Part 43

The mesenteric part is connected with the dorsal abdominal wall by the =great mesentery=. This is a wide fan-shaped fold, consisting of two layers of peritoneum, between which the vessels and nerves reach the bowel; it also contains the mesenteric lymph glands and some fat. The visceral border of the mesentery contains the intestine, while the parietal border or =root= (Radix mesenterii) is attached to a small area around the great mesenteric trunk under the first and second lumbar vertebræ. The root is thick, as it contains a large number of vessels and nerves placed close together. The mesentery is short at first, but soon reaches a length of one and a half to two feet (ca. 50 cm.)—sufficient to allow coils of the intestine to reach the abdominal floor, the pelvic cavity, or even to descend into the scrotum through the inguinal canal. Near its termination the intestine (ileum) leaves the border of the mesentery, so that the latter has a free edge which passes to the cæcum.

=Structure.=—The wall consists of four coats—serous, muscular, submucous, and mucous, enumerated from without inward.

The =serous coat= is complete except at the mesenteric edge, where the vessels and nerves reach the bowel.

The =muscular coat= consists of an outer longitudinal and an inner circular layer, the latter being the thicker. In the last few feet of the intestine the muscular coat is very thick, and being usually firmly contracted in the dead subject, gives the impression that this part of the bowel is of smaller caliber; such, however, is not the case during life.

The =submucous coat= is a layer of areolar tissue in which the vessels and nerves ramify. It contains also the duodenal glands and the bases of the solitary glands and Peyer’s patches.

The =mucous membrane= is soft and velvety. It has a grayish or yellowish-red color and is very vascular. About five or six inches from the pylorus it forms a pouch, the =diverticulum duodeni=, in which the pancreatic and hepatic ducts open. On a small papilla opposite this is the termination of the accessory pancreatic duct. At the ileo-cæcal opening the mucous membrane projects slightly into the cavity of the cæcum, forming the =ileo-cæcal valve=. The free surface is thickly beset with villi, small projections of the mucous membrane which can be seen well by placing a piece of the membrane in water. They are relatively short and thick and have a distinct neck in the horse. Each contains a central lymph vessel (lacteal), and around this a plexus of capillaries, lymphoid tissue, and unstriped muscle-fibers. They are important agents in absorption from the contents of the intestine. The epithelium is columnar, with many goblet cells. Underneath the basement membrane is a layer of unstriped muscle-fibers, the =muscularis mucosæ=.

The glands of the small intestine are of three kinds:

1. The =intestinal glands= (Glandulæ intestinales Lieberkuehni) are found throughout. They are simple tubular glands which open between the villi.

2. The =duodenal glands= (Glandulæ duodenales Brunneri) are found in the first twenty feet (ca. 6 meters) of the bowel. They are racemose glands, and are situated in the submucosa, so that their ducts perforate the muscularis mucosæ and the mucous membrane.

3. The =lymph follicles= (Noduli lymphatici) are found either scattered or in groups. In the former case they are termed =solitary glands= (Noduli lymphatici solitarii), in the latter =Peyer’s patches= (Noduli lymphatici aggregati). The solitary glands are about the size of a millet-seed or a small sago grain. Peyer’s patches are situated chiefly along the surface opposite to the mesenteric attachment and begin about three or four feet from the pylorus. They number one to two hundred, and are usually one to two inches (2 to 5 cm.) long and a quarter of an inch to one-half inch (ca. 2 to 14 mm.) wide. Larger ones occur in the terminal part, where one patch may have a length of seven to fifteen inches (ca. 17 to 38 cm.) and a width of half an inch to one inch (ca. 5 to 25 mm.) in young horses (Ellenberger). They undergo atrophy in old subjects.

=Vessels and Nerves.=—The =arteries= of the small intestine come from the cœliac and anterior mesenteric arteries. The =veins= go to the portal vein. The =lymph vessels= are numerous and go to the mesenteric lymph glands. The =nerves= are derived from the vagus and sympathetic through the solar plexus.

