Intestino crasso

Il colon si presenta di solito retroperitoneale o intraperitoneale a seconda della presenza o dell’assenza di un mesentere o, con altro termine, di un mesocolon. In uno studio di Treves su 100 soggetti, nel 52% dei casi il colon ascendente e quello discendente non possedevano un mesocolon e pertanto erano per definizione retroperitoneali. Nel 14% entrambe le porzioni del colon avevano un mesocolon distinto (ed erano quindi intraperitoneali, insieme alle porzioni trasversa e sigmoidea del colon). Nel 12% il colon ascendente aveva un mesentere e nel 22% dei casi il colon discendente era sospeso a un mesentere.

Le variazioni principali sono dovute a uno sviluppo irregolare o difettoso.

Nei casi di trasposizione completa dei visceri, il cieco e l’appendice si trovano nella fossa iliaca sinistra e il colon sigmoideo in quella destra. Il colon ascendente può non essere completamente retroperitoneale, con la conseguenza che il colon trasverso ricade obliquamente attraverso l’addome, coprendo il cieco e l’appendice, ed estendendosi dallo stretto superiore della pelvi a destra fino alla flessura splenica a sinistra.

La porzione prossimale dell’intestino crasso, fino alla parte sinistra del colon trasverso, può rimanere fissata, insieme al digiuno-ileo, alla parete addominale posteriore mediante un mesentere comune.

La rotazione dell’ansa intestinale, associata alla discesa del cieco e dell’appendice e alla formazione di un colon discendente, può arrestarsi definitivamente in qualsiasi punto del suo svolgimento. In alcuni casi il colon discendente rimane presso il piano mediano ed è connesso alla faccia anteriore della colonna vertebrale da un mesentere.

Il colon discendente può attraversare la parete addominale posteriore, con il colon sigmoideo che discende sul lato destro. Il sigma può trovarsi nell’addome subito al di sotto della flessura splenica del colon trasverso, oppure nella fossa iliaca destra. Occasionalmente il retto si apre nella vescica o nell’uretra, oppure può terminare a fondo cieco, dando luogo alla condizione nota come ano imperforato.

È stata riportata una duplicazione parziale dell’intestino crasso, che può anche risultare doppio.

L’intestino crasso è lungo circa 2 m.

Il microcolon congenito è stato riportato con una frequenza dello 0,004% sulla base di due studi su 261.451 autopsie (Greig, 1925). In questa condizione il diametro del colon è di circa 5 mm e l’alterazione si estende dal cieco al tratto terminale del retto.

Le anomalie anorettali congenite hanno una frequenza di 1/5000 - 1/10.000.

Riferimenti dell’opera originale

Elenco riportato come compare nella fonte, senza normalizzazione dei formati bibliografici. Le voci non sono tradotte: un riferimento bibliografico si cita nella lingua in cui è pubblicato.

