18

CASE 18


A 21-year-old woman presented to her physician with complaints of diarrhea and abdominal pain. During the history, the patient stated that she suffered from these symptoms for a period of 2 to 3 weeks about 1 year ago and that her mother suffers from similar symptoms. A mass in the right lower abdominal quadrant was detected upon palpation. Laboratory tests showed that the patient’s leukocyte count was slightly elevated and stool culture was negative for pathogenic organisms. Radiologic studies revealed a narrowed distal ileum accompanied by dilation of the segment proximal to the obstructive lesion and mucosal cobblestoning ulcerations. Abscesses and fistulae were not observed radiologically. Endoscopic examination showed areas of ulceration in the colon (the rectum was normal) interspersed with normal mucosa as well as the cobblestoning ulcerations of the distal ileum. The patient was diagnosed with Crohn’s disease and treated with Pentasa, an oral 5-aminosalicylic acid, and folic acid supplementation.



WHAT IS THE ARTERIAL SUPPLY TO THE ILEUM AND THE COLON?


The ileum being a midgut derivative is supplied by the superior mesenteric artery. The colon is dually derived from the midgut and the hindgut. The cecum, vermiform appendix, ascending colon, and the right half to right two-thirds of the transverse colon are supplied by the superior mesenteric artery. The branches of the superior mesenteric artery that supply these segments of the large intestine are the ileocecal, right colic, and middle colic arteries.


The remaining distal colon formed from the hindgut is supplied by the inferior mesenteric artery. The middle rectal and the inferior rectal arteries provide blood in the inferior rectum and anal canal. The middle rectal is a branch of the internal iliac artery and the inferior rectal artery springs from the internal pudendal artery. The internal pudendal artery issues from the internal iliac artery.



COMPARE AND CONTRAST THE HISTOLOGIC CHARACTERISTICS OF THE ILEUM AND COLON


The histologic characteristics of the wall of the ileum and colon are described in Table 3-3.


TABLE 3-3 Histologic Characteristics of the Ileum and Colon










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Jun 16, 2016 | Posted by in ANATOMY | Comments Off on 18

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Wall Layer Ileum Colon
Mucosa
Plicae circulares (valves of Kerckring) are present proximally, but progressively diminish in height until they disappear in the terminal ileum.

Villi are present.

Absorptive cells exhibit well-developed microvilli (brush border).

Intestinal glands (crypts of Lieberkuhn) contain Paneth cells.