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Sigmoid colon
Sigmoid colon
Sigmoid colon
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Sigmoid colon
Drawing of colon seen from front
(sigmoid colon coloured blue)
Front of abdomen, showing surface markings for liver, stomach and large intestine
Details
PrecursorHindgut
Part ofLarge intestine
SystemDigestive system
ArterySigmoid branches of inferior mesenteric artery, sigmoid arteries, internal iliac artery
NerveInferior mesenteric ganglia and sacral nerve[1]
Identifiers
Latincolon sigmoideum
MeSHD012809
TA98A05.7.03.007
TA22987
FMA14548
Anatomical terminology

The sigmoid colon (or pelvic colon) is the part of the large intestine that is closest to the rectum and anus. It forms a loop that averages about 35–40 centimetres (14–16 in) in length. The loop is typically shaped like a Greek letter sigma (ς) or Latin letter S (thus sigma + -oid). This part of the colon normally lies within the pelvis, but due to its freedom of movement it is liable to be displaced into the abdominal cavity.[2]

Structure

[edit]

The sigmoid colon begins at the superior aperture of the lesser pelvis, where it is continuous with the iliac colon, and passes transversely across the front of the sacrum to the right side of the pelvis.

It then curves on itself and turns toward the left to reach the middle line at the level of the third piece of the sacrum, where it bends downward and ends in the rectum.

Its function is to expel solid and gaseous waste from the gastrointestinal tract. The curving path it takes toward the anus allows it to store gas in the superior arched portion, enabling the colon to expel gas without excreting faeces simultaneously.

Coverings

[edit]

The sigmoid colon is completely surrounded by peritoneum (and thus is not retroperitoneal), which forms a mesentery (sigmoid mesocolon), which diminishes in length from the center toward the ends of the loop, where it disappears, so that the loop is fixed at its junctions with the iliac colon and rectum, but enjoys a considerable range of movement in its central portion.

Nerve supply

[edit]

Pelvic splanchnic nerves are the primary source for parasympathetic innervation. Lumbar splanchnic nerves provide sympathetic innervation via the inferior mesenteric ganglion.

Relations

[edit]

Behind the sigmoid colon are the external iliac vessels, ovary, obturator nerve, the left piriformis, and left sacral plexus of nerves.

In front, it is separated from the bladder in the male, and the uterus in the female, by some coils of the small intestine.

Clinical significance

[edit]

Diverticulosis often occurs in the sigmoid colon in association with increased intraluminal pressure and focal weakness in the colonic wall. It is a common cause of hematochezia.

Volvulus occurs when a portion of the bowel twists around its mesentery, which can lead to obstruction and infarction. Volvulus in the elderly commonly occurs in the sigmoid colon, whereas in infants and children it is more likely to occur in the midgut. This may correct itself spontaneously or the rotation may continue until the blood supply of the gut is cut off completely.

Additional images

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References

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[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Sigmoid colon

View on Grokipedia
from Grokipedia
The sigmoid colon is the terminal, S-shaped segment of the , connecting the to the and serving as the final site for water absorption and fecal compaction before . Approximately 25 to 40 centimeters (10 to 16 inches) in length, it begins at the where the ends and terminates at the level of the third sacral vertebra (S3), forming an intraperitoneal loop attached to the posterior abdominal wall by the sigmoid mesocolon, which contributes to its mobility within the or lower . Anatomically, the sigmoid colon features a muscular wall with longitudinal taeniae coli and circular layers that enable peristaltic contractions to propel contents forward, while its mucosa absorbs electrolytes, vitamins, and remaining from undigested material, transforming it into formed stool. Its blood supply primarily derives from the via sigmoidal branches, with venous drainage into the and lymphatic flow toward the inferior mesenteric nodes, supporting its role in the 's metabolic functions. Embryologically, it develops from the , partitioned during cloacal division, which underscores its shared vascular and functional ties with the . Clinically, the sigmoid colon's mobility and position predispose it to conditions such as , , and , with its diameter and fixation influencing surgical approaches like sigmoidectomy for obstructions or malignancies. It also plays a key role in by contracting to increase intraluminal pressure, pushing feces into the for storage until expulsion.