• Ancel, P. and P. Cavaillon (1907) Sur les mesocolons ascendant et descendant et leur mode de formation chez l'homme. Assoc. Anatomistes Comptes Rendus 9:1-11.
• Aitken, J. A case of colon and ileum duplex. Brit. J. Surg. 37:349-351.
• Anger, T. (1872) Absence du rectum. Bulletins et Mem. de la Société Anatomique de Paris XLVIII(1):13.
• Anson, B.J., Lyman, R.Y. and H.H. Lander (1936) The abdominal viscera in situ. A study of 125 consecutive cadavers. Anat. Rec. 67:17-21.
• Anton, J.L., Panoff, C.E. and M.B. Spiegel. (1941) Segmental abdominal heterotaxy. Ann. Surg. 56:446- 456.
• Arkema, K.K. and L. Calenoff. (1977) Adenocarcinoma in tubular duplication of the sigmoid colon. Gastro. Intest. Radiol. 2:137-138.
• Aubrespy, P., Boureau, M., Derlon, S., Weisgerber, M. and A. Alesandrini. (1984) Les duplications digestives abdominothoraciques. Revue générale à propos de 2 observations. J. Chir. 121:85-89.
• Ault, G.W., Castro, A.F. and R.S. Smith. (1952) Clinical study of ligation of the inferior mesenteric artery in left colon resections. Surg. Gynecol. Obstet. 94:223-228.
• Bacon, H.E. and C.H. Smith. (1948) The arterial supply of the distal colon pertinent to abdominoperineal proctosigmoidectomy, with preservation of the sphincter mechanism. Ann. Surg. 127:28-33.
• Bennett, W.H. and H.D. Rolleston. (1890) Abnormal arrangement of the ileo-coecal portion of the intestine. J. Anat. Physiol. 25:878-880.
• Bhattachayya, B. (1926) Three cases of right-sided sigmoid colon. J. Anat. 60:229-232.
• Bodian, M., Stephens, F.D. and B.C.H. Ward. (1949) Hirschsprung's disease and idiopathic megacolon. Lancet 1:6-11.
• Bonnet Zeigler, L. (1970) Contribution personnele à l'étude des duplications du tube digestif, à propos de 18 observations. Thèse 1977, Lyon.
• Bremer, J. (1944) Diverticula and duplications of intestinal tract. Arch. Pathol. 38:132.
• Brunschwig, A., Dargeon, H.W. and W.A. Russell. (1948) Duplication of the entire colon and lower ileum, with termination of the colon into a vaginal anus. Surgery, 24:1010-1013.
• Buirge, R.E. (1943) Gross variations in the ileocecal valve: A study of the factors underlying incompetency. Anat. Rec. 86:373-385.
• Campenon, -. (1871) Deux cas d'imperforation de l'anus: position anormale de l'ampoule rectale. Bulletins et Mem. de la Société Anatomique de Paris XLVI(9 and 10):275-277.
• Carslow, R.B. (1927-28) Right-sided viscerptosis: An estimate of the importance of abnormal mobility and prolapse of the ascending colon and caecum in the causation of various abnormal conditions, based on observations in a series of 242 cases treated by right coloprexy. Brit. J. Surg. 15:545-604.
• Cohen, S.J. (1968) Diphallus with duplication of the colon and bladder. Proc. R. Soc. Med. 61:305-306.
• Coran, A.G. and A.J. Eraklis. (1969) Atresia of the colon. Surgery 65:828-831.
• Colton, E.J., Anson, B.J., Gibbs, E.W., McCormack, L.J., Reimann, A.F. and E.H. Daseler. (1947) Positions of abdominal viscera. Q. Bull. Northwestern University Medical School. 21:154-155.
• Cozzi, F. and A.W. Wilkinson. (1968) Familial incidence of congenital anorectal anomalies. Surgery 64:669-671.
• Daudet, M. (1967) In symposium consacré aux duplications intestinales. Ann. Chir. Inf. 8:55-56.
• Delmas, J. (1906) Sur la forme du caecum. Assoc. Anatomistes Comptes Rendus 8:94-96.
• Donald, C. (1927-28) Volvulus of small gut, caecum, and ascending colon, associated with congenital reversed rotation of intestine and with pregnancy. Brit. J. Surg. 15:269-272.
• Dott, N.M. (1923-24) Anomalies of intestinal rotation: their embryology and surgical aspects: with a report of five cases. Brit. J. Surg. 11:251-286.
• Dubey, P.N. (1907) Anomalous descending colon. J. Anat. Soc. India 7:112.
• DuSèjours, D. (1922) Sur un cas d'occlusion intestinale par coudure et torsion du côlon ascendant. Bull. et Mém. Soc. de Chir. de Paris 48:285-287.
• Eggers, C. (1922) Non-rotation of the large intestine. Ann. Surg. 75:757-758.
• Espalieu, Ph., Balique, J.G. and J. Cuilleret. (1985) Tublar colonic duplications . A case report and literature review. Anatomia Clinica 7(2):125-130.
• Faraboeuf, -. (1885) Arrêt de l'Evolution de l'intestin. Progrès Méd. 1885:411.
• Frazer, J.E. and R.H. Robbins. (1915) On the factors concerned in causing rotation of the intestine in man. J. Anat. 50:75.
• Gardner, C.E., Jr. (1950) The surgical significance of anomalies of intestinal rotation. Ann. Surg. 131:879-898.
• Gross, R.E., Holocomb, G.W. and S. Faber. (1952) Duplications of the alimentary tract. Pediatrics 9:449-456.
• Gruber, W. (1865) Weiterer Beiträge zu den durch Bildungsfehler bedingten Lagerungsanomalien des Darmes. Arch. Pathol. Anat. Physiol. Klin. Med. 32:94-104.
• Hamdy, M. and M.F. Sorour. (1909) On a case of displacement of the descending colon. J. Anat. Physiol. 43:242-243.
• Hunter, J.I. (1922) A mesentric cyst of jejunal origin, complicated by retrojejunal position of the transverse colon. Brit. Med. J. ii:800-802.
• Huntington, G.S. (1903) The Anatomy of the Human Peritoneum. Kimpton and Co., London.
• Hurst, A.F. and T.B. Johnston. (1921) Left-sided colon, with an anatomical note on non-rotation of the gut. Guy's Hospital Reports 71:369-375.
• Clopp, E.J. (1922) Non-rotation of the colon. Ann. Surg. 76:281-282.
• Koch, W. (1899) Die angeborenen ungewöhnlichen Lagen und Gestaltungen des menschlichen Darmes. Dtsch. Z. Chir. 50:1-63.
• Korfel, Z., Choinacki, M., Chilimoniuk, M. and I. Szewko-Szawkowska. (1973) Variations of position of the abdominal viscera in man. Folia Morphol. 32:71-78.
• Kottra, J.J. and W.J. Dodds. (1971) Duplication of the large bowel. Am. J. Roentgenol. 113:310-315.
• Kratzer, G.L., Dixon, C.F. and J.A. Bargen. (1951) Duplication of the entire colon and terminal part of the ileum associated with parasitic twin. Proc. Staff Meet., Mayo Clin. 26:15-18.
• Ladd, W.E. and R.E. Gross. (1934) Congenital malformations of anus and rectum: Report of 162 cases. Am. J. Surg. 23:167-183.
• LeWald, L.T. (1915) Abnormal position of the colon. Ann. Surg. 61:112-113.
• Lohman, A.J.M. and St. J. Ziekenhuis. (1946) Partieele verdubbeleling van den dikken darm (colon duplex) met unipolaire atresie. Nederlandsch Tijdschrift voor Geneeskunde 90:1735-1738. Cited in Excerpta Medica, Sec. 1, Vol. 2: abstract 200, p. 101, 1948.
• Low, F.N. and W.C. Hilderman. (1940) A case of hyper-rotation of the colon. Anat. Rec. 77:27-30.
• Lyons, A.S. (1948) The sigmoid as a source of right-sided symptoms. Ann. Surg. 127:399-409.
• Maddox, E.E. (1883) Right-sided sigmoid flexure and rectum. J. Anat. Physiol. 17:403.
• Mall, F.P. (1898) Development of the human intestine and its position in the adult. Johns Hopkins Hospital, Bulletin. 9:197-208.
• Mayo, C.H. (1912) Failure of the colon to rotate. Med. Record 81:401-403.
• McCoy, W.N. (1877) Imperforate anus; the rectum opening into the vulva; successful operation. American J. Med. Sci. 74:287-288.
• McPherson, A.G., Trapnell, J.E. and G.R. Airth. (1969) Duplication of the colon. Brit. J. Surgery 56:138-142.
• Mezzacappa, P.M., Price, A.P., Haller, J.O., Kassner, G. and F. Hansbrough. (1987) MR and CT demonstration of the levator sling in congenital anorectal anomalies. J. Computer Assist. Tomograph. 11(2):273-275.
• Mole, R.H. (1929-30) Congenital non-rotation of the intestine. Brit. J. Surg. 17:670-672.
• Morito, Y. (1941-42) über eine seltene Varietät des Blinddarmes und Colon ascendens bei einem Japaner. Folia Anat. Jpn. 21:541-551.
• Nakazima, T. (1939) Eine Reisenschlingenbildung des Colon transversum bei einem Japaner. Folia Anat. Jpn. 18:219-222.
• Nicola, N.E. (1921) Abnormal position of the iliac and pelvic colons. J. Anat. 56:53.
• Pires de Lima, J.A. (1927) La duplicité de l'anus et sa signification morphologique. Assoc. Anatomistes Comptes Rendus 22:203-205.
• Quénu, L., Chabrol, J. et P. Herlemont. (1954) Le colon, ses variations, ses artères. Assoc. Anatomistes Comptes Rendus 41:760-769.
• Quervain, F. de (1902) über Rechtslagerung des ganzen Dickdarms und partiellen Situs inversus. Arch. Klin. Chir. 65:256-265.
• Rannshoff, J. (1888) Considerations of the anatomy, physiology and pathology of the caecum and appendix. JAMA 11:40-46.
• Ravitch, N. (1953) Hind gut duplication. Doubling of colon and genitourinary tract. Ann. Surg. 137:588-601.
• River, L.P. and F.A. Reed. (1942) Volvulus of the cecum: Report of four cases. Ann. Surg. 116:874- 881.
• Rixford, E. (1920) Failure of primary rotation of the intestine (left-sided colon) in relation to intestinal obstruction. Ann. Surg. 72:114-120.
• Roberts, W.H. and P. Engen. (1977) The blood supply of the abdominally placed vertical sigmoid colon. Anat. Anz. 142:165-167.
• Rothman, M., Bruckner, J.P. and D.F. Zetena. (1943) Volvulus of the cecum and ascending colon: A review of the literature and presentation of a case. Am. J. Surg. 60:292-297.
• Sato, Y., Pringle, K.C., Bergman, R.A., Yuh, W.T.C., Smith, W.L., Soper, R.T. and E.A. Franken, Jr. (1988) Congenital anorectal anomalies: MR imaging. Radiology 168:157-162.
• Schrupp, J.H. (1915) Left-sided appendicitis. Surg., Gynecol. Obstet. 21:442-447.
• Seifert, F. (1914-15) Lageanomalien des Darmes bei einem Erwachsenen. Anat. Anz. :47:209-217.
• Shepard, D. (1966) Antiperistaltic bowel segment in the treatment of the short bowel syndrome. Ann. Surgery 163:850-855.
• Sielbauer, F. (1910) Verlagerung des Colon sigmoideum mit Tiefstand der linken Niere. Anat. Anz. 35:33-47.
• Small, A. (1937) The surgical correction of anomalies in the fixation of the ascending colon. Ann. Surgery 106:230-241.
• Smith, G.M. (1911) A statistical review of the variations in the anatomic positions of the caecum and processes vermiformis in the infant. Anat. Rec. 5:549-556.
• Smith, G.E. (1904) Note on an abnormal colon. J. Anat. Physiol. 38:32-33.
• Soper, R.T. (1968) Tublar duplication of the colon and distal ileum: case report and discussion. Surg. 63:998-1004.
• Stephenson, F.B. (1936) Microcolon: Two case reports. Radiology 27:494-497.
• Stone, H.B. (1939) Megarectum and megasigmoid. Ann. Surgery 109:791-798.
• Strehl, H. (1908) Congenitale Retroposition des Dickdarmes. Arch. Klin. Chir. 87:8-19.
• Sturgis, M.G. (1915) Congenital intestinal anomalies. Surg., Gynecol. Obstet. 21:447-451.
• Tamoney, H.J. and R.E. Testa (1967) Carcinoma arising in a duplicated colon. Cancer 20:478-481.
• Treves, F. (1885) Anatomy of the intestinal canal and peritneum in man. Brit. Med. J. i:470-474.
• Treves, F. (1885) Lectures on the anatomy of the intestinal canal and peritoneum in man. Br. Med. J. 1:415, 470, 527, 580.
• Tricomi-Allegra, G. (1906) Cas d'absence complète congénitale du rectum. Arch. Ital. Biol. 46:320.
• Underhill, B.M.L. (1955) Intestinal length in man. Brit. Med. J. 2:1243-1246.
• Veeraraghavan, K.A., Gonzales, E.T., Gibbons, M.D., Wagner, M.L. and F.J. Harberg. (1983) Cloacal duplication: Genitourinary and lower intestinal implications. J. Urol. 129:389-391.
• Veneekas, G.M.H. (1951) Intrathoracic cysts of the stomach. Mandschr. Kinder 19:37.
• deVries, P.A. and K.L. Cox. (1985) Surgery of anorectal anomalies. Surg. Clin. North America 65:1139-1169.
• Weinstein, M. (193 8) Volvulus of the cecum and ascending colon. Ann. Surg. 107:248-259.
• Wierda, J.1 (1947) An unusual peritoneal anomaly - a sac containing the jejunum, ileum, and transverse colon. Anat. Rec. 97:265-275.
• Wolfer, J.A., Beaton, L.E. and B.J. Anson. (1942) Volvulus of the cecum: Anatomical factors in its etiology. Report of a case. Surg. Gynecol. Obstet. 74:882-894.
• Wright, C.W. (1955) A case of a left-sided vermiform appendix, caecum and anomalous intestine. Anat. Rec. 123:291-298.