THE LARGE INTESTINE

The large intestine (Intestinum crassum) extends from the termination of the ileum to the anus. It is about twenty-five feet (ca. 7.5 to 8 in.) in length. It differs from the small intestine in its greater size, in being sacculated, for the most part, possessing longitudinal bands, and having a more fixed position. It is divided into cæcum, great colon, small colon, and rectum.

THE CÆCUM

The =cæcum= (Intestinum cæcum) is a great cul-de-sac intercalated between the small intestine and the colon. It has a remarkable size, shape, and position in the horse. Its length is three to four feet (ca. 1 to 1.25 m.), and its capacity about seven to eight gallons (ca. 25 to 30 liters). It is conical in form, and is curved somewhat like a reversed comma. It is situated almost entirely to the right of the median plane, extending from the right iliac and sublumbar regions to the abdominal floor behind the xiphoid cartilage. Both extremities are blind, and the two orifices are placed close together on the concave curvature. It presents for description a base, a body, and an apex.

The =base= (Saccus cæcus) extends from about the thirteenth intercostal space backward almost to the pelvic inlet. Its greater curvature is dorsal, its lesser ventral; connected with the latter are the termination of the ileum and the origin of the colon. The =body= (Corpus cæci) extends downward and forward from the base and rests largely on the ventral wall of the abdomen. Its lesser curvature is about parallel with the costal arch and about five to six inches (10 to 15 cm.) below it. The =apex= (Apex cæci) lies usually on the abdominal floor about a hand’s length behind the xiphoid cartilage.

The base is attached dorsally by connective tissue and peritoneum on the ventral surface of the pancreas and right kidney, the psoas muscles, and the iliac fascia; internally, it is attached to the terminal part of the great colon, and ventrally to the origin of the great colon. The body is attached dorsally to the first part of the colon by the cæco-colic fold. The apex is free, and consequently may vary in position.

The cæcum has four =longitudinal bands= (Tæniæ), situated on the dorsal, ventral, right, and left surfaces; these cause four rows of =sacculations= (Haustra). The ventral band is entirely exposed or free (Tænia libera); the dorsal band is free on the apex. The cæcal arteries are placed on the other two. The right or parietal surface of the cæcum is related chiefly to the right abdominal wall, the diaphragm, duodenum, and liver. The left or visceral surface lies against the left divisions of the colon, the root of the great mesentery, and the small intestine.

The =ileo-cæcal orifice= (Ostium ileocæcale) is situated in the lesser curvature of the base, about four or five inches (ca. 10 to 12 cm.) to the right of the median plane and about opposite the lower end of the last rib. The end of the ileum is partially telescoped into the cæcum, so that the orifice is surrounded by a fold of mucous membrane, forming the =ileo-cæcal valve= (Valvula ileocæcalis). The peritoneum and longitudinal muscle-fibers do not take part in its formation.

The =cæco-colic orifice= (Ostium cæcocolicum) is placed above and external to the preceding one; the interval between them is only about two inches (ca. 5 cm.), and they are separated by a distinct ridge which projects into the interior of the cæcum. The orifice is slit-like and is small in relation to the size of the cæcum and colon. It has a =valvular fold= (Valvula cæcocolica) at its lower margin and a =muscular ring= (Sphincter cæci). Large crescentic or semilunar folds (Plicæ cæci) project into the cavity of the bowel, and between these are large pouches (Cellulæ cæci).

=Vessels and Nerves.=—The cæcal arteries come from the great mesenteric artery. The veins go to the portal vein. The nerves are derived from the great mesenteric plexus of the sympathetic.

