Summary
The perirectal fasciae and their vascular and neural relationships were studied based on the dissection of 46 fresh cadavers. The rectal fascia is a tubular sleeve, areolar in nature, which houses the superior rectal vessels and lymphatics. The nerves which supply fibres to the pelvic plexus run close to the rectum, contained in the urogenital and presacral fasciae. The rectum is attached to these two fasciae by the rectal stalks, which take a spiral course round the rectum, being posterolateral in the upper rectum, lateral in the mid-rectum and anterolateral in the lower rectum. During rectal resection the pelvic nn. may be preserved if the rectal dissection proceeds close to the rectal fascia. After cutting the rectal insertion of the presacral fascia, the lower rectal stalks (paraproctium) come into direct view and can be divided close to the rectal wall with no risk of damage to the pelvic plexus.
Résumé
Les fascias péri-rectaux et leurs rapports vasculo-nerveux ont été étudiés par dissection de 46 cadavres frais. Le fascia rectal est un manchon tubulaire, de nature aréolaire, qui enveloppe les vaisseaux rectaux supérieurs et les lymphatiques. Les nerfs qui alimentent le plexus pelvien courent près du rectum, contenus par les fascias uro-génital et pré-sacré. Le rectum est relié à ces deux fascias par les ailerons du rectum, dont le trajet en spirale est postéro-latéral à la partie haute du rectum, latéral à sa partie moyenne, antéro-latéral à sa partie inférieure. Au cours des résections rectales, il est possible de respecter les nerfs pelviens si la dissection du rectum est menée au ras du fascia rectal. Après avoir coupé l'insertion rectale du fascia présacré, les ailerons rectaux inférieurs (paraproctium) sont directement visibles et peuvent être sectionnés au ras de la paroi rectale sans risque de lésion du plexus pelvien.
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References
Ashley FL, Anson FJ (1946) The pelvic autonomic nerves in the male. Surg Gynec & Obstet 82: 598–601
Berglas B, Rubin IC (1953) Histologic study of the pelvic connective tissue. Surg Gynec Obstet 97: 277–280
Brizzi E, DeCaro R, Sgambati E, Todescan GC, Munari PF (1994) The organization of subperitoneal connective tissue in the female pelvis. Clin Exp Obstet Gynec 21: 253–258
Church JM, Raudkivi PJ, Hill GL (1987) The surgical anatomy of the rectum — a review with particular relevance to the hazards of rectal mobilisation. Int J Colorectal Dis 2: 158–166
Fozard JBJ, Pemberton JH (1993) Applied surgical anatomy: pelvic contents. In: Fielding LP, Goldberg SM eds. Surgery of the colon, rectum and anus. 5th ed. Rob & Smith's Operative Surgery. Butterworth Heinenann, Oxford, pp 11–23
Gérard G (1921) Manuel d'anatomie humaine. 2nd ed. Masson, Paris, pp 1103–1207
Hafferl A (1957) Lehrbuch der Topographischen Anatomie. 2nd ed. Springer-Verlag, Berlin, pp 545–554
Heald RJ, Goligher JC (1993) Anterior resection of the rectum. In: Fielding LP, Goldberg SM, eds. Surgery of the colon, rectum and anus. 5th ed. Rob & Smith's Operative Surgery. Butterworth Heinernann, Oxford, pp 456–471
Hollinshead WH (1971) Anatomy for surgeons. 2nd ed, vol. 2. Harper & Row, New York, pp 630–720
Lenck LC, Vanneuville G, Lewery D, Suanne F, Jacquetin B (1993) Le mésouro-génito-rectal chez la femme. Evolution du fascia parietalis pelvien dans l'excavation pelvienne. Rev Fr Gynecol Obstet 88: 7–11
Maissonet J, Coudane R (1950) Anatomie clinique et opératoire. vol. 2. G. Doin, Paris, pp 1139–1182
Peliam H, Americh J (1930) Gynäkologische Operationslehre. Karger, Berlin, pp 177–209
Pernkopf E (1941) Topographische Anatomie des Menschen. vol. 2. Bauch, Becken und Beckengliedmasse. Urban & Schwarzenberg, Berlin, pp 447–635
Poirier P, Charpy A, Cuneo B (1909) Abrégé d'anatomie. vol. 3. Masson, Paris, pp 1437–1551
Redman JF (1983) Anatomy of the retroperitoneal connective tissue. J Urol 130: 45–48
Ricliter K, Frich H (1985) Anatomy of the visceral fascia of the pelvis from the didactic viewpoint. Geburtshilfe-Frauenheilkd 45: 281–285
Roberts WH, Habenicht J, Krishinger G (1964) The pelvic and perineal fasciae and their neural and vascular relationship. Anat Rec 149: 707–711
Roberts WH, Holmes W, Tayler C (1970) The presacral component of the visceral pelvic fascia and its relation to the pelvic splanchnic innervation of the bladder. Anat Rec 166: 207–213
Rouvière H (1924) Anatomie humaine descriptive et topographique. Vol. 1. Masson, Paris, pp 947–954
Sato K, Sato T (1991) The vascular and neuronal composition of the lateral ligament of the rectum and the rectosacral fascia. Surg Radiol Anat 13: 17–22
Tandler J (1923) Lehrbuch der systematischen Anatomie. Vol. 2. Vogel, Leipzig, pp 303–313
Testut L, Jacob O (1914) Traité d'anatomie topographique. 3rd ed, vol. 2. Abdomen, bassin, membres. Doin, Paris, pp 381–546
Williams PL (1995) Gray's anatomy. 38th ed. Churchill Livingstone, New York, pp 1297, 1308–1309