What Is the Transverse Colon?

Transverse colon: The transverse colon starts from the right curve of the colon, and the left row forms a sagging bow-shaped curve. It turns down to form the left curve of the colon on the inner side of the spleen in the left quarter, and descends the colon. The transverse colon is all peritoneal-coated, and the mesentery of the transverse colon is fixed on the posterior wall of the abdomen, and the mobility is large.

Chinese name: Transverse colon
Foreign name: transverse colon
Pinyin: heng jie chang

long: About 40-50cm
Start: Right colon
at last: Mid-abdominal cavity

Transverse Colon Overview

It is part of the colon. From the right bow of the colon, to the left quarter ribs, bend into an acute angle at the lower edge of the spleen, forming a left bow of the colon, and continue to descend the colon. The central part of the transverse colon sags and is connected to the posterior abdominal wall by the mesentery. The upper part of the transverse colon contacts the lower part of the right lobe of the liver and the large curvature of the stomach, the lower part contacts the small intestine, the rear part adjoins the pancreas and duodenum, and the front part is covered with the omentum. The left curve of the colon is slightly higher than the right curve and touches the upper part of the left kidney. The transverse colon is adjacent and complicated, and there are many diseases of the surrounding organs, which often cause difficulties in clinical diagnosis and treatment.

Pointing from the right curve of the colon, it goes to the left, front, and lower left, and then turns slightly to the left and back, forming a slightly downward bowed curve to the left quarter rib area, which is divided into the left spleen of the colon (or spleen). Song), continued down the descending colon, about 50cm long. The transverse colon is an internal organ of the peritoneum, which is connected to the posterior wall of the abdominal wall by the transverse colon mesentery, which has a large degree of mobility, and the middle part can sag to or below the umbilical plane.

Transverse colon anatomy

The transverse colon is about 50 cm long. In the right quarter costal region, it starts from the right bowel of the colon, and starts to shift to the lower left forward, and then gradually extends to the upper left and rear, forming a downward curved bow, and then extends straight to the left quarter costal region. On the underside of the spleen hilum, then turn from back to front to form a left bowel curvature, or colonic spleen curvature. Its position is slightly higher than the liver curve, and it is closer to the abdominal wall. The bending angle is also generally larger than the liver curvature. From the spleen to the descending colon. The degree of bow-like sagging of the transverse colon can vary due to changes in physiological conditions. For example, when the intestinal cavity is empty, the bowel's downward convexity is smaller and the position is higher. Conversely, when the intestinal lumen is full, the bowel's downward convexity is greater, and it is generally located in the upper abdominal region or near the umbilical region, and in a few cases can reach below the level of the iliac crest. The body surface projection of the transverse colon is an arc downward from the front end of the 10th costal cartilage on the right to the front end of the 9th costal cartilage on the left.

The front of the right end of the transverse colon is covered by the peritoneum, and there is no peritoneum at the back. Only the connective tissue is connected to the lower part of the duodenum and the front of the pancreatic head. The other parts up to the spleen are completely covered by the peritoneum, and the two layers of peritoneum meet and overlap along the mesangial band of the transverse colon, forming a wider transverse colonic mesangium, which suspends the transverse colon in front of the pancreas. The mesangium gradually becomes shorter toward the liver curvature and spleen curvature, and the middle is longer, causing the bowel to sag.

Transcolonic colostomy

Colostomy can be divided into permanent stoma and temporary stoma. According to the type of stoma, it can be divided into single cavity stoma, double cavity stoma and stoma stoma.

Cecal intubation and ostomy:

Transverse Colon Indication

1. For acute colon obstruction (especially obstructive obstruction caused by ascending colon cancer and transverse colon cancer), patients with poor general condition (aged, extremely exhausted, with heart, liver, lung, and renal insufficiency), or intolerant Subject to other abdominal decompression surgery.

2. Occasionally used for repair of colon rupture or intestinal segment resection and anastomosis (especially anastomosis at the transverse colon), by reducing the pressure of the proximal colon, in order to reduce the occurrence of fistulas at the repair and anastomotic site.

3. The perforation of the appendix root involves the cecum, which makes the intestinal wall part necrotic, and is not suitable for repair.