Anatomy

Location and gross structure

The sigmoid colon is the S-shaped segment that follows the , forming the final intraperitoneal portion of the before transitioning to the . It typically measures 35 to 40 cm in length, though this can vary from 25 to 40 cm among individuals, with a diameter of approximately 4 to 5 cm. The organ's characteristic sigma-like curvature arises from its flexible, looped configuration, which allows adaptation to the pelvic space. Positioned in the left lower quadrant of the , the sigmoid colon begins at the within the left , where it continues from the distal . It then descends into the lesser , curving medially and posteriorly across the anterior surface of the , before turning downward to terminate at the rectosigmoid junction at the level of the third sacral vertebra (S3). This path forms two primary curvatures: a superior loop that remains in the and an inferior loop that extends deeper into the , contributing to its overall mobility and variable positioning. The sigmoid colon's high degree of mobility stems from its completely intraperitoneal location and attachment to the posterior pelvic wall via the sigmoid mesocolon, a broad, inverted V-shaped peritoneal fold. This mesocolon permits the organ to shift within the or even extend upward into the , depending on factors such as body habitus and fecal content. The peritoneal covering of the sigmoid colon is complete, distinguishing it from the more fixed retroperitoneal segments of the proximal colon. Externally, the sigmoid colon exhibits the typical gross features of the , including three longitudinal muscle bands known as taeniae coli (mesocolic, omental, and free), which converge at the rectosigmoid junction. Contractions of these taeniae produce haustra, the pouch-like sacculations that give the colon its segmented appearance, while scattered appendices epiploicae—small, fat-laden peritoneal pouches—dot its serosal surface. These structures are consistent across colonic segments but are particularly prominent in the mobile sigmoid due to its intraperitoneal nature.

Mesentery and relations

The sigmoid mesocolon is a fan-shaped peritoneal fold that attaches the sigmoid colon to the posterior of the , providing support while allowing considerable mobility. This consists of two layers of enclosing connective tissue, fat, and neurovascular structures, and its line of attachment forms an inverted V-shape with the apex located near the bifurcation of the left at the . The left limb of this V extends superiorly along the medial border of the toward the left , while the right limb descends into the toward the third sacral vertebra. In contrast to the retroperitoneal descending colon, which is fixed to the posterior , the sigmoid colon receives a complete double layer of peritoneal covering via the sigmoid mesocolon. This intraperitoneal position, combined with the relatively long and variable length of the mesentery (typically around 15 cm), enables extensive mobility of the sigmoid colon within the , facilitating its S-shaped configuration and adaptation to fecal storage. Posteriorly, the sigmoid colon is related to the left ureter, which crosses the inferior to the gonadal vessels; the left gonadal vessels; the external iliac vessels; and the , which emerges from the medial border of the psoas major. These relations occur along the root of the where it attaches to the pelvic wall. Anteriorly, the sigmoid colon lies in close proximity to the urinary bladder in males and to the and ovaries in females, often separated by loops of that occupy the pelvic peritoneal space. The sigmoid colon has no prominent superior or inferior relations beyond its continuity with the at the sigmoid-descending junction and with the at the level of the third sacral .

Vascular supply

The sigmoid colon receives its arterial supply primarily from the (IMA), which arises from the at the level of the third . The IMA gives rise to three to four sigmoid arteries that course through the sigmoid mesocolon to supply the sigmoid colon, forming arcades that anastomose with one another. These sigmoid arteries connect to the marginal artery of Drummond, a continuous arterial arcade along the inner margin of the colon that provides collateral circulation between the branches of the IMA and the at the rectosigmoid junction. Venous drainage of the sigmoid colon parallels its arterial supply, with sigmoid veins accompanying the sigmoid arteries and draining into the (IMV). The IMV ascends to join the and ultimately enters the . Lymphatic drainage follows the vascular pathways, beginning with epicolic and paracolic nodes on the colonic surface, then progressing to sigmoid mesenteric nodes within the sigmoid mesocolon. From the sigmoid nodes, lymph flows to the inferior mesenteric nodes along the IMA, and subsequently to preaortic nodes, ultimately reaching the .

