Gross Anatomy
The colon is a 5-6–ft long, inverted, U-shaped part of the large intestine (lower gastrointestinal tract). By definition, the cecum (and appendix) and ano-rectum, which are parts of the large intestine, are not included in the colon.
Embryologically, the colon develops partly from the midgut (ascending colon to proximal transverse colon) and partly from the hind gut (distal transverse colon to sigmoid colon).
On plain abdominal radiographs, the colon is seen to be filled with air and some fecal material. The colon is identified with haustra (irregular incomplete sacculations confer regular complete valvulae conniventes in jejunum).
The colon anatomy is displayed in the image below.
Colon anatomy, front of abdomen.
Ascending colon
The ascending (right) colon lies vertically in the most lateral right part of the abdominal cavity, occupying the right iliac fossa, right lumbar region and right hypochondrium. The proximal blind end (pouch) of the ascending colon is called the cecum. The ascending colon takes a right-angled turn just below the liver (right colic or hepatic flexure) and becomes the transverse colon, which has a horizontal course from right to left, occupying the right hypochondrium, epigastrium, and left hypochondrium.
Transverse colon
The transverse colon again takes a right-angled turn just below the spleen (left colic or splenic flexure, which is attached to the diaphragm by the phrenocolic ligament) and becomes the descending (left) colon, which lies vertically in the most lateral left part of the abdominal cavity, occupying the left hypochondrium, left lumbar region, and left iliac fossa. Splenic flexure is higher (cranial) to hepatic flexure. The descending colon leads to the inverted V-shaped sigmoid colon, which then becomes the rectum at the S3 level; the sigmoid colon is so called because of its S-shape.
Paracolic gutters
Lateral to ascending and descending colon are the right and left paracolic gutters of the peritoneal cavity, through which fluid/pus in the upper abdomen can trickle down into the pelvic cavity. The ascending and descending colon are related to the kidney, ureter, and gonadal vessels of the corresponding side that lie behind them in the retroperitoneum; the ascending colon is also related to the C loop (second part) of the duodenum.
Transverse colon and sigmoid colon
The transverse colon and the sigmoid colon have a mesentery (ie, transverse mesocolon and sigmoid mesocolon, respectively), but the ascending colon and descending colon are retroperitoneal, while the cecum is intraperitoneal but uses the mesentery of the ileum. The base of the transverse mesocolon lies horizontally across the duodenum and pancreas. The greater omentum has several parts, including the 4-layered omental apron hanging down off of the transverse colon and the 2-layered gastrocolic ligament connecting the greater curvature of the stomach and the transverse colon.
Three longitudinal teniae coli are present in the cecum, ascending colon, transverse colon, descending colon, and sigmoid colon; they are not present in the rectum. In the ascending and descending colon, they are present anteriorly and on the posterolateral and posteromedial aspects. Appendages of fat, containing small blood vessels, called omental appendages (appendices epiploicae) are attached to colon.
Blood supply
The colon is supplied by the superior mesenteric artery through its right colic and middle colic branches and by the inferior mesenteric artery through its left colic and multiple sigmoid branches. The terminal branches of these arteries entering the colonic wall are called vasa recta.
A continuing series of anastomoses between the distal branch of the proximal artery and the proximal branch of the distal artery runs along the mesenteric (inner) border of the colon and is called the marginal artery of Drummond. The marginal artery allows a long length of colon to be mobilized (eg, to be taken up into the chest to replace the esophagus after esophagectomy).
The arc of Riolan or the meandering mesenteric artery is a communication between the middle colic artery (or its left branch) and the left colic artery (or its ascending branch).
The junction of the proximal two thirds and distal one third of the transverse colon, where the terminal branches of the superior and inferior mesenteric arteries meet, is the watershed area, which is prone to ischemia.
The superior mesenteric vein accompanies the superior mesenteric artery, but the inferior mesenteric vein drains higher than the origin of the inferior mesenteric artery; it runs vertically upward to the left of the duodenojejunal junction (flexure) and enters the splenic vein or its junction with the superior mesenteric vein to form the portal vein.
Lymphatics of the colon drain into the epicolic (on the surface of colon), paricolic (next to colon), intermediate (along branches of named vessels), and main or mesocolic (along the named colic vessels) lymph nodes.