The Right Lower Quadrant

By placing the patient in the Trendelenburg position with the right side up, the terminal ileum, its retroperitoneal attachments, the cecum, and the ligament of Treitz can be visualized (Figure 7.12, see color plate). The vascular structures of the ileum and right colon may also be identified (Figure 7.13, see color plate), and their relationship to the duodenum may be appreciated. With dissection of the ileum and right colon away from their retroperitoneal attachments, then the psoas major muscle, the psoas minor tendon, and the right gonadal vessels and ureter are easily seen. The hepatic flexure is well visualized as the ascending colon is mobilized from the retroperitoneum (Figure 7.14). In thinner patients, the vascular structures in the transverse mesocolon (i.e., right and left branches of middle colic vessels) can be clearly demonstrated even before mesenteric dissection (Figure 7.15, see color plate).

Ica Smv Sma VascularTreitz Dissection

Figure 7.12. With a patient in the Trendelenburg position and the right side tilted upward, the terminal ileum, cecum, and ligament of Treitz may all be visualized. I, terminal ileum; LT, ligament of Treitz; C, cecum. (See color plate.)

Trendelenburg Position

Figure 7.13. The major vascular structures of the right colon may be appreciated through the mesoco-lon, along with the right kidney and duodenum, with the small bowel retracted inferiorly and to the left. ICA, ileocolic artery; ICV, ileocolic vein; K, right kidney; D, duodenum; SMV, superior mesenteric vein; SMA, superior mesenteric artery. (See color plate.)

Figure 7.13. The major vascular structures of the right colon may be appreciated through the mesoco-lon, along with the right kidney and duodenum, with the small bowel retracted inferiorly and to the left. ICA, ileocolic artery; ICV, ileocolic vein; K, right kidney; D, duodenum; SMV, superior mesenteric vein; SMA, superior mesenteric artery. (See color plate.)

Ileocolic Artery And Duodenum
Figure 7.14. As the right colon is mobilized, the retroperitoneal structures are well seen. HF, hepatic flexure; Ps, psoas major muscle; GV, gonadal vessels; U, ureter; D, duodenum; P, pancreatic head; Ap, appendix.
Large Intestine Ruminant
Figure 7.15. In thin patients, the vessels of the transverse colon and major structures in this region may be seen. L, inferior edge of liver; TC, transverse colon; MCV, middle colic vein; MCA, middle colic artery; D, duodenum; P, head of pancreas. (See color plate.)

Was this article helpful?

0 0
Baby Sleeping

Baby Sleeping

Everything You Need To Know About Baby Sleeping. Your baby is going to be sleeping a lot. During the first few months, your baby will sleep for most of theday. You may not get any real interaction, or reactions other than sleep and crying.

Get My Free Ebook


Post a comment