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



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.


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.


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.


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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  1. 1.

    Moore KL (2003) The digestive system. In: Moore KL (ed) The developing human, 7th edn. Philadelphia Saunders, Philadelphia, pp 211–241

    Google Scholar 

  2. 2.

    Treves SF (1885) Lectures on the anatomy of the intestinal canal and peritoneum in man. Br Med J 1:415

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  3. 3.

    Standring S (2008) Large intestine. In: Standring S (ed) Gray's anatomy: The anatomical basis of clinical practice, 40th edn. Churchill Livingstone, London, 1137

    Google Scholar 

  4. 4.

    McMinn RH (1994) The gastrointestinal tract. In: McMinn RH (ed) Last‘s Anatomy: Regional and Applied, 9th edn. Langman group Ltd, London, pp 331–342

    Google Scholar 

  5. 5.

    Netter FH (2007) Abdomen. In: Netter FH (ed) Atlas of human anatomy. Saunders, Philadelphia, 270

    Google Scholar 

  6. 6.

    Coffey JC (2013) Surgical anatomy and anatomic surgery – Clinical and scientific mutualism. Surgeon 11:177–182

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Culligan K, Coffey JC, Kiran RP et al (2012) The mesocolon: a prospective observational study. Color Dis 14:421–430

    Article  CAS  Google Scholar 

  8. 8.

    Culligan K, Remzi FH, Soop M et al (2013) Review of nomenclature in colonic surgery - Proposal of a standardised nomenclature based on mesocolic anatomy. Surgeon 11:1–5

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Culligan K, Walsh S, Dunne C, et al (2014) The mesocolon - a histological and electron microscopic characterisation of the mesenteric attachment of the colon prior to and after surgical mobilisation. Ann Surg. Jan 16

  10. 10.

    Culligan K, Sehgal R, Mulligan D, et al (2014) A detailed appraisal of mesocolic lymphangiology - an immunohistochemical and stereological analysis. J Anat. Jul 19

  11. 11.

    Tirkes T, Sandrasegaran K, Patel AA et al (2012) Peritoneal and retroperitoneal anatomy and its relevance for cross-sectional imaging. Radiographics 32:437–451

    Article  PubMed  Google Scholar 

  12. 12.

    Oliphant M, Berne AS (1982) Computed tomography of the subperitoneal space: demonstration of direct spread of intraabdominal disease. J Comput Assist Tomogr 6:1127–1137

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Dodds WJ, Darweesh RM, Lawson TL et al (1986) The retroperitoneal spaces revisited. AJR Am J Roentgenol 147:1155–1161

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    Spitzer V, Ackerman MJ, Scherzinger AL, Whitlock D (1996) The visible human male: a technical report. J Am Med Inform Assoc 3:118–130

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  15. 15.

    Ackerman MJ (1998) The Visible Human Project. Proc IEEE 86:504–510

    Article  Google Scholar 

  16. 16.

    Gray H (1918) Anatomy of the Human Body. Lea & Febiger, Philadelphia, pp 1147–1161

    Google Scholar 

  17. 17.

    Sinnatamby CS (2006) Last’s Anatomy: Regional and Applied, 11th edn. Churchill Livingstone Elsevier, London, p 242

    Google Scholar 

  18. 18.

    Shamshuddin S, Matthews HR (2014) Use of OsiriX in developing a digital radiology teaching library. Clin Radiol May 28

  19. 19.

    Rosset A, Spadola L, Ratib O (2004) OsiriX: an open-source software for navigating in multidimensional DICOM images. J Digit Imaging 17:205–216

    PubMed Central  Article  PubMed  Google Scholar 

  20. 20.

    Charnsangavej C, DuBrow RA, Varma DG, Herron DH, Robinson TJ, Whitley NO (1993) CT of the mesocolon. Part 1. Anatomic considerations. Radiographics 13:1035–1045

    Article  CAS  PubMed  Google Scholar 

  21. 21.

    Charnsangavej C, Dubrow RA, Varma DG, Herron DH, Robinson TJ, Whitley NO (1993) CT of the mesocolon. Part 2. Pathologic considerations. Radiographics 13:1309–1322

    Article  CAS  PubMed  Google Scholar 

  22. 22.

    Healy JC, Reznek RH (1998) The peritoneum, mesenteries and omenta: normal anatomy and pathological processes. Eur Radiol 8:886–900

    Article  CAS  PubMed  Google Scholar 

  23. 23.

    Johnson PT, Horton KM, Fishman EK (2009) Nonvascular mesenteric disease: utility of multidetector CT with 3D volume rendering. Radiographics 29:721–740

    Article  PubMed  Google Scholar 

  24. 24.

    Dighe S, Purkayastha S, Swift I et al (2010) Diagnostic precision of CT in local staging of colon cancers: a meta-analysis. Clin Radiol 65:708–719

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Dewhurst C, Rosen MP, Blake MA et al (2012) ACR Appropriateness Criteria pretreatment staging of colorectal cancer. J Am Coll Radiol 9:775–781

    Article  PubMed  Google Scholar 

  26. 26.

    MERCURY Study Group (2007) Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology 243:132–139

    Article  Google Scholar 

  27. 27.

    Koo BC, Chinogureyi A, Shaw AS (2010) Imaging acute pancreatitis. Br J Radiol 83:104–112

    PubMed Central  Article  CAS  PubMed  Google Scholar 

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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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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).

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