THE GREAT COLON

The =great colon= (Colon crassum) begins at the cæco-colic orifice, and terminates by joining the small colon behind the saccus cæcus of the stomach. It is ten to twelve feet (ca. 3 to 3.7 m.) long, and its average diameter (exclusive of its narrowest part) is about eight to ten inches (ca. 20 to 25 cm.). Its capacity is more than double that of the cæcum. When removed from the abdomen, it consists of two parallel portions, which are connected by peritoneum and partially by areolar tissue also. _In situ_, it is folded so that it consists of four parts, which are designated according to their position or numerically. The three bent connecting parts are termed the flexures. The first, =right ventral part= (Colon ventrale dextrum), begins at the cæco-colic orifice about opposite the middle of the last rib, passes downward and forward along the right costal arch, and reaches the floor of the abdomen. Over the xiphoid cartilage it bends sharply to the left and backward, forming the =sternal flexure= (Flexura diaphragmatica ventralis). The second, =left ventral part= (Colon ventrale sinistrum), passes backward on the left part of the abdominal floor, and, on reaching the pelvic inlet, bends sharply dorsally and forward, forming the =pelvic flexure= (Flexura pelvina). This is continued by the third, =left dorsal part= (Colon dorsale sinistrum), which passes forward above the left ventral portion. On reaching the stomach, diaphragm, and left lobe of the liver, it turns to the right, forming the =diaphragmatic= or =gastro-hepatic flexure= (Flexura diaphragmatica dorsalis). The fourth or =right dorsal part= (Colon dorsale dextrum) passes backward above the first portion, and on reaching the inner or left surface of the base of the cæcum it turns upward and to the left behind the left sac of the stomach; here it becomes constricted, and joins the small colon below the left kidney.

The =caliber= of the great colon varies greatly at different points. At its origin it is only about two to three inches (ca. 5 to 7.5 cm.) in diameter. This soon increases to about eight to ten inches (ca. 20 to 25 cm.) for the ventral portions. Beyond the pelvic flexure the diameter is reduced to about three or four inches (ca. 8 to 9 cm.). Near the diaphragmatic flexure the caliber rapidly increases, and reaches its maximum in the last division, where it may be about twenty inches (50 cm.) in its widest part. This is succeeded by a somewhat funnel-shaped terminal contraction.

The first part of the great colon is attached to the lesser curvature of the cæcum by two layers of peritoneum which form the =cæco-colic fold=. The ventral parts of the colon are similarly connected to the dorsal parts of the same side by the mesocolon. The right portions are united also by areolar tissue and muscular fibers, the surface of contact being about four or five inches (ca. 10 to 12 cm.) wide; the left portions are attached to each other by a peritoneal fold wide enough to allow them to be drawn apart five or six inches (ca. 12 to 15 cm.) near the pelvic flexure. The terminal part of the colon is attached by peritoneum and areolar tissue to the ventral surface of the pancreas dorsally and to the base of the cæcum externally. It is connected indirectly with the diaphragm and liver by means of a fold derived from the right lateral ligament of the liver.

The =relations= are complex, but the more important facts are as follows: The ventral portions (first and second) have extensive contact with the abdominal wall ventrally and laterally. On the right side the colon is almost entirely excluded from contact with the flank by the cæcum; on the left side it has no contact with the upper part of the flank, being excluded here by coils of the small colon and small intestine. Dorsally the chief relations are to the stomach, duodenum, liver, pancreas, small colon, small intestine, aorta, vena cava, and portal vein. Since there are no transverse attachments of the right and left portions, and the latter have no attachment to the wall, they are subject to considerable displacement.[94] The pelvic flexure is variable in position, but usually it is directed to the right across the pelvic inlet.

The ventral portions of the colon have four longitudinal =muscular bands= (Tæniæ) which produce four rows of sacculations (Haustra). On the first part the external and internal bands are free; the dorsal band is covered by the adhesion to the overlying dorsal division, while the ventral band is largely covered by the adhesion to the cæcum. On the left ventral part the external and ventral bands are free; of the two dorsal bands, the inner one is concealed by the mesocolon, the outer one is chiefly free. The pelvic flexure has a band on its lesser curvature, which is continued on to the third part, concealed by the peritoneal attachment; these parts are practically non-sacculated. Near the diaphragmatic flexure two other bands appear, so that the flexure has three bands; two of these are dorsal and free, the third is ventral and concealed. The last part has three bands, of which the inner and outer ones are free, the ventral one covered.

