Anatomy Atlases(tm) : A digital library of anatomy information

Home | About | FAQ | Reviews | Search

Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus IV: Organ Systems: Large Intestine

Illustrated Encyclopedia of Human Anatomic Variation: Opus IV: Organ Systems: Digestive System and Spleen

Large Intestine

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD

Peer Review Status: Internally Peer Reviewed

The colon is usually found to be either retroperitoneal or intraperitoneal depending on the presence or absence of a mesentery or, another term, mesocolon. In a study of 100 subjects by Treves, 52% of ascending and descending colons did not have a mesocolon, hence they were by definition retroperitoneal. In 14%, both divisions of the colon had a distinct mesocolon (therefore, they were intraperitoneal along with the transverse and sigmoid divisions of the colon). In 12%, the ascending colon had a mesentery and 22% of the descending colons were suspended in a mesentery.

The principal variations are due to irregular or defective development.

In cases of of complete transposition of the viscera, the cecum and appendix lie in the left iliac fossa, and the sigmoid colon in the right. The ascending colon may not be completely retroperitoneal, resulting in a condition in which the transverse colon falls obliquely across the abdomen, covering the cecum and appendix, and extends from the right pelvic inlet to the left splenic flexure.

The proximal portion of the large intestine, as far as the left part of the transverse colon, may remain attached, along with the jejunoileum, to the posterior abdominal wall by a common mesentery.

The rotation of the intestinal loop, associated with the descent of the cecum and appendix and the formation of a descending colon, may be permanently arrested in any part of its course. In some cases, the descending colon remains near the median plane and is connected to the front of the vertebral column by a mesentery.

The descending colon may cross the posterior abdominal wall, with the sigmoid colon descending on the right side. The sigmoid may lie in the abdomen just inferior to the splenic flexure of the transverse colon, or in the right iliac fossa. Occasionally, the rectum opens into the bladder or urethra, or it may terminate blindly, giving rise to the condition known as imperforate anus.

Partial duplication of the large intestine has been reported and it may also be doubled.

The large intestine is about 2m in length.

Congenital microcolon has been reported with a frequency of 0.004% based upon two studies of 261,451 autopsies (Greig, 1925). The diameter of the colon in this disorder is about 5mm and extends from the caecum to the terminal part of the rectum.

Congenital anorectal anomalies have a frequency of 1/5000 - 1/10,000.


Ancel, P. and P. Cavaillon (1907) Sur les mesocolons ascendant et descendant et leur mode de formation chez l'homme. Assoc. Anatomistes Comptes Rendus 9:1-11.

Aitken, J. A case of colon and ileum duplex. Brit. J. Surg. 37:349-351.

Anger, T. (1872) Absence du rectum. Bulletins et Mem. de la Société Anatomique de Paris XLVIII(1):13.

Anson, B.J., Lyman, R.Y. and H.H. Lander (1936) The abdominal viscera in situ. A study of 125 consecutive cadavers. Anat. Rec. 67:17-21.

Anton, J.L., Panoff, C.E. and M.B. Spiegel. (1941) Segmental abdominal heterotaxy. Ann. Surg. 56:446- 456.

Arkema, K.K. and L. Calenoff. (1977) Adenocarcinoma in tubular duplication of the sigmoid colon. Gastro. Intest. Radiol. 2:137-138.

Aubrespy, P., Boureau, M., Derlon, S., Weisgerber, M. and A. Alesandrini. (1984) Les duplications digestives abdominothoraciques. Revue générale à propos de 2 observations. J. Chir. 121:85-89.

Ault, G.W., Castro, A.F. and R.S. Smith. (1952) Clinical study of ligation of the inferior mesenteric artery in left colon resections. Surg. Gynecol. Obstet. 94:223-228.

Bacon, H.E. and C.H. Smith. (1948) The arterial supply of the distal colon pertinent to abdominoperineal proctosigmoidectomy, with preservation of the sphincter mechanism. Ann. Surg. 127:28-33.

Bennett, W.H. and H.D. Rolleston. (1890) Abnormal arrangement of the ileo-coecal portion of the intestine. J. Anat. Physiol. 25:878-880.

Bhattachayya, B. (1926) Three cases of right-sided sigmoid colon. J. Anat. 60:229-232.

Bodian, M., Stephens, F.D. and B.C.H. Ward. (1949) Hirschsprung's disease and idiopathic megacolon. Lancet 1:6-11.

