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Sigmoidectomy, laparoscopic
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Descending and sigmoid colon
- 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
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Blood supply
- 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
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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