
22
 ANAL CANAL
EXTERNAL ANAL SPHINCTER
– Large voluntary sphincter
– Forms a band around each
side of the inferior 2/3rds of
the anal canal
– Attached anteriorly to the
perineal body and posteriorly
to the anococcygeal ligament
– Supplied mainly by S4 through
inferior rectal nerve
– Consists of three parts
(subcutaneous, superficial and
deep) considered more as
zones
– These zones are often
indistinct 23
 ANAL CANAL
EXTERNAL ANAL SPHINCTER CONTD

 SUBCUTANEOUS PART
– Surrounds the lower
part of the anal canal
– Attached anteriorly to
the perineal body and
posteriorly to
anococcygeal ligament

24
 ANAL CANAL
EXTERNAL ANAL SPHINCTER

 SUPERFICIAL PART
– Surrounds the lower part of
the internal anal sphincter
– Only part with a bony
attachment
– Deep to the subcutaneous part
– Arises from theposterior part
of the coccyx by the
anococcygeal raphe
– Inserted into the perineal body
 ANAL CANAL CONTD

EXTERNAL ANAL SPHINCTER

DEEP PART
– Surrounds the upper
part of the internal
anal sphincter
– Its deepest fibres
fuse with the
puborectalis

26
 RELATIONS OF THE ANAL CANAL 27

Anterior:
 In males
– Membranous urethra and bulb
of penis
 In females
– Posterior part of the vagina

Posterior
– Anococcygeal ligament
Lateral
– Ischiorectal fossa
RELATIONSHIP OF THE ANAL CANAL TO STRUCTURES IN THE ANAL TRIANGLE
 THE ANAL CANAL CONTD…
Blood Supply:
 Superior rectal artery
 Part superior to pectinate line

 2 Inferior rectal arteries

 Part inferior to pectinate line
 Surrounding muscles and
perianal skin

 Middle rectal artery

 Forms an anastomosis with
superior and inferior rectal
arteries

29
 THE ANAL CANAL CONTD…
Veins:
 Internal rectal venous plexus
› Superior to the pectinate line
 superior rectal veins
 portal system
› Inferior to the pectinate line ---
inferior rectal veins
› internal iliac

 Middle rectal veins anastomose

with superior and inferior rectal
veins
› Drain the muscularis externa of
the ampulla 30
 THE ANAL CANAL CONTD…

Lymph drainage
 Superior to pectinate line:
1)superior rectal nodes pre-
aortic nodes iliac
2)middle rectalinternal iliac
nodescommon iliac to
lumbar nodes

 Inferior to pectinate line;

superficial inguinal nodes
31
 NERVE SUPPLY
• Autonomic supply:
sympathetic– pelvic plexus
parasympathetic—splanchnic plexus
• Inferior rectal branches from internal
pudendal supplies sensory and motor to the
external sphincter
 CLINICAL CORELATES
• Rectal fecal impaction resulting in constipation
• Fecal incontinence
• Haemorroids
• Rectal prolapse
• Metaplasia
• Imperforate anus
34