Innervation

The sigmoid colon receives autonomic innervation primarily from the parasympathetic and sympathetic divisions of the , which regulate its motor, secretory, and vascular functions, along with sensory afferents that convey visceral signals. The provides intrinsic coordination within the gut wall. Parasympathetic innervation arises from the (also known as nervi erigentes), originating from the ventral roots of spinal nerves S2 to S4. These preganglionic fibers travel through the and in intramural ganglia of the sigmoid colon wall, providing motor control to stimulate and glandular secretion. This innervation supports the "rest-and-digest" response, enhancing colonic motility. Sympathetic innervation is supplied by the lumbar splanchnic nerves, which emerge from the sympathetic trunks at levels L1 to L2 and synapse in the inferior mesenteric ganglion. Postganglionic fibers then distribute along branches of the to the sigmoid colon, where they mediate and inhibit motility and secretion. This contributes to the "fight-or-flight" response by reducing gastrointestinal activity. Sensory innervation involves visceral afferent fibers that travel alongside both sympathetic and parasympathetic pathways to transmit signals of distension, , and other visceral sensations from the sigmoid colon. Afferents via the lumbar splanchnic nerves (sympathetic) project to the thoracolumbar (T10-L2), while those via (parasympathetic) reach the sacral cord (S2-S4), enabling perception of colonic stimuli such as or cramping. These pathways ensure reflexive adjustments to gut distension. The integrates extrinsic autonomic inputs through the myenteric (Auerbach's) , located between the longitudinal and circular muscle layers, which primarily coordinates peristaltic , and the submucosal (Meissner's) , situated in the , which regulates local and blood flow in the sigmoid colon. These plexuses contain sensory neurons, , and motor neurons that function semi-autonomously, modulated by sympathetic inhibition and parasympathetic excitation.

Histology

The sigmoid colon exhibits the typical four-layered structure of the wall, adapted for its role in water absorption and fecal compaction. The innermost layer is the mucosa, consisting of a lined by absorptive enterocytes and numerous goblet cells that secrete to lubricate the luminal contents. Unlike the , the colonic mucosa lacks villi and instead features straight, tubular crypts of Lieberkühn that extend from the luminal surface to the , facilitating and absorption through stem cells at their base and interspersed enteroendocrine and Paneth cells. The beneath the is a rich in capillaries, lymphatics, and immune cells, including plasma cells, macrophages, and ; it often contains lymphoid follicles and aggregates that contribute to mucosal immunity. A thin of separates the mucosa from the , which comprises denser harboring blood vessels, nerves (including Meissner's ), and occasional extensions of lymphoid tissue. The muscularis externa consists of an inner thick circular layer of and an outer longitudinal layer that is concentrated into three bands known as taeniae coli, with Auerbach's ( situated between them to regulate motility; interstitial cells of Cajal within this layer generate electrical slow waves for . The outermost serosa is a layer of visceral covering the sigmoid colon, lined by mesothelial cells and supported by subserosal fibroadipose tissue. Histologically, the sigmoid colon resembles other segments of the descending and left colon but features a higher density of goblet cells compared to the right colon, enhancing production to protect the mucosa from abrasive fecal material and bacterial load.

Function

Motility and absorption

The sigmoid colon plays a crucial role in the final stages of by absorbing and s from the residual contents entering from the , thereby concentrating the contents and facilitating the formation of solid . This process is driven primarily by active sodium absorption through epithelial sodium channels and sodium-potassium pumps in the colonic mucosa, with ions following via exchange mechanisms, and moving passively along osmotic gradients to prevent . The reclaims a substantial portion of the sodium and accompanying that enters it, maintaining balance and forming compact for storage. Bacterial in the sigmoid colon further supports its physiological roles by breaking down undigested carbohydrates and fibers that escape small intestinal absorption, producing (SCFAs) such as , propionate, and butyrate. These SCFAs serve as the primary energy source for colonocytes, providing approximately 70% of their metabolic needs and promoting epithelial and barrier integrity through mechanisms like inhibition and G-protein coupled receptor activation. The fermentation process also generates vitamins like , , and , enhancing nutrient availability without requiring extensive host enzymatic breakdown. Motility in the sigmoid colon is characterized by coordinated contractions that promote slow transit and mixing, with haustral contractions occurring approximately every 30 minutes to gently knead and propel contents distally at a rate that allows for maximal absorption. Peristaltic waves, mediated by giant migrating contractions (2-10 times per day), provide periodic mass movements to advance fecal material, resulting in a total colonic transit time of 30-40 hours in healthy individuals. This slow progression through the distal colon, including the sigmoid, contributes to the overall colonic transit time of 30-40 hours in healthy individuals. Fermentation by colonic in the sigmoid colon also produces gases including , , and , which accumulate as flatus and are stored temporarily in the distensible lumen before expulsion. These gases arise from the breakdown of indigestible , with the sigmoid's function accommodating volumes that contribute to normal daily of 14-23 episodes.

