Sigmoidectomy, laparoscopic

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  1. Descending and sigmoid colon
  2. Blood supply
  3. Topography

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  • Descending and sigmoid colon

    Paid content (image)
    • Splenic flexure anchored to diaphragm via phrenocolic ligament 
    • Secondarily retroperitoneal location of descending colon
    • Transition from descending to sigmoid colon within left iliac fossa
    • Sigmoid located intraperitoneally (àsigmoid mesocolon)
    • Transition from sigmoid to rectum anterior to second / third sacral vertebra

  • Blood supply

    46-2
    • Superior (medial colic artery) and inferior mesenteric artery (left colic artery) anastomose close to the splenic flexure(arc of Riolan)
    • Arterial blood supply of the left hemicolon, sigmoid and upper rectum by the inferior mesenteric artery (left colic artery, sigmoid arteries with marginal artery of Drummond, superior rectal artery)
    • Venous drainage into the portal system mirrors the arterial blood supply

  • Topography

    • Cephalocaudad the descending colon is in close relation with the spleen (splenic flexure), omental bursa (dorsomedial to splenic flexure), left kidney, and the pancreatic tail (cephalic segment of descending colon)
    • The root of the sigmoid mesocolon courses mediad from the left iliac fossa crossing the common iliac vessels, ureter and the ovarian/testicular vessels
    • The ureter crosses the psoas muscle from superolateral to inferomedial
    • The ureter courses below the Gerota fascia posterior to the descending colon