Ішек қабыршағы: құрылысы мен функциясы

the mesentery in humans
Contiguous fold of tissues that supports the intestines

In human anatomy, the mesentery, an organ that attaches the intestines to the posterior abdominal wall, comprises the double fold of the peritoneum. It helps (among other functions) in storing fat and allowing blood vessels, lymphatics, and nerves to supply the intestines. The mesocolon (the part of the mesentery that attaches the colon to the abdominal wall) was formerly thought to be a fragmented structure, with all named parts—the ascending, transverse, descending, and sigmoid mesocolons, the mesoappendix, and the mesorectum—separately terminating their insertion into the posterior abdominal wall. However, in 2012, new microscopic and electron microscopic examinations showed the mesocolon to be a single structure derived from the duodenojejunal flexure and extending to the distal mesorectal layer. Thus the mesentery is an internal organ.

The mesentery of the small intestine arises from the root of the mesentery (or mesenteric root) and is the part connected with the structures in front of the vertebral column. The root is narrow, about 15 cm long, 20 cm in width, and is directed obliquely from the duodenojejunal flexure at the left side of the second lumbar vertebra to the right sacroiliac joint. The root of the mesentery extends from the duodenojejunal flexure to the ileocaecal junction. This section of the small intestine is located centrally in the abdominal cavity and lies behind the transverse colon and the greater omentum. The mesentery becomes attached to the colon at the gastrointestinal margin and continues as the several regions of the mesocolon. The parts of the mesocolon take their names from the part of the colon to which they attach. These are the transverse mesocolon attaching to the transverse colon, the sigmoid mesocolon attaching to the sigmoid colon, the mesoappendix attaching to the appendix, and the mesorectum attaching to the upper third of the rectum. The mesocolon regions were traditionally taught to be separate sections with separate insertions into the posterior abdominal wall. In 2012, the first detailed observational and histological studies of the mesocolon were undertaken and this revealed several new findings. The microscopic structure of the mesocolon and associated fascia is consistent from ileocecal to mesorectal levels. A surface mesothelium and underlying connective tissue is universally apparent. Adipocytes lobules within the body of the mesocolon are separated by fibrous septa arising from submesothelial connective tissue. Where apposed to the retroperitoneum, two mesothelial layers separate the mesocolon and underlying retroperitoneum. Between these is Toldt's fascia, a discrete layer of connective tissue. Lymphatic channels are evident in mesocolic connective tissue and in Toldt's fascia. During these topographic changes, the dorsal mesentery undergoes corresponding changes. Most anatomical and embryological textbooks say that after adopting a final position, the ascending and descending mesocolons disappear during embryogenesis. Embryology—An Illustrated Colour Text, "most of the mid gut retains the original dorsal mesentery, though parts of the duodenum derived from the mid gut do not. The mesentery associated with the ascending colon and descending colon is resorbed, bringing these parts of the colon into close contact with the body wall." To reconcile these differences, several theories of embryologic mesenteric development—including the "regression" and "sliding" theories—have been proposed, but none has been widely accepted. The lesser omentum is formed, by a thinning of the mesoderm or ventral mesogastrium, which attaches the stomach and duodenum to the anterior abdominal wall. By the subsequent growth of the liver, this leaf of mesoderm is divided into two parts – the lesser omentum between the stomach and liver, and the falciform and coronary ligaments between the liver and the abdominal wall and diaphragm. Thrombosis of the superior mesenteric vein can cause mesenteric ischemia also known as ischemic bowel. Mesenteric ischemia can also result from the formation of a volvulus, a twisted loop of the small intestine that when it wraps around itself and also encloses the mesentery too tightly can cause ischemia. The rationalization of mesenteric and peritoneal fold anatomy permits the surgeon to differentiate both from intraperitoneal adhesions—also called congenital adhesions. These are highly variable among patients and occur in several locations. Congenital adhesions occur between the lateral aspect of the peritoneum overlying the mobile component of the mesosigmoid and the parietal peritoneum in the left iliac fossa. During the lateral to the medial approach of mobilizing of the mesosigmoid, these must be divided first before the peritoneum proper can be accessed. Similarly, focal adhesions occur between the undersurface of the greater omentum and the cephalad aspect of the transverse mesocolon. These can be accessed after dividing the peritoneal fold that links the greater omentum and transverse colon. Adhesions here must be divided to separate the greater omentum off the transverse mesocolon, thus allowing access to the lesser sac proper. Recently, the surgical principles underpinning TME in rectal cancer have been extrapolated to colonic surgery. Total or complete mesocolic excision (CME), use planar surgery and extensive mesenterectomy (high tie) to minimise breach of the mesentery and maximise lymph nodes yield. Application of this T/CME reduces local five year recurrence rates in colon cancer from 6.5% to 3.6%, while cancer related five year survival rates in patients resected for cure increased from 82.1% to 89.1%.

Recent radiologic appraisals of the mesenteric organ have been conducted in the context of the contemporary understanding of mesenteric organ anatomy. When this organ is divided into non flexural and flexural regions, these can readily be differentiated in most patients on CT imaging. Clarification of the radiological appearance of the human mesentery resonates with the suggestions of Dodds and enables a clearer conceptualization of mesenteric derangements in disease states.

The word "mesentery" and its Neo Latin equivalent mesenterium (,/m//ɛ//z//ə//n/'/t//ɛ//r//i//ə//m/) use the combining forms mes + enteron, ultimately from ancient Greek μεσεντερον , from [[wikt:μέσος#Ancient Greek (, "middle") + [[wikt:ἔντερον#Ancient Greek (, "gut"), yielding "mid intestine" or "midgut". The adjectival form is "mesenteric" (,/m//ɛ//z//ə//n/'/t//ɛ//r//ᵻ//k/).

An improved understanding of mesenteric structure and histology has enabled a formal characterization of mesenteric lymphangiology. Stereologic assessments of the lymphatic vessels demonstrate a rich lymphatic network embedded within the mesenteric connective tissue lattice. On average, vessels occur every , and within from the mesocolic surfaces—anterior and posterior. Lymphatic channels have also been identified in Toldt's fascia, though the significance of this is unknown.