The Transverse Mesocolon

Anatomic dissections and injection experiments have documented that the mesenteric plane of the transverse mesocolon extends preferentially downward along the TM-TL haustra toward the TO-TL row5 (Fig. 15-27). This constitutes the inferior border of the transverse colon.

Pancreatic lesions, by extending along the leaves of the transverse mesocolon, may then be revealed by their characteristic effects on the inferior haustral row. In severe pancreatitis, extravasated enzymes typically flatten the lower contours of the TO-TL row (Fig. 15-28). The enzymes may spread along the limits of the transverse mesocolon toward the left, so that the effects on the colon may end specifically at the level of the phreni-cocolic ligament. The haustral pattern of the uninvolved

Fig. 15-26. Choledochal cyst.

(a) Supine radiograph, oral cholecystogram. There is nonopacification of the gallbladder. Residual Telepaque outlines unaffected TM-TL haustra (arrows). However, the TM-TO row shows a double convex depression (arrowheads).

(From Meyers et al.5)

(b) At surgery, an enlarged gallbladder containing stones accounted for the lateral depression. This T-tube study shows that a choledochal cyst accounts for the medial depression of the TM-TO row.

Fig. 15-26. Choledochal cyst.

(a) Supine radiograph, oral cholecystogram. There is nonopacification of the gallbladder. Residual Telepaque outlines unaffected TM-TL haustra (arrows). However, the TM-TO row shows a double convex depression (arrowheads).

(From Meyers et al.5)

(b) At surgery, an enlarged gallbladder containing stones accounted for the lateral depression. This T-tube study shows that a choledochal cyst accounts for the medial depression of the TM-TO row.

Mesocolon Transverse

Fig. 15-27. Sagittal section through transverse colon.

Specimen shows that contrast material injected into the transverse mesocolon spreads preferentially downward along the TM-TL haustra toward the TO-TL row. TrM = transverse mesocolon; GC = gastrocolic ligament; GO = greater omentum; (Reproduced from Meyers et al.5)

Fig. 15-27. Sagittal section through transverse colon.

Specimen shows that contrast material injected into the transverse mesocolon spreads preferentially downward along the TM-TL haustra toward the TO-TL row. TrM = transverse mesocolon; GC = gastrocolic ligament; GO = greater omentum; (Reproduced from Meyers et al.5)

Fig. 15-28. Traumatic pancreatitis.

The extravasated enzymes have spread along the transverse mesocolon to involve the TO-TL row on the inferior contour with irregular flattening and rigidity. The process ends laterally at the level of the phrenicocolic ligament (arrows). The fixation results in pseudosaccular haustral outpouchings from the uninvolved TM-TO row on the superior border. This constellation of findings is pathognomonic of a process originating in the pancreas and extending along the transverse mesocolon. (Reproduced from Meyers et al.5)

Fig. 15-28. Traumatic pancreatitis.

The extravasated enzymes have spread along the transverse mesocolon to involve the TO-TL row on the inferior contour with irregular flattening and rigidity. The process ends laterally at the level of the phrenicocolic ligament (arrows). The fixation results in pseudosaccular haustral outpouchings from the uninvolved TM-TO row on the superior border. This constellation of findings is pathognomonic of a process originating in the pancreas and extending along the transverse mesocolon. (Reproduced from Meyers et al.5)

Fig. 15—29. Carcinoma of the pancreas extending along the transverse mesocolon results in fixation and mass along the inferior border of the transverse colon.

TM-TO row on the superior contour of the transverse colon is often thrown into a pseudosaccular appearance.

In a similar manner, direct extension of carcinoma of the pancreas to the transverse colon along the mesoco-lon characteristically involves the TO-TL row first or predominantly (Fig. 15-29).

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