Surgical and Radiologic Anatomy

, Volume 40, Issue 4, pp 431–438 | Cite as

Is it possible to give a single definition of the rectosigmoid junction?

  • Damien Massalou
  • David Moszkowicz
  • Daniela Mariage
  • Patrick Baqué
  • Olivier Camuzard
  • Nicolas Bronsard
Original Article
  • 76 Downloads

Abstract

Aim

The rectosigmoid junction is the limit separating the sigmoid colon and rectum. This transition zone has different definitions. We want to highlight different landmarks of the rectosigmoid junction (RSJ), to help the clinicians to adopt a consensual definition.

Method

We reviewed anatomical, endoscopic, physiological and surgical points of view concerning the rectosigmoid junction (RSJ).

Results

The rectosigmoid junction has a different definition depending on who is studying it. Nevertheless, it is a high pressure location, a place connecting different muscles organizations, neurological systems or vascular anastomosis. The clear pathophysiology of the RSJ is not yet determined with certainty, but its resection is essential for the therapeutic care of patients and also for the improvement of surgical skills. From a surgical point of view, anatomical landmarks has to be chosen: easily reproducible and identifiable. The disappearance of taenia coli (belonging to the colon) and the peritoneal reflection (recto-genital pouch), located below the upper rectum, seem the most reliable. The level of rectal section must, in any case, be below the promontory.

Conclusion

There is not a single definition, but rather several definitions of the RSJ. Each one of them reflects one appearance of this region: embryological and anatomical evolution or clinical entity. From a surgical point of view, the criterion which seems to be the most reliable is the disappearance of taenia coli and the peritoneal reflection (recto-genital pouch).

Keywords

Rectosigmoid junction Anatomy Rectum Lymph node 

Notes

Acknowledgements

We thank Mr Brian Collins for his assistance in editing the article, and Mr Benjamin Maes for his drawings.

Compliance with ethical standards

Conflict of interest

We have no conflict of interest.

Funding

This study received no funding.

