Rectum

The Rectum (intestinum rectum) is continuous above with the sigmoid colon, while below it ends in the anal canal.

From its origin at the level of the third sacral vertebra it passes downward, lying in the sacrococcygeal curve, and extends for about 2.5 cm. in front of, and a little below, the tip of the coccyx, as far as the apex of the prostate. It then bends sharply backward into the anal canal.

The rectum presents two antero-posterior curves: an upper flexure (Sacral flexure), with its convexity backward, and a lower flexure (Anorectal flexure; Perineal flexure), with its convexity forward, at the junction between the rectum and the anal canal.

Three lateral flexures (lateral curves) of hare also described:

• One to the right opposite the junction of the third and fourth sacral vertebræ: Superodextral lateral flexure; Superior lateral flexure
• The other to the left, opposite the left sacrococcygeal articulation (however, of little importance) : Intermediosinistral lateral flexure; Intermediate lateral flexure
• The third, as the lower flexure with a right side convexity : Inferodextral lateral flexure; Inferior lateral flexure

The rectum is about 12 cm. long, and at its commencement its caliber is similar to that of the sigmoid colon, but near its termination it is dilated to form the rectal ampulla.

The rectum has no sacculations comparable to those of the colon, but when the lower part of the rectum is contracted, its mucous membrane is thrown into a number of folds, which are longitudinal in direction and are effaced by the distension of the gut. Besides these there are certain permanent transverse folds, of a semilunar shape, known as the transverse folds of rectum (Houston's valves). They are usually three in number; sometimes a fourth is found, and occasionally only two are present. One is situated near the commencement of the rectum, on the right side; a second extends inward from the left side of the tube, opposite the middle of the sacrum; a third, the largest and most constant, projects backward from the forepart of the rectum, opposite the fundus of the urinary bladder. When a fourth is present, it is situated nearly 2.5 cm. above the anus on the left and posterior wall of the tube. These folds are about 12 mm. in width, and contain some of the circular fibers of the gut. In the empty state of the intestine they overlap each other, as Houston remarks, so effectually as to require considerable maneuvering to conduct a bougie or the finger along the canal. Their use seems to be, "to support the weight of fecal matter, and prevent its urging toward the anus, where its presence always excites a sensation demanding its discharge.

The peritoneum is related to the upper two-thirds of the rectum, covering at first its front and sides, but lower down its front only; from the latter it is reflected on to the seminal vesicles in the male and the posterior vaginal wall in the female.

The level at which the peritoneum leaves the anterior wall of the rectum to be reflected on to the viscus in front of it is of considerable importance from a surgical point of view, in connection with the removal of the lower part of the rectum. It is higher in the male than in the female. In the former the height of the rectovesical excavation is about 7.5 cm., i. e., the height to which an ordinary index finger can reach from the anus. In the female the height of the rectouterine excavation is about 5.5 cm. from the anal orifice. The rectum is surrounded by a dense tube of fascia derived from the fascia endopelvina, but fused behind with the fascia covering the sacrum and coccyx. The facial tube is loosely attached to the rectal wall by areolar tissue in order to allow of distension of the viscus.

Relations of the Rectum.—The upper part of the rectum is in relation, behind, with the superior hemorrhoidal vessels, the left Piriformis, and left sacral plexus of nerves, which separate it from the pelvic surfaces of the sacral vertebræ; in its lower part it lies directly on the sacrum, coccyx, and Levatores ani, a dense fascia alone intervening; in front, it is separated above, in the male, from the fundus of the bladder; in the female, from the intestinal surface of the uterus and its appendages, by some convolutions of the small intestine, and frequently by the sigmoid colon; below, it is in relation in the male with the triangular portion of the fundus of the bladder, the vesiculæ seminales, and ductus deferentes, and more anteriorly with the posterior surface of the prostate; in the female, with the posterior wall of the vagina.