. A manual of operative surgery . the female, so that the lower thirdhas no covering of peritoneum. The pouch formed by its passage tothe bladder in the male is known as the recto-vesical pouch, the corre-sponding pouch in the female between the vagina and rectum being thepouch of Douglas. The point of reflexion averages 3\ inches from theanus. The fossae formed by the peritoneum on either side by itsreflexion from the rectum to the posterior wall of the pelvis are knownas the pararectal fossce. 702 chap, xxxi] ANATOMY OF THE RECTUM 703 General relations.—Behind the rectum is closely connected
. A manual of operative surgery . the female, so that the lower thirdhas no covering of peritoneum. The pouch formed by its passage tothe bladder in the male is known as the recto-vesical pouch, the corre-sponding pouch in the female between the vagina and rectum being thepouch of Douglas. The point of reflexion averages 3\ inches from theanus. The fossae formed by the peritoneum on either side by itsreflexion from the rectum to the posterior wall of the pelvis are knownas the pararectal fossce. 702 chap, xxxi] ANATOMY OF THE RECTUM 703 General relations.—Behind the rectum is closely connected by areolartissue with the front of the sacrum and coccyx, and below these withthat portion of the pelvic floor formed by the meeting of the two leva-tores ani to form the ano-coccygeal raphe : when distended it may lieon each side on the pyriformis and sacral plexus. The two chief branchesof the superior hsemorrhoidal artery lie behind in the upper part, butlower down they pass to the sides. Laterally it is above in relation-. FIG. 189.—MEDIAN SECTION OF RECTUM AND BLADDER, ETC., IN THE MALE. {From Testut.) The relations of the peritoneum and sacrum and coccyx respectively to the rectum are shown ;it will be noticed how much of the rectum can be reached after excision of the coccyx. ship with the pararectal fossse and their contents, ileum or pelviccolon, below with the coccygei and levatores ani. In front, in the male, the lower part is in close contact with theprostate gland, the vesiculse seminales and the vasa deferentia, beingseparated from these only by the recto-vesical layer of the pelvic this is a triangular area where the base of the bladder and therectum are in close contact, the recto-vesical layer of the pelvic fasciaalone intervening. The boundaries of this triangle are, the reflexionof the peritoneum above, and the vasa deferentia at the sides ;above this, again, the rectum is covered on its anterior surface byperitoneum. On the anterior surface
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