Henry Gray (18251861). Anatomy of the Human Body. 1918.
the sacculi. In the rectum it is thicker, of a darker color, more vascular, and connected loosely to the muscular coat, as in the esophagus.
As in the small intestine, the mucous membrane (Fig. 1082) consists of a muscular layer, the muscularis mucosæ; a quantity of retiform tissue in which the vessels ramify; a basement membrane and epithelium which is of the columnar variety, and resembles the epithelium found in the small intestine. The mucous membrane of the large intestine presents for examination glands and solitary lymphatic nodules.
The glands of the great intestine are minute tubular prolongations of the mucous membrane arranged perpendicularly, side by side, over its entire surface; they are longer, more numerous, and placed in much closer apposition than those of the small intestine; and they open by minute rounded orifices upon the surface, giving it a cribriform appearance. Each gland is lined by short columnar epithelium and contains numerous goblet cells.
The solitary lymphatic nodules (noduli lymphatic solitarii) (Fig. 1082) of the large intestine are most abundant in the cecum and vermiform process, but are irregularly scattered also over the rest of the intestine. They are similar to those of the small intestine.
Vessels and Nerves.The arteries supplying the colon are derived from the colic and sigmoid branches of the mesenteric arteries. They give off large branches, which ramify between and supply the muscular coats, and after dividing into small vessels in the submucous tissue, pass to the mucous membrane. The rectum is supplied by the superior hemorrhoidal branch of the inferior mesenteric, and the anal canal by the middle hemorrhoidal from the hypogastric, and the inferior hemorrhoidal from the internal pudendal artery. The superior hemorrhoidal, the continuation of the inferior mesenteric, divides into two branches, which run down either side of the rectum to within about 12.5 cm. of the anus; they here split up into about six branches which pierce the muscular coat and descend between it and the mucous membrane in a longitudinal direction, parallel with each other as far as the Sphincter ani internus, where they anastomose with the other hemorrhoidal arteries and form a series of loops around the anus. The veins of the rectum commence in a plexus of vessels which surrounds the anal canal. In the vessels forming this plexus are smaller saccular dilatations just within the margin of the anus; from the plexus about six vessels of considerable size are given off. These ascend between the muscular and mucous coats for about 12.5 cm., running parallel to each other; they then pierce the muscular coat, and, by their union, form a single trunk, the superior hemorrhoidal vein. This arrangement is termed the hemorrhoidal plexus; it communicates with the tributaries of the middle and inferior hemorrhoidal veins, at its commencement, and thus a communication is established between the systemic and portal circulations. The lymphatics of the large intestine are described on page 711. The nerves are derived from the sympathetic plexuses around the branches of the superior and inferior mesenteric arteries. They are distributed in a similar way to those found in the small intestine.
Congenital Hernia.There are some varieties of oblique inguinal hernia (Fig. 1084) depending upon congenital defects in the saccus vaginalis, the pouch of peritoneum which precedes the descent of the testis. Normally this pouch is closed before birth, closure commencing at two points, viz., at the abdominal inguinal ring and at the top of the epididymis, and gradually extending until the whole of the intervening portion is converted into a fibrous cord. From failure in the completion of this process, variations in the relation of the hernial protrusion to the testis and tunica vaginalis are produced; these constitute distinct varieties of inguinal hernia, viz., the hernia of the funicular process and the complete congenital variety.
Where the saccus vaginalis remains patent throughout, the cavity of the tunica vaginalis communicates directly with that of the peritoneum. The intestine descends along this pouch into the cavity of the tunica vaginalis which constitutes the sac of the hernia, and the gut lies in contact with the testis. Though this form of hernia is termed complete congenital, the term