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.