References

  1. 1.
    Abhishek K, Kaushik S, Kazemi MM, El-Dika S (2008) An unusual case of hematochezia: acute ischemic proctosigmoiditis. J Gen Intern Med 23:1525–1527CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Bagla N, Schofield JB (2007) Rectosigmoid tumours: should we continue sitting on the fence? Colorectal Dis 9:606–608CrossRefPubMedGoogle Scholar
  3. 3.
    Ballantyne GH (1986) Rectosigmoid sphincter of O’Beirne. Dis Colon Rectum 29:525–531CrossRefPubMedGoogle Scholar
  4. 4.
    Bampton PA, Dinning PG, Kennedy ML, Lubowski DZ, deCarle D, Cook IJ (2000) Spatial and temporal organization of pressure patterns throughout the unprepared colon during spontaneous defecation. Am J Gastroenterol 95:1027–1035CrossRefPubMedGoogle Scholar
  5. 5.
    Bassotti G, Gaburri M, Imbimbo BP, Morelli A, Whitehead WE (1994) Distension-stimulated propagated contractions in human colon. Dig Dis Sci 39:1955–1960CrossRefPubMedGoogle Scholar
  6. 6.
    Bassotti G, Germani U, Morelli A (1996) Flatus-related colorectal and anal motor events. Dig Dis Sci 41:335–338CrossRefPubMedGoogle Scholar
  7. 7.
    Bassotti G, de Roberto G, Castellani D, Sediari L, Morelli A (2005) Normal aspects of colorectal motility and abnormalities in slow transit constipation. WJG 11:2691–2696CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Beck D, Roberts P, Saclarides T, Senagore AJ, Stamos M, Wexner SD (2011) The ASCRS textbook of colon and rectal surgery. Springer, New YorkCrossRefGoogle Scholar
  9. 9.
    Burns AJ, Le Douarin NM (2001) Enteric nervous system development: Analysis of the selective developmental potentialities of vagal and sacral neural crest cells using quail-chick chimeras. Anat Rec 262:16–28CrossRefPubMedGoogle Scholar
  10. 10.
    Canessa CE, Badía F, Fierro S, Fiol V, Háyek G (2001) Anatomic study of the lymph nodes of the mesorectum. Dis Colon Rectum 44:1333–1336CrossRefPubMedGoogle Scholar
  11. 11.
    Chauve A, Devroede G, Bastin E (1976) Intraluminal pressures during perfusion of the human colon in situ. Gastroenterology 70:336–340PubMedGoogle Scholar
  12. 12.
    Clark RV, Thomas IG, Roy AD (1965) Sigmoidoscopic and radiological study of the recto-sigmoid junction. Gut 6:509–512CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Coe A, Collins MH, Lawal T, Louden E, Levitt MA, Peña A (2012) Reoperation for hirschsprung disease: pathology of the resected problematic distal pull-through. Pediatr Dev Pathol 15:30–38CrossRefPubMedGoogle Scholar
  14. 14.
    Couinaud C (1963). Anatomie de l’abdomen (petit bassin excepté) (Doin)Google Scholar
  15. 15.
    Farrugia G (2008) Interstitial cells of Cajal in health and disease. Neurogastroenterol Motil 20:54–63CrossRefPubMedGoogle Scholar
  16. 16.
    Gattuso JM, Kamm MA, Myers C, Saunders B, Roy A (1996) Effect of different infusion regimens on colonic motility and efficacy of colostomy irrigation. Br J Surg 83:1459–1462CrossRefPubMedGoogle Scholar
  17. 17.
    Hagger R, Gharaie S, Finlayson C, Kumar D (1998) Regional and transmural density of interstitial cells of Cajal in human colon and rectum. Am J Physiol—Gastrointest Liver Physiol 275:G1309–G1316CrossRefPubMedGoogle Scholar
  18. 18.
    Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Colorectal Dis 11:354–364CrossRefPubMedGoogle Scholar
  19. 19.
    Hojo K, Koyama Y, Moriya Y (1982) Lymphatic spread and its prognostic value in patients with rectal cancer. Am J Surg 144:350–354CrossRefPubMedGoogle Scholar
  20. 20.
    Junginger T, Hermanek P (2008) Problems in the treatment of upper rectal carcinoma. Chir. Z. Für Alle Geb. Oper Medizen 79:327–339Google Scholar
  21. 21.
    Kamm MA, van der Sijp JR, Lennard-Jones JE (1992) Colorectal and anal motility during defaecation. Lancet 339:820CrossRefPubMedGoogle Scholar
  22. 22.
    Käser SA, Froelicher J, Li Q, Müller S, Metzger U, Castiglione M, Laffer UT, Maurer CA (2014). Adenocarcinomas of the upper third of the rectum and the rectosigmoid junction seem to have similar prognosis as colon cancers even without radiotherapy, SAKK 40/87. Langenbecks Arch Surg 1–8Google Scholar
  23. 23.
    Lorijn F de, Jonge WJ de, Wedel T, Vanderwinden JM, Benninga MA, Boeckxstaens GE (2005) Interstitial cells of Cajal are involved in the afferent limb of the rectoanal inhibitory reflex. Gut 54:1107–1113CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Massalou D, Masson C, Foti P, Afquir S, Baqué P, Berdah S-V, Bège T. Dynamic biomechanical characterization of colon tissue according to anatomical factors. J. BiomechGoogle Scholar
  25. 25.
    Nemeth L, Maddur S, Puri P (2000) Immunolocalization of the gap junction protein Connexin43 in the interstitial cells of Cajal in the normal and Hirschsprung’s disease bowel. J Pediatr Surg 35:823–828CrossRefPubMedGoogle Scholar
  26. 26.
