THE RECTUM

Definition
 The rectum is the distal part of the large gut.
 It is placed between the sigmoid colon above
and the anal canal below.
 The rectum is not straight
 In fact it is curved in an anteroposterior
direction and also from side to side.
 The three cardinal features of the large
intestine, e.g. saccula-tions, appendices
epiploicae and taeniae are absent in the
rectum
Situation
 The rectum is situated in the posterior part of the
lesser pelvis.
 In front of the lower three pieces of the sacrum and
the coccyx.
Extent
 The rectum begins as a continuation of the sigmoid
colon at the level of third sacral vertebra.
 The rectosigmoid junction is indicated by the lower
end of the sigmoid mesocolon.
 The rectum ends by becoming continuous with the
anal canal at the anorectal junction.
Dimensions
 The rectum is 12 cm long.
 In the lower part it is dilated to form the rectal
ampulla
Course and Direction
 In its course, the rectum runs first downwards
and backwards, then downwards, and finally
downwards and forwards
 It shows two types of curvatures in its course
Two anteroposterior curves
(I) The sacral flexure of the rectum follows the
concavity of the sacrum and coccyx
(2) the perineal flexure of the rectum is the
backward bend at the anorectal junction
Three lateral curves
(1) The upper lateral curve of rectum is convex to
the right
(2) The middle lateral curve is convex to the left
and is most prominent
(3) The lower lateral curve is convex to the right.
Mucosal Folds
The mucous membrane of an empty rectum shows two types of
folds, longitudinal and transverse.
The longitudinal folds are transitory. They are present in the
lower part of an empty rectum, and are obliterated by
distension.
The transverse or horizontal folds are permanent and most
marked when the rectum is distended.
(1) The upper fold lies near the upper end of the rectum, and
projects from the right or the left wall
(2) The middle fold, the largest and most constant, lies at the
upper end of the rectal ampulla, and projects from the
anterior and right walls.
(3) The lowest fold which is inconstant lies 2.5 cm below the
middle fold, and projects from the left wall
Relations
Peritoneal Relations
(1) The upper one-third of the rectum is covered
with peritoneum in front and on the sides;
(2) the middle one-third is covered only in front;
and
(3) the lower one-third, which is dilated to form
the ampulla, is devoid of peritoneum, and lies
below the rectovesical pouch in males and
below the rectouterine pouch in females.
 Visceral Relations
(a) Anteriorly in males
(1) The upper two-thirds of the rectum are related to the
rectovesical pouch
(2) The lower one-third of the rectum is related to the
base of the urinary bladder, the terminal parts of the
ureters, the seminal vesicles, the deferent ducts and
the prostate.
Anteriorly in females :
(1) The upper two-thirds of the rectum are related to the
rectouterine pouch
(2) The lower one-third of the rectum is related to the
lower part of the vagina
 Posteriorly
They are as follows :
(1) Lower three pieces of the sacrum, the
coccyx and the anococcygeal ligament;
(2) Piriformis, the coccygeus and the levator ani;
(3) The median sacral, the superior rectal
vessels.
(4) the sympathetic chain with the ganglion
impar;
Arterial Supply
1. Superior rectal artery
2. Middle rectal arteries
3. Median sacral artery
Venous Drainage
Superior rectal vein
Middle rectal vein
Nerve Supply
The rectum is supplied by both sympathetic (LI,
L2) and parasympathetic (S2, S3, S4) nerves