Bonnet Zeigler, L. (1970) Contribution personnele à l'étude des duplications du tube digestif, à propos de 18 observations. Thèse 1977, Lyon.

Bremer, J. (1944) Diverticula and duplications of intestinal tract. Arch. Pathol. 38:132.

Brunschwig, A., Dargeon, H.W. and W.A. Russell. (1948) Duplication of the entire colon and lower ileum, with termination of the colon into a vaginal anus. Surgery, 24:1010-1013.

Buirge, R.E. (1943) Gross variations in the ileocecal valve: A study of the factors underlying incompetency. Anat. Rec. 86:373-385.

Campenon, -. (1871) Deux cas d'imperforation de l'anus: position anormale de l'ampoule rectale. Bulletins et Mem. de la Société Anatomique de Paris XLVI(9 and 10):275-277.

Carslow, R.B. (1927-28) Right-sided viscerptosis: An estimate of the importance of abnormal mobility and prolapse of the ascending colon and caecum in the causation of various abnormal conditions, based on observations in a series of 242 cases treated by right coloprexy. Brit. J. Surg. 15:545-604.

Cohen, S.J. (1968) Diphallus with duplication of the colon and bladder. Proc. R. Soc. Med. 61:305-306.

Coran, A.G. and A.J. Eraklis. (1969) Atresia of the colon. Surgery 65:828-831.

Colton, E.J., Anson, B.J., Gibbs, E.W., McCormack, L.J., Reimann, A.F. and E.H. Daseler. (1947) Positions of abdominal viscera. Q. Bull. Northwestern University Medical School. 21:154-155.

Cozzi, F. and A.W. Wilkinson. (1968) Familial incidence of congenital anorectal anomalies. Surgery 64:669-671.

Daudet, M. (1967) In symposium consacré aux duplications intestinales. Ann. Chir. Inf. 8:55-56.

Delmas, J. (1906) Sur la forme du caecum. Assoc. Anatomistes Comptes Rendus 8:94-96.

Donald, C. (1927-28) Volvulus of small gut, caecum, and ascending colon, associated with congenital reversed rotation of intestine and with pregnancy. Brit. J. Surg. 15:269-272.

Dott, N.M. (1923-24) Anomalies of intestinal rotation: their embryology and surgical aspects: with a report of five cases. Brit. J. Surg. 11:251-286.

Dubey, P.N. (1907) Anomalous descending colon. J. Anat. Soc. India 7:112.

DuSèjours, D. (1922) Sur un cas d'occlusion intestinale par coudure et torsion du côlon ascendant. Bull. et Mém. Soc. de Chir. de Paris 48:285-287.

Eggers, C. (1922) Non-rotation of the large intestine. Ann. Surg. 75:757-758.

Espalieu, Ph., Balique, J.G. and J. Cuilleret. (1985) Tublar colonic duplications . A case report and literature review. Anatomia Clinica 7(2):125-130.

Faraboeuf, -. (1885) Arrêt de l'Evolution de l'intestin. Progrès Méd. 1885:411.

Frazer, J.E. and R.H. Robbins. (1915) On the factors concerned in causing rotation of the intestine in man. J. Anat. 50:75.

Gardner, C.E., Jr. (1950) The surgical significance of anomalies of intestinal rotation. Ann. Surg. 131:879-898.

Gross, R.E., Holocomb, G.W. and S. Faber. (1952) Duplications of the alimentary tract. Pediatrics 9:449-456.

Gruber, W. (1865) Weiterer Beiträge zu den durch Bildungsfehler bedingten Lagerungsanomalien des Darmes. Arch. Pathol. Anat. Physiol. Klin. Med. 32:94-104.

Hamdy, M. and M.F. Sorour. (1909) On a case of displacement of the descending colon. J. Anat. Physiol. 43:242-243.

Hunter, J.I. (1922) A mesentric cyst of jejunal origin, complicated by retrojejunal position of the transverse colon. Brit. Med. J. ii:800-802.

Huntington, G.S. (1903) The Anatomy of the Human Peritoneum. Kimpton and Co., London.

Hurst, A.F. and T.B. Johnston. (1921) Left-sided colon, with an anatomical note on non-rotation of the gut. Guy's Hospital Reports 71:369-375.

Clopp, E.J. (1922) Non-rotation of the colon. Ann. Surg. 76:281-282.