Transverse colon contraindications

1. Poor body conditions and intolerance of surgery, such as severe malnutrition and ascites.

2. Preoperative stoma, intestinal tuberculosis, severe blood flow disorders, suspicious vitality, etc.

3. This procedure is not used for preoperative preparation for elective surgery of the distal colon.

4. Patients with complete obstruction of the distal colon, generally do not use this method if they can tolerate other colostomy (such as transverse colostomy or sigmoid colostomy) or internal bypass.

Transverse colon surgery steps and precautions

1. The right inferior abdominal incision is often taken, because temporary cecal stoma is often a component of distal colectomy and anastomosis. At this time, the incision is usually made with a median or lateral median incision, and only a small jaw is required in the right lower abdomen. To lead out the stoma catheter that has been placed in the colon.

2. Cut into the abdomen in layers, reveal and gently raise the cecum, and protect the surrounding with normal saline gauze. Two purse sutures were placed on the anterior cecal zone of the cecum with a silk thread of No. 1 and the distance between them was about 1 cm.

3. Make a small incision in the center of the purse with an electric knife, insert the suction tube from the incision, and suck out the contents of the intestine. After the cecum collapses, remove the suction tube and insert a 24 to 26 mushroom-shaped cutout into it. Catheter, catheter insertion length is about 15cm, ligate the inner pouch suture, and then ligate the outer pouch suture. While ligating, invert the catheter and the cecum wall a little.

4. The stoma tube is drawn from the abdominal wall incision or another puncture in the right lower abdomen, and the intestinal wall around the catheter is fixed to the peritoneum with an absorbable line, so that the colon wall around the stoma is closely attached to the parietal peritoneum.

5. After the surgical field is flushed, the abdominal wall incision is sutured layer by layer, and the stoma tube is fixed on the skin.

6. If the appendix has not been removed, it can also be removed in the usual way, and a mushroom-shaped catheter is inserted through the root of the appendix to intubate the stoma. The operation steps are omitted.

7. If it is estimated that the obstruction cannot be relieved satisfactorily by the above method, when the cecum is opened for decompression after surgery, the cecum can be slightly freed, the wall peritoneum of the abdominal wall incision and the dermis layer of the skin can be sutured intermittently, and the serosa of the cecum Layer and parietal peritoneal suture, retain this suture for ligation of vaseline gauze, and finally cover the stoma colon with vaseline gauze.

8. Precautions Strictly aseptic operation to prevent postoperative incision and abdominal cavity infection; Do not penetrate the intestinal wall with suture needles, so as to cause rupture of the cecum wall and overflow of the needle eye, contaminating the abdominal cavity.

Transverse colonic iliostomy:

Transverse Colon Indication

1. Intestinal obstruction caused by unresectable left colon cancer, rectal cancer, or pelvic tumor requires permanent transcolostomy.

2. As an early operation for left colon or rectal cancer with obstruction.

3. There is an anastomosis in the left colon and rectum, but when the anastomosis is not very reliable or satisfactory, a temporary protective transverse colon stoma is made.

4. As a preliminary preparation for diseases such as complex anal fistula, rectal bladder fistula or rectal vaginal fistula.

5. When the left colon or rectal acute injury or perforation is repaired, it is used as a protective stoma.

Transverse colon contraindications

Where there is obstructive disease in the proximal colon, transcolostomy should not be performed.

Transverse colon surgery steps and precautions

1. Generally take a right upper abdominal transverse incision, make a horizontal incision on the right side of the midpoint of the line connecting the umbilicus and xiphoid. The medial end may include a part of the right rectus sheath and muscles, or a midline incision or the right side. Transabdominal rectus incision. It is best to take plain radiographs of the abdomen before surgery, and select an appropriate incision according to the position of the transverse colon shown on the plain film. The incision should be of sufficient length to allow adequate exposure and free expansion of the transverse colon.

2. After entering the abdominal cavity, carry out the necessary investigations. While examining the transverse colon, check the cecum for plasma muscular dehiscence and intestinal wall necrosis, and understand the condition of the left colon and rectum (there is no tumor, the location of the tumor, And whether radical resection can be done). After the exploration, the right lateral colon to be placed externally was removed, and the omentum attached to the transverse colon was cut along the edge of the lateral colon. If the intestine is extremely dilated, intestinal decompression is performed first, which can make it safe and easy to handle the intestine.

3. Use your left hand to lift the transverse colon and its mesentery. Use a hemostat to poke a small hole in the avascular region of the mesentery. Pass a glass tube through this hole. Connect the silicone tube at both ends of the glass tube to fix it. Use several layers of dry gauze. Place a glass rod to ensure that the external colon has sufficient length.

4. Another method is to make an incision of about 4 cm in the mesangial non-vascular area of the proposed transverse colon. Use a silk thread to suture the abdominal wall fascia muscles and peritoneum on both sides of the abdominal wall incision through this incision to form a fascial support Pay attention to observe the blood flow of the colon and whether the bowel is compressed after suture.

5. Suture the peritoneum at both ends of the incision for a few stitches to prevent the bowel from bulging, but not too tight, so as not to compress the intestine (the tightness is such that a finger can be inserted near the colon). The intestinal lipid sac in the colon and the mesentery and the peritoneum are sutured and fixed, and the gap between the stoma intestine and the abdominal wall incision is closed. Be careful not to penetrate the intestinal wall when sutured. The skin and subcutaneous tissue at both ends of the incision are sutured. The stoma and intestine section and the incision are covered with vaseline gauze and bandaged with dry gauze.

6. If the flatulence is not obvious, do not cut the stoma intestine temporarily, and cut it 2 to 3 days after the operation.

7. Precautions Before and after suture of intestinal loop and peritoneum, care should be taken to distinguish the distal and proximal ends to prevent twisting; When suture the intestinal wall and the peritoneum, the stitches must not penetrate the entire intestinal wall to prevent intestinal contents from overflowing and contaminating Abdominal cavity; When intestinal decompression, it is advisable to bring more of the transverse colon, and it is advisable to sew a purse first and puncture the decompression; except for suturing the skin, absorbable sutures should be used to prevent sinus from forming after infection.

Transverse and Transverse Colon Related Diseases

1. Transverse colon cancer:

[Summary of Medical History]

Patient, male, 61 years old. Repeated mucus pus and blood will be accompanied by abdominal pain for more than 4 months.

[Image Signs]

A plain CT scan revealed that the intestinal wall of the transverse colon had thickened inhomogeneity, narrowed eccentricity of the intestinal lumen, and localized soft tissue mass shadows. The CT value was about 49 Hu, and the central layer was 3.7 cm × 5.8 cm. A patchy shadow was seen in the fat space. There were no obvious enlarged lymph nodes in the adjacent abdominal cavity and retroperitoneum.

[Imaging diagnosis] Transverse colon cancer.

[Final diagnosis] Transverse colon cancer.

[Comment]

Overview:

Colon cancer is a common malignant tumor in the gastrointestinal tract, with the highest incidence in the 40-50 age group. In China, the incidence of colon cancer is second only to gastric cancer and esophageal cancer, ranking third. The vast majority of colon cancers are adenocarcinomas, most of which are due to the malignant changes of adenomas, and a few have developed on the basis of atypical hyperplasia of the mucosa. Advanced colon cancer can be divided into Borrmann types 1, 2, 3, and 4 according to their general morphology. Most of them are ulcerative (Borrmann 2, 3), and invasive (Borrmann 4) are rare. Clinical manifestations include changes in bowel habits, blood in the stool, abdominal pain, intestinal obstruction, anemia, low fever, and weight loss.

Image performance:

The important value of CT in the diagnosis of colon cancer is to determine the size and scope of the cancer, whether it penetrates the intestinal wall, the invasion of adjacent organs, the presence of complications, lymph nodes and distant metastases, etc., and provide a basis for choosing a reasonable treatment plan. The imaging manifestations of colon cancer include: Mass type (Borrmannl type) is a large and wide basal eccentric lobular mass in the intestinal cavity with thickening of the intestinal wall; ulcerous cancer (Borrmann type 2, 3) often appears as a ring or half Thickening of the ring-shaped intestinal wall with irregular narrowing of the intestinal cavity; invasive cancer (Borrmann type 4) is rare in colon cancer, manifested by diffuse uniform thickening of the intestinal wall, stiffness, also known as leather pocket colon. The disappearance of the fat gap between the tumor and adjacent organs is often used as a diagnostic criterion for cancer to penetrate the intestinal wall. Local lymph node metastasis is the most common form of metastasis in colon cancer, often causing enlargement of the mesenteric lymph nodes (next to the abdominal aorta) and paraintestinal lymph nodes. The most distant metastasis of colon cancer is liver (75%), followed by lung, and adrenal, ovary, bone, and brain. Colon cancer is often distinguished from intestinal spasms, intestinal polyps, intestinal lymphomas, ileocecal tuberculosis, and Crohn's disease.