Abstract
An anatomical definition of the anal canal is from the dentate line to the anal verge. The dentate line is located approximately 2 cm proximal from the anal verge and about the middle of the internal sphincter. The pelvic muscles can be classified into three categories: (1) muscles attached along the pelvic bones, (2) pelvic floor muscles, and (3) anal sphincter muscles. The fascia structure is an anatomically important surgical index as it is a surgical resection plane and also a pathway of disease such as an abscess. Anorectal spaces including the perianal, intersphincteric, ischiorectal, postanal, and retrorectal space are comprised of the levator and anal sphincter muscles. The rectum is supplied by the median sacral artery and upper, middle, and lower rectal artery. The venous drainage of the rectum is to the inferior mesenteric vein into the portal system. Lymphatic drainage of the rectum is parallel to the running of arterial blood.
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Shafik A, Doss S, Ali YA, et al. Transverse folds of rectum: anatomic study and clinical implications. Clin Anat. 2001;14(3):196–203.
Abramson DJ. The valves of Houston in adults. Am J Surg. 1978;136(3):334–6.
Saleno G, Sinnatamby C, Branagan G, Daniels IR, Heald RJ, Moran BJ. Defining the rectum: surgically, radiologically and anatomically. Colorectal Dis. 2006;8(Suppl 3):5–9.
Wendell-Smith CP. Anorectal nomenclature: fundamental terminology. Dis Colon Rectum. 2000;43:1349–58. P.1-26.
Nivatvongs S, Stern HS, Fryd DS. The length of the anal canal. Dis Colon Rectum. 1981;24:600–1.
Klosterhalfen B, Offner F, Vogel P, et al. Anatomic nature and surgical significance of anal sinus and anal intramuscular glands. Dis Colon Rectum. 1991;34:156–60.
Heald RJ, Moran BJ. Embryology and anatomy of the rectum. Semin Surg Oncol. 1998;15(2):66–71.
Fenger C. The anal transitional zone. Acta Pathol Microbiol Immunol Scand Suppl. 1987;289(supplement):1–42.
Fenger C. The anal canal epithelium. A review. Scand J Gastroenterol Suppl. 1979;54:114–7.
von Seebach HB, Stumm D, Misch P, et al. Hidrocystoma and adenoma of apocrine anal glands. Virchows Arch A Pathol Anat Histol. 1980;386:231–7.
Strohbehn K. Normal pelvic floor anatomy. Obstet Gynecol Clin North Am. 1988;25:683–705.
Stoker J. Anorectal and pelvic anatomy. Best Pract Rec Clin Gastroenterol. 2009;23:463–75.
Fucini C, Elbetti C, Messerini L. Anatomic plane of separation between external anal sphincter and puborectalis muscle: clinical implications. Dis Colon Rectum. 1999;42:374–9.
Shafik A. Physioanatomic entirety of external anal sphincter with bulbocavernosus muscle. Arch Androl. 1999;42:45–54.
Larson KA, Yousuf A, Lewicky-Gaupp C, Fenner DE, DeLancey JO. Perineal body anatomy I living women: 3-dimensional analysis using thin-slice magnetic resonance imaging. Am J Obstet Gynecol. 2010;203:494.e15–21.
Mittal RK, et al. Purse-string morphology of external anal sphincter revealed by novel imaging technique. Am J Physiol Gastrointest Liver Physiol. 2014;306(6):G505–14.
Rociu E, Stoker J, Eijkemans MJ, Lame’ris JS. Normal anal sphincter anatomy and age- and sex-related variations at high-spatial resolution endoanal MR imaging. Radiology. 2000;217:395–401.
Lawson JO. Structure and function of the internal anal sphincter. Proc R Soc Med. 1970;63:84–9.
Gerdes B, Kohler HH, Zielke A, et al. The anatomical basis of anal endosonography. A study in postmortem specimens. Surg Endosc. 1997;11:986–90.
Shafic A. A concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. Dis Colon Rectum. 1987;30:970–82.
Bogduk N. Issues in anatomy: the external anal sphincter revisited. Aust N Z J Surg. 1996;66:626–9.
Haas PA, Fox TA Jr. The importance of the perianal connective tissue in the surgical anatomy and function of the anus. Dis Colon Rectum. 1977;20:303–13.
Macchi V, Porzionato A, Stecco C, Vigato E, Parenti A, DeCaro R. Histo-topographic study of the longitudinal anal muscle. Clin Anat. 2008;21:447–52.
Thomson WH. The nature of haemorrhoids. Br J Surg. 1975;62:542–52.
Lunniss PJ, Phillips RK. Anatomy and function of the anal longitudinal muscle. Br J Surg. 1992;79:882–4.
Heald RJ. The ‘Holy Plane’ of recta surgery. J R Soc Med. 1988;81(9):503–8.
Pearl RK, Monsen H, Abcarian H. Surgical anatomy of the pelvic autonomic nerves. A practical approach. Am Surg. 1986;52:236–7.
Shafic A, el-Sherif M, Youssef A, et al. Surgical anatomy of the pudendal nerve and its clinical applications. Clin Anat. 1995;8:110–5.
Stoss F. Investigation of the muscular architecture of the rectosigmoid junction in humans. Dis Colon Rectum. 1990;33:378–83.
Jones OM, Smeulders N, Wiseman O, et al. Lateral ligaments of the rectum: an anatomical study. Br J Surg. 1999;86(4):487–9.
Maurer CA. Urinary and sexual function after total mesorectal excision. Recent Results Cancer Res. 2005;165:196–204.
Barleben A, Mills S. Anorectal anatomy and physiology. Surg Clin North Am. 2010;90(1):1–15.
Llauger J, et al. The normal and pathologic ischiorectal fossa at CT and MR imaging. Radiographics. 1998;18(1):61–82.
Schuurman JP, Go PM, Bleys RL. Anatomical branches of the superior rectal artery in the distal rectum. Colorectal Dis. 2009;11(9):967–71.
Didio LJ, Diaz-Franco C, Schemainda R, et al. Morphology of the middle rectal arteries: a study of 30 cadaveric dissections. Surg Radiol Anat. 1986;8(4):229–36.
Siddharth P, Ravo B. Colorectal neurovasculature and anal sphincter. Surg Clin North Am. 1988;68(6):1185–200.
Lund JN, Binch C, McGrath J, et al. topographical distribution of blood supply to the anal canal. Br J Surg. 1999;86:496–8.
Sato K, Sato T. The vascular and neuronal composition of the lateral ligament of the rectum and the rectosacral fascia. Surg Radiol Anat. 1991;13:17–22.
Wang C, Zhou Z, Wang Z, et al. Patterns of neoplastic foci and lymph node micrometastasis within the mesorectum. Langenbecks Arch Surg. 2005;390(4):312–8.
Topor B, Acland R, Kolodko V, et al. Mesorectal lymph nodes: their location and distribution within the mesorectum. Dis Colon Rectum. 2003;46(6):779–85.
Canessa CE, Badia F, Fierro S, et al. Anatomic study of the lymph nodes of the mesorectum. Dis Colon Rectum. 2001;44:1333–6.
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Chung, C.S. (2019). Anorectal Anatomy. In: Lee, D. (eds) Practices of Anorectal Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-13-1447-6_1
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DOI: https://doi.org/10.1007/978-981-13-1447-6_1
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