Koch, W. (1899) Die angeborenen ungewöhnlichen Lagen und Gestaltungen des menschlichen Darmes. Dtsch. Z. Chir. 50:1-63.

Korfel, Z., Choinacki, M., Chilimoniuk, M. and I. Szewko-Szawkowska. (1973) Variations of position of the abdominal viscera in man. Folia Morphol. 32:71-78.

Kottra, J.J. and W.J. Dodds. (1971) Duplication of the large bowel. Am. J. Roentgenol. 113:310-315.

Kratzer, G.L., Dixon, C.F. and J.A. Bargen. (1951) Duplication of the entire colon and terminal part of the ileum associated with parasitic twin. Proc. Staff Meet., Mayo Clin. 26:15-18.

Ladd, W.E. and R.E. Gross. (1934) Congenital malformations of anus and rectum: Report of 162 cases. Am. J. Surg. 23:167-183.

LeWald, L.T. (1915) Abnormal position of the colon. Ann. Surg. 61:112-113.

Lohman, A.J.M. and St. J. Ziekenhuis. (1946) Partieele verdubbeleling van den dikken darm (colon duplex) met unipolaire atresie. Nederlandsch Tijdschrift voor Geneeskunde 90:1735-1738. Cited in Excerpta Medica, Sec. 1, Vol. 2: abstract 200, p. 101, 1948.

Low, F.N. and W.C. Hilderman. (1940) A case of hyper-rotation of the colon. Anat. Rec. 77:27-30.

Lyons, A.S. (1948) The sigmoid as a source of right-sided symptoms. Ann. Surg. 127:399-409.

Maddox, E.E. (1883) Right-sided sigmoid flexure and rectum. J. Anat. Physiol. 17:403.

Mall, F.P. (1898) Development of the human intestine and its position in the adult. Johns Hopkins Hospital, Bulletin. 9:197-208.

Mayo, C.H. (1912) Failure of the colon to rotate. Med. Record 81:401-403.

McCoy, W.N. (1877) Imperforate anus; the rectum opening into the vulva; successful operation. American J. Med. Sci. 74:287-288.

McPherson, A.G., Trapnell, J.E. and G.R. Airth. (1969) Duplication of the colon. Brit. J. Surgery 56:138-142.

Mezzacappa, P.M., Price, A.P., Haller, J.O., Kassner, G. and F. Hansbrough. (1987) MR and CT demonstration of the levator sling in congenital anorectal anomalies. J. Computer Assist. Tomograph. 11(2):273-275.

Mole, R.H. (1929-30) Congenital non-rotation of the intestine. Brit. J. Surg. 17:670-672.

Morito, Y. (1941-42) über eine seltene Varietät des Blinddarmes und Colon ascendens bei einem Japaner. Folia Anat. Jpn. 21:541-551.

Nakazima, T. (1939) Eine Reisenschlingenbildung des Colon transversum bei einem Japaner. Folia Anat. Jpn. 18:219-222.

Nicola, N.E. (1921) Abnormal position of the iliac and pelvic colons. J. Anat. 56:53.

Pires de Lima, J.A. (1927) La duplicité de l'anus et sa signification morphologique. Assoc. Anatomistes Comptes Rendus 22:203-205.

Quénu, L., Chabrol, J. et P. Herlemont. (1954) Le colon, ses variations, ses artères. Assoc. Anatomistes Comptes Rendus 41:760-769.

Quervain, F. de (1902) über Rechtslagerung des ganzen Dickdarms und partiellen Situs inversus. Arch. Klin. Chir. 65:256-265.

Rannshoff, J. (1888) Considerations of the anatomy, physiology and pathology of the caecum and appendix. JAMA 11:40-46.

Ravitch, N. (1953) Hind gut duplication. Doubling of colon and genitourinary tract. Ann. Surg. 137:588-601.

River, L.P. and F.A. Reed. (1942) Volvulus of the cecum: Report of four cases. Ann. Surg. 116:874- 881.

Rixford, E. (1920) Failure of primary rotation of the intestine (left-sided colon) in relation to intestinal obstruction. Ann. Surg. 72:114-120.

Roberts, W.H. and P. Engen. (1977) The blood supply of the abdominally placed vertical sigmoid colon. Anat. Anz. 142:165-167.

Rothman, M., Bruckner, J.P. and D.F. Zetena. (1943) Volvulus of the cecum and ascending colon: A review of the literature and presentation of a case. Am. J. Surg. 60:292-297.

