Illustrated Encyclopedia of Human Anatomic Variation: Opus IV: Organ Systems: Digestive System and Spleen

Large Intestine

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed

The colon is usually found to be either retroperitoneal or intraperitoneal depending on the presence or absence of a mesentery or, another term, mesocolon. In a study of 100 subjects by Treves, 52% of ascending and descending colons did not have a mesocolon, hence they were by definition retroperitoneal. In 14%, both divisions of the colon had a distinct mesocolon (therefore, they were intraperitoneal along with the transverse and sigmoid divisions of the colon). In 12%, the ascending colon had a mesentery and 22% of the descending colons were suspended in a mesentery.

The principal variations are due to irregular or defective development.

In cases of of complete transposition of the viscera, the cecum and appendix lie in the left iliac fossa, and the sigmoid colon in the right. The ascending colon may not be completely retroperitoneal, resulting in a condition in which the transverse colon falls obliquely across the abdomen, covering the cecum and appendix, and extends from the right pelvic inlet to the left splenic flexure.

The proximal portion of the large intestine, as far as the left part of the transverse colon, may remain attached, along with the jejunoileum, to the posterior abdominal wall by a common mesentery.

The rotation of the intestinal loop, associated with the descent of the cecum and appendix and the formation of a descending colon, may be permanently arrested in any part of its course. In some cases, the descending colon remains near the median plane and is connected to the front of the vertebral column by a mesentery.

The descending colon may cross the posterior abdominal wall, with the sigmoid colon descending on the right side. The sigmoid may lie in the abdomen just inferior to the splenic flexure of the transverse colon, or in the right iliac fossa. Occasionally, the rectum opens into the bladder or urethra, or it may terminate blindly, giving rise to the condition known as imperforate anus.

Partial duplication of the large intestine has been reported and it may also be doubled.

The large intestine is about 2m in length.

Congenital microcolon has been reported with a frequency of 0.004% based upon two studies of 261,451 autopsies (Greig, 1925). The diameter of the colon in this disorder is about 5mm and extends from the caecum to the terminal part of the rectum.

Congenital anorectal anomalies have a frequency of 1/5000 - 1/10,000.

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