Role in defecation

The sigmoid colon serves as a primary for fecal matter in the distal , storing formed stool after water and absorption in the proximal segments, which allows for controlled transfer to the prior to . This storage capacity, facilitated by its S-shaped configuration and haustra, enables the accumulation of fecal material without immediate expulsion, maintaining overall colonic . At the rectosigmoid junction, the abrupt angulation between the sigmoid colon and functions as a physiologic , preventing premature leakage of stool into the and contributing to voluntary control over . This anatomical feature, supported by the surrounding and structures, creates a high-pressure zone that aids in retaining fecal contents until appropriate conditions for expulsion arise. During , the sigmoid colon coordinates with rectal distension to initiate key es, including the , where postprandial gastric distension stimulates colonic motility and mass movements that propel fecal matter distally toward the . Rectal filling further triggers the rectoanal inhibitory , but sigmoid involvement ensures synchronized propulsion via parasympathetic efferents from the sacral , facilitating efficient stool evacuation. Additionally, sigmoido-anal inhibitory es, where distension of the sigmoid colon leads to relaxation, and ano-sigmoid excitatory es, promoting sigmoid contraction in response to anal stimulation, enhance the overall mechanism. The sigmoid colon contributes to fecal continence through haustral segmentation, a pattern of localized contractions that mixes and compacts stool while preventing uncontrolled distal movement, thereby supporting the anal sphincters in maintaining continence between defecation episodes. This segmentation, driven by the , ensures stool remains malleable yet contained, reducing the risk of incontinence during daily activities.

Embryology and variations

Development

The sigmoid colon originates from the during early embryonic development. By the fourth week of , the primitive gut tube has differentiated into , , and regions, with the proliferating rapidly to form the foundational of the distal colon, including the future descending and sigmoid segments. This al layer, in conjunction with surrounding splanchnic , establishes the initial tubular structure that will elongate and differentiate into the hindgut derivatives. Between weeks 6 and 10, the developing intestines undergo and fixation, during which the and sigmoid colon differentiate from the midgut-hindgut junction. Initially positioned sagittally, these segments shift leftward through counterclockwise of the intestinal loop, becoming fixed to the posterior via the and adopting their characteristic positions—the along the left flank and the sigmoid forming an S-shaped curve in the . This process ensures proper alignment for the adult configuration, with the sigmoid colon's mobility retained due to its mesocolon. Concomitant with these changes, the cloaca—the common chamber for hindgut and urogenital derivatives—is septated by the urorectal septum. Derived from mesoderm, this septum grows caudally between weeks 7 and 8 to divide the cloaca into a ventral urogenital sinus and a dorsal anorectal canal, thereby isolating the hindgut-derived rectum (continuous with the sigmoid colon) from the developing urinary and genital systems. The vascular supply for the sigmoid colon emerges from the remodeling of the embryonic vitelline arteries, which initially form a paired series arising from the dorsal aortas to nourish the yolk sac and gut. The inferior mesenteric artery specifically develops from the persistence of the 21st vitelline arterial segment, while adjacent segments regress, ensuring targeted blood flow to the hindgut structures including the sigmoid colon from the mid-transverse colon distally.

Anatomical variations

The sigmoid colon exhibits notable anatomical variations, particularly in its length, which can range from shorter configurations to redundant forms exceeding the typical 25-40 cm average. A redundant sigmoid colon, characterized by excessive length and looping that prevents straightforward accommodation within the , may extend up to 70 cm in some individuals, often requiring or to fit anatomically. This variation, known as dolichosigmoid or part of , has a reported of approximately 16% in certain cohorts, with incidences ranging from 1.9% to 28.5% across studies. It occurs more frequently in specific ethnic groups, such as Africans, who demonstrate significantly longer sigmoid lengths and narrower mesocolons compared to other populations. Anomalous positions of the sigmoid colon arise from incomplete or aberrant fixation during development, potentially linked to embryonic rotation anomalies. These include extensions of a mobile influencing sigmoid positioning or non-rotation leading to inadequate pelvic fixation, resulting in a freely mobile or ectopically placed sigmoid, such as a right-sided variant. Such positional anomalies are rare, often discovered incidentally during , and deviate from the standard left lower quadrant location. Vascular anomalies in the sigmoid colon primarily involve variations in the marginal artery of Drummond, which may be absent or incomplete in some cases, thereby increasing the risk of ischemia due to compromised collateral blood flow. This absence has been observed in approximately 9% of anatomical dissections in the sigmoid region.

Clinical significance

Diseases and disorders

refers to the formation of multiple sac-like outpouchings, known as pseudodiverticula, in the wall of the sigmoid colon, primarily due to increased intraluminal pressure from low-fiber diets and altered colonic motility that weakens the colonic wall. These pseudodiverticula develop most commonly in the sigmoid colon because of its narrow lumen and high pressure gradients. occurs when these diverticula become inflamed or infected, often from fecal matter trapping and bacterial overgrowth, leading to symptoms such as acