The Left Lower Quadrant

Sweeping the camera from the LUQ caudally, the descending colon, the ligament of Treitz, and vascular structures of the left mesocolon may be appreciated (Figure 7.8). To best see this area, the patient must be tilted with the left side up, and in some degree of Trendelenburg position. The attachments of the sigmoid colon to the lateral abdominal side wall and to the pelvis are easy to visualize, and the vessels supplying the left colon and rectum, including the inferior mesenteric artery and vein may be identified by retracting the small bowel to the right side of the abdomen (Figure 7.9). The retroperitoneal structures in this quadrant, including the left gonadal vessels, the left ureter (Figure 7.10), and the hypogastric plexus (Figure 7.11, see color plate), are all readily visualized when the left colon and sigmoid are mobilized as in a rectosigmoid cancer operation.

Figure 7.8. Just inferior to the splenic flexure, the ligament of Treitz and the main vessels of the left colon are seen. LT, ligament of Treitz; IMV, inferior mesenteric vein; IMA, inferior mesenteric artery.

Figure 7.8. Just inferior to the splenic flexure, the ligament of Treitz and the main vessels of the left colon are seen. LT, ligament of Treitz; IMV, inferior mesenteric vein; IMA, inferior mesenteric artery.

Splenic FlexureLigament Treitz

Figure 7.9. By retracting the small bowel to the right side of the abdomen, the attachments of the sigmoid colon and the main vessels of the left colon may be seen.

Figure 7.9. By retracting the small bowel to the right side of the abdomen, the attachments of the sigmoid colon and the main vessels of the left colon may be seen.

Inferior Hypogastric ArteryMobilization The Right Colon
Figure 7.10. During the surgical mobilization of the sigmoid colon, the relationships of the gonadal vessels and the ureter are appreciated. SC, sigmoid colon; GV, gonadal vessels; U, ureter.
Gonadal Vessels

Figure 7.11. During a surgical dissection of the origin of the inferior mesenteric artery, the relationships of the hypogastric nerves and the aorta are appreciated. Note how the two branches (left and right) are straddling the aorta. IMA, inferior mesenteric artery; A, aorta; HN, left branch of the hypogastric nerve plexus. (See color plate.)

Figure 7.11. During a surgical dissection of the origin of the inferior mesenteric artery, the relationships of the hypogastric nerves and the aorta are appreciated. Note how the two branches (left and right) are straddling the aorta. IMA, inferior mesenteric artery; A, aorta; HN, left branch of the hypogastric nerve plexus. (See color plate.)

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