    Pignon J-C, Grisanzio C, Geng Y, Song J, Shivdasani RA, Signoretti S (2013) p63-expressing cells are the stem cells of developing prostate, bladder, and colorectal epithelia. Proc Natl Acad Sci USA 110:8105–8110CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Pirro N, Pignodel C, Cathala P, Fabbro-Peray P, Godlewski G, Prudhomme M (2008) The number of lymph nodes is correlated with mesorectal morphometry. Surg Radiol Anat 30:297–302CrossRefPubMedGoogle Scholar
  28. 28.
    Raftery AT, Delbridge MS, Douglas HE (2012). Basic Science for the MRCS: a revision guide for surgical trainees (Elsevier Health Sciences)Google Scholar
  29. 29.
    Salerno G, Sinnatamby C, Branagan G, Daniels IR, Heald RJ, Moran BJ (2006) Defining the rectum: surgically, radiologically and anatomically. Colorectal Dis 8:5–9CrossRefPubMedGoogle Scholar
  30. 30.
    Shafik A (1996) Sigmoido-rectal junction reflex: role in the defecation mechanism. Clin Anat N Y N 9:391–394CrossRefGoogle Scholar
  31. 31.
    Shafik A (1999) A study of the effect of distension of the rectosigmoid junction on the rectum and anal canal with evidence of a rectosigmoid-rectal reflex. J Surg Res 82:73–77CrossRefPubMedGoogle Scholar
  32. 32.
    Shafik A, Doss S, Asaad S, Ali YA (1999) Rectosigmoid junction: anatomical, histological, and radiological studies with special reference to a sphincteric function. Int J Colorectal Dis 14:237–244CrossRefPubMedGoogle Scholar
  33. 33.
    Shafik A, El-Sibai O, Mostafa RM, Shafik AA (2001) Electric activity of the rectosigmoid canal and its relation to rectal and sigmoid electric activity: an evidence of a sphincteric function of the rectosigmoid canal. Front Biosci J Virtual Libr 6:B6–B9CrossRefGoogle Scholar
  34. 34.
    Shafik A, Mostafa RM, Shafik AA (2002) Electrophysiological study of the rectosigmoid canal: evidence of a rectosigmoid sphincter. J Anat 200:517–521CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Shafik A, Shafik AA, El Sibai O, Ahmed I, Mostafa RM (2006) Role of the rectosigmoidal junction in fecal continence: Concept of the primary continent mechanism. Arch Surg 141:23–26CrossRefPubMedGoogle Scholar
  36. 36.
    Simunovic M, Smith Aj, Heald Rj (2009) Rectal cancer surgery and regional lymph nodes. J Surg Oncol 99:256–259CrossRefPubMedGoogle Scholar
  37. 37.
    Sobin LH, Gospodarowicz MK, Wittekind C (2011). TNM classification of malignant tumours. WileyGoogle Scholar
  38. 38.
    Standring S (2005) Gray’s anatomy: the anatomical basis of clinical practice. Elsevier Churchill, LivingstoneGoogle Scholar
  39. 39.
    Steup WH, Moriya Y, van de Velde CJH (2002) Patterns of lymphatic spread in rectal cancer. A topographical analysis on lymph node metastases. Eur J Cancer 38:911–918CrossRefPubMedGoogle Scholar
  40. 40.
    Stollman N, Raskin JB (2004) Diverticular disease of the colon. The Lancet 363:631–639CrossRefGoogle Scholar
  41. 41.
    Stoss F (1990) Investigations of the muscular architecture of the rectosigmoid junction in humans. Dis Colon Rectum 33:378–383CrossRefPubMedGoogle Scholar
  42. 42.
    Topor B, Acland R, Kolodko V, Galandiuk S (2003) Mesorectal lymph nodes: their location and distribution within the mesorectum. Dis Colon Rectum 46:779–785CrossRefPubMedGoogle Scholar
  43. 43.
    Toyota S, Ohta H, Anazawa S (1995) Rationale for extent of lymph node dissection for right colon cancer. Dis Colon Rectum 38:705–711CrossRefPubMedGoogle Scholar
  44. 44.
    Wadhwa RP, Mistry FP, Bhatia SJ, Abraham P (1996) Existence of a high pressure zone at the rectosigmoid junction in normal Indian men. Dis Colon Rectum 39:1122–1125CrossRefPubMedGoogle Scholar
  45. 45.
    Wei Z, Yao J, Wang S, Liu J, Summers M, R (2012) Automated teniae coli detection and identification on computed tomographic colonography. Med Phys 39:964–975CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Yamazaki T, Shirai Y, Sakai Y, Hatakeyama K (1997) Ischemic stricture of the rectosigmoid colon caused by division of the superior rectal artery below Sudeck’s point during sigmoidectomy: report of a case. Surg Today 27:254–256CrossRefPubMedGoogle Scholar
  47. 47.
    Yin J, Chen JD (2008) Roles of interstitial cells of Cajal in regulating gastrointestinal motility: in vitro versus in vivo studies. J Cell Mol Med 12:1118–1129CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2017

Authors and Affiliations

  • Damien Massalou
    • 1
    • 2
    • 3
  • David Moszkowicz
    • 4
    • 5
  • Daniela Mariage
    • 1
  • Patrick Baqué
    • 1
    • 3
  • Olivier Camuzard
    • 3
  • Nicolas Bronsard
    • 3
  1. 1.Acute Care Surgery, Chirurgie Générale d’Urgencen Universitary Hospital of NiceHôpital Pasteur 2, Nice Sophia-Antipolis UniversityNiceFrance
  2. 2.Biomechanical Applied Laboratory, UMRT24, IFSTTARAix-Marseille UniversityMarseilleFrance
  3. 3.Institute of Anatomy, Medical school of NiceNice Sophia-Antipolis UniversityNiceFrance
  4. 4.AP-HP, Hôpital Ambroise Paré, Service de chirurgie digestive, oncologique et métaboliqueBoulogne-BillancourtFrance
  5. 5.UVSQ, Université Paris Saclay, UFR des sciences de la santé Simone VeilMontigny-Le-BretonneuxFrance

Personalised recommendations