Sato, Y., Pringle, K.C., Bergman, R.A., Yuh, W.T.C., Smith, W.L., Soper, R.T. and E.A. Franken, Jr. (1988) Congenital anorectal anomalies: MR imaging. Radiology 168:157-162.

Schrupp, J.H. (1915) Left-sided appendicitis. Surg., Gynecol. Obstet. 21:442-447.

Seifert, F. (1914-15) Lageanomalien des Darmes bei einem Erwachsenen. Anat. Anz. :47:209-217.

Shepard, D. (1966) Antiperistaltic bowel segment in the treatment of the short bowel syndrome. Ann. Surgery 163:850-855.

Sielbauer, F. (1910) Verlagerung des Colon sigmoideum mit Tiefstand der linken Niere. Anat. Anz. 35:33-47.

Small, A. (1937) The surgical correction of anomalies in the fixation of the ascending colon. Ann. Surgery 106:230-241.

Smith, G.M. (1911) A statistical review of the variations in the anatomic positions of the caecum and processes vermiformis in the infant. Anat. Rec. 5:549-556.

Smith, G.E. (1904) Note on an abnormal colon. J. Anat. Physiol. 38:32-33.

Soper, R.T. (1968) Tublar duplication of the colon and distal ileum: case report and discussion. Surg. 63:998-1004.

Stephenson, F.B. (1936) Microcolon: Two case reports. Radiology 27:494-497.

Stone, H.B. (1939) Megarectum and megasigmoid. Ann. Surgery 109:791-798.

Strehl, H. (1908) Congenitale Retroposition des Dickdarmes. Arch. Klin. Chir. 87:8-19.

Sturgis, M.G. (1915) Congenital intestinal anomalies. Surg., Gynecol. Obstet. 21:447-451.

Tamoney, H.J. and R.E. Testa (1967) Carcinoma arising in a duplicated colon. Cancer 20:478-481.

Treves, F. (1885) Anatomy of the intestinal canal and peritneum in man. Brit. Med. J. i:470-474.

Treves, F. (1885) Lectures on the anatomy of the intestinal canal and peritoneum in man. Br. Med. J. 1:415, 470, 527, 580.

Tricomi-Allegra, G. (1906) Cas d'absence complète congénitale du rectum. Arch. Ital. Biol. 46:320.

Underhill, B.M.L. (1955) Intestinal length in man. Brit. Med. J. 2:1243-1246.

Veeraraghavan, K.A., Gonzales, E.T., Gibbons, M.D., Wagner, M.L. and F.J. Harberg. (1983) Cloacal duplication: Genitourinary and lower intestinal implications. J. Urol. 129:389-391.

Veneekas, G.M.H. (1951) Intrathoracic cysts of the stomach. Mandschr. Kinder 19:37.

deVries, P.A. and K.L. Cox. (1985) Surgery of anorectal anomalies. Surg. Clin. North America 65:1139-1169.

Weinstein, M. (193 8) Volvulus of the cecum and ascending colon. Ann. Surg. 107:248-259.

Wierda, J.1 (1947) An unusual peritoneal anomaly - a sac containing the jejunum, ileum, and transverse colon. Anat. Rec. 97:265-275.

Wolfer, J.A., Beaton, L.E. and B.J. Anson. (1942) Volvulus of the cecum: Anatomical factors in its etiology. Report of a case. Surg. Gynecol. Obstet. 74:882-894.

Wright, C.W. (1955) A case of a left-sided vermiform appendix, caecum and anomalous intestine. Anat. Rec. 123:291-298.

Young, R.B. (1885) Abnormal disposition of the colon. J. Anat. Physiol. 19:98-108.

Section Top | Title Page
Home | About Us | FAQ | Reviews | Contact Us | Search

Anatomy Atlases is curated by Michael P. D'Alessandro, M.D. and Ronald A. Bergman, Ph.D.

Please send us comments by filling out our Comment Form.

All contents copyright © 1995-2017 the Author(s) and Michael P. D'Alessandro, M.D. All rights reserved.

"Anatomy Atlases", the Anatomy Atlases logo, and "A digital library of anatomy information" are all Trademarks of Michael P. D'Alessandro, M.D.

Anatomy Atlases is funded in whole by Michael P. D'Alessandro, M.D. Advertising is not accepted.

Your personal information remains confidential and is not sold, leased, or given to any third party be they reliable or not.

The information contained in Anatomy Atlases is not a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.