The Gastrocolic Ligament

Figure 15-19 shows that processes extending along or arising within the gastrocolic ligament may be clearly identified by their specific effect on the transverse colon. Anatomic dissections have shown that the point of attachment of the gastrocolic ligament is actually within a couple of centimeters cephalad to the taenia omentalis. Injection experiments consistently demonstrate that the mesenteric plane of extension is preferentially upward along the TM-TO haustral row.5 This constitutes the superior border of the transverse colon.

Selective involvement of this row of sacculations may thus reveal extension of a carcinoma of the stomach along the gastrocolic ligament (Figs. 15-20 and 15-21).

With even greater mural invasion and consequent fixation, the haustral pattern of the uninvolved TO-TL row on the inferior contour of the transverse colon is often thrown into a pseudosaccular appearance (Fig. 15-20).

The pseudosacculations of the haustral row opposite to that primarily involved by fixation are basically a functional phenomenon. They are largely a consequence of disordered peristaltic contractions and thus change in size, shape, and axis. In contrast, the pseudosacculations of scleroderma of the colon are constant structures brought about by atrophy of the muscle and collagenous replacement. Characteristically, they have wide mouths, contain fecaliths, and fail to contract on postevacuation studies. They are most consistently seen arising from the TO-TL haustra of the transverse colon (Fig. 15-22).

Lesions originating within the gastrocolic ligament may produce similar changes of the TM-TO haustra, but characteristically, they are either more localized or lack the tethering of mucosal folds. Fig. 15-23 illustrates localized changes involving only three haustra of the TM-TO row secondary to an actinomycotic abscess within the gastrocolic ligament. If a mass within the ligament bulges anteriorly, it may characteristically extend to depress the TO-TL haustral row as well (Fig. 15-24).

Not all instances of extrinsic involvement of the TM-TO row reflect a lesion within the gastrocolic ligament.

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Fig. 15—18. Appendices epi-ploicae of the colon.

(a and b) In an instance of massive ascites, appendices epiploi-cae are visible as tabulated and fingerlike projections from the descending and sigmoid colon (arrows). These appendages are contiguous with subserosal peri-colic fat.

Pancreas Transverse SectionDiverticula Between Taenia

Fig. 15—19. Sagittal section through the transverse colon.

Specimen shows that injection of contrast material into the gastrocolic ligament spreads preferentially to the superior TM-TO haustral row. GC = gastrocolic ligament; GO = greater omentum; TM = transverse mesocolon; S = stomach; P = pancreas. (Reproduced from Meyers et al.5)

Fig. 15—19. Sagittal section through the transverse colon.

Specimen shows that injection of contrast material into the gastrocolic ligament spreads preferentially to the superior TM-TO haustral row. GC = gastrocolic ligament; GO = greater omentum; TM = transverse mesocolon; S = stomach; P = pancreas. (Reproduced from Meyers et al.5)

Fig. 15—20. Extensive invasion of the TM-TO row (arrowheads) by gastric carcinoma spreading down the gastrocolic ligament.

The fixation results in pseudosaccular haustral outpouchings from the uninvolved TO-TL row on the inferior border.

(Reproduced from Meyers et al.5)

Fig. 15—20. Extensive invasion of the TM-TO row (arrowheads) by gastric carcinoma spreading down the gastrocolic ligament.

The fixation results in pseudosaccular haustral outpouchings from the uninvolved TO-TL row on the inferior border.

(Reproduced from Meyers et al.5)

Haustral Apprearance The Colon

Fig. 15—21. Carcinoma of the stomach extending down the gastrocolic ligament involves the TM-TO haustral row on the superior contour of the transverse colon (arrowheads). The TM-TL and TO-TL rows are not affected.

(Reproduced from Meyers et al.5)

Scleroderma Colon Pics

Fig. 15-22. Scleroderma of the colon.

Fecalith-containing pseudosacculations (arrowheads) arise characteristically from the TO-TL haustral row. (Reproduced from Meyers et al.5)

Fig. 15-22. Scleroderma of the colon.

Fecalith-containing pseudosacculations (arrowheads) arise characteristically from the TO-TL haustral row. (Reproduced from Meyers et al.5)

Fig. 15-23. Localized abscess in the gastrocolic ligament results in effacement, depression, and mucosal irregularities of TM-TO haustra (arrows) in the transverse colon.

Fig. 15—24. Hemorrhagic cyst of the gastrocolic ligament.

(a) Mass in the region of the gastrocolic ligament bulges anteriorly into the greater peritoneal cavity. It elevates the stomach (S), compresses the TM-TO row from in front, and depresses the superior contour of the TO-TL row (arrows).

Fig. 15—24. Hemorrhagic cyst of the gastrocolic ligament.

(a) Mass in the region of the gastrocolic ligament bulges anteriorly into the greater peritoneal cavity. It elevates the stomach (S), compresses the TM-TO row from in front, and depresses the superior contour of the TO-TL row (arrows).

Gastrocolic Flexure

Fig. 15-25. Courvoisier gallbladder secondary to pancreatic carcinoma.

Double-contrast barium enema. Prone film demonstrates extrinsic mass compression on the superior borders of the TM-TO haustral row of the hepatic flexure.

Fig. 15-25. Courvoisier gallbladder secondary to pancreatic carcinoma.

Double-contrast barium enema. Prone film demonstrates extrinsic mass compression on the superior borders of the TM-TO haustral row of the hepatic flexure.

The normal gallbladder may locally indent the superior border of this row in the hepatic flexure. Conspicuous depression, however, indicates enlargement of the gallbladder, as may be seen in hydrops, empyema, or a Courvoisier condition (Fig. 15-25). Figure 15-26 illustrates the value of haustral analysis in the diagnosis of choledochal cyst.

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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