THE SMALL COLON

The =small colon= (Colon tenue) begins at the termination of the great colon, behind the saccus cæcus of the stomach and below the left kidney, and is continued by the rectum at the pelvic inlet. Its length is about ten to twelve feet (ca. 3.5 m.), and its diameter about three to four inches (ca. 7.5 to 10 cm.).

Its coils lie in the space between the stomach and the pelvic inlet, dorsal to the left portions of the great colon. They are mingled with those of the small intestine, from which they are easily distinguished by the tæniæ and sacculation.

It is attached to the sublumbar region by the =colic mesentery=, and to the termination of the duodenum by a short peritoneal fold (Lig. duodeno-colicum). The great omentum is also attached to the origin of the bowel. The colic mesentery is narrow at its origin, but soon reaches a width of about three feet (ca. 80 to 90 cm.). Its parietal border is attached along a line extending from the ventral surface of the left kidney to the sacral promontory; it is continuous in front with the root of the great mesentery, and behind with the mesorectum.

There are two =tæniæ= and two rows of sacculations. Of the tæniæ, one is free, the other concealed by the mesentery. When the bowel is hardened _in situ_ its lumen between the pouches is reduced to a narrow slit.

THE RECTUM

The =rectum= (Intestinum rectum) is the terminal part of the bowel; it extends from the pelvic inlet to the anus.[95] Its length is about one foot (ca. 30 cm.). Its direction may be straight or oblique. The first or =peritoneal part= of the rectum is like the small colon, and is attached by a continuation of the colic mesentery termed the =mesorectum=. The second or =retroperitoneal part= forms a flask-shaped dilatation termed the =ampulla recti=; it is attached to the surrounding structures by connective tissue and muscular bands.

The first part of the rectum is related to the small colon and the pelvic flexure of the great colon. It is frequently deflected to the left by the latter. The second part of the rectum is related dorsally and laterally to the pelvic wall. Ventrally the relations differ in the two sexes. In the male they are the bladder, the terminal parts of the vasa deferentia, the vesiculæ seminales, the prostate, the bulbo-urethral (Cowper’s) glands, and the urethra. In the female they are the uterus, vagina, and vulva.[96]

=Structure of the Large Intestine.=—The =serous coat= covers the different parts in varying degrees. It does not cover (_a_) the opposed surfaces of the cæcum and colon which are between the layers of the cæco-colic fold and mesocolon; (_b_) the areas of attachment of the cæcum and colon to the pancreas, right kidney, and sublumbar region; (_c_) the second part of the rectum.

The =muscular coat= consists of longitudinal and circular fibers. The bulk of the former is in the bands already described. Some of the circular fibers pass from one part of the colon to another, where they are attached to each other, forming the fibræ transversæ coli. The muscular coat of the second part of the rectum presents special features. The longitudinal layer of fibers is very thick and consists of large bundles, loosely united. A large band, the =recto-coccygeus=, is detached from it on either side, and passes upward and backward to be inserted into the fourth and fifth coccygeal vertebræ.

The =submucous tissue= is abundant in the wall of the rectum, so that the mucous membrane is loosely attached to the muscular coat, and forms numerous folds when the bowel is empty.

The =mucous membrane= of the large intestine is thicker and darker in color than that of the small intestine. It forms large crescentic or semilunar folds corresponding to the external constrictions. It has no villi, Brunner’s glands, or Peyer’s patches. The =intestinal glands= (of Lieberkühn) are large and numerous. =Solitary glands= are also numerous, especially at the apex of the cæcum and in the left dorsal part of the colon.

=Blood-supply.=—Greater and lesser mesenteric and internal pudic arteries. The veins go to the portal vein.

=Nerve-supply.=—Mesenteric plexus of the sympathetic nerves.