An appraisal of the computed axial tomographic appearance of the human mesentery based on mesenteric contiguity from the duodenojejunal flexure to the mesorectal level

Abstract

Objective

The human mesentery is now regarded as contiguous from the duodenojejunal (DJ) to anorectal level. This interpretation prompts re-appraisal of computed tomography (CT) images of the mesentery.

Methods

A digital model and reference atlas of the mesentery were generated using the full-colour data set of the Visible Human Project (VHP). Seventy one normal abdominal CT images were examined to identify mesenteric regions. CT appearances were correlated with cadaveric and histological appearances at corresponding levels.

Results

Ascending, descending and sigmoid mesocolons were identifiable in 75 %, 86 % and 88 % of the CTs, respectively. Flexural contiguity was evident in 66 %, 68 %, 71 % and 80 % for the ileocaecal, hepatic, splenic and rectosigmoid flexures, respectively. A posterior mesocolic boundary corresponding to the anterior renal fascia was evident in 40 % and 54 % of cases on the right and left, respectively. The anterior pararenal space (in front of the boundary) corresponded to the mesocolon.

Conclusions

Using the VHP, a mesenteric digital model and reference atlas were developed. This enabled re-appraisal of CT images of the mesentery, in which contiguous flexural and non-flexural mesenteric regions were repeatedly identifiable. The anterior pararenal space corresponded to the mesocolon.

Key Points

The Visible Human Project (VHP) allows direct identification of mesenteric structures.

Correlating CT and VHP allows identification of flexural and non-flexural mesenteric components.

Radiologic appearance of intraperitoneal structures is assessed, starting from a mesenteric platform.

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Acknowledgments

The scientific guarantor of this publication is Prof. J. Calvin Coffey. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study received funding from the Graduate Entry Medical School, University of Limerick seed funding alone. No complex statistical methods were necessary for this paper. Images from the VHP were used under license. The cadavers used in the study had been bequeathed to the Medical School at the National University of Ireland Galway for the purpose of the advancement of medical knowledge. This is covered by legislation governing the practice of Anatomy in the Republic of Ireland (Anatomy Act 1832, the Anatomy Act 1871, Health Order 1949, Medical Practitioners Act 2007). Methodology: prospective, observational, multicenter study.

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Correspondence to J. Calvin Coffey.

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Coffey, J.C., Culligan, K., Walsh, L.G. et al. An appraisal of the computed axial tomographic appearance of the human mesentery based on mesenteric contiguity from the duodenojejunal flexure to the mesorectal level. Eur Radiol 26, 714–721 (2016). https://doi.org/10.1007/s00330-015-3883-0

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Keywords

  • Mesentery
  • Mesocolon
  • Radiology
  • Computed axial tomography
  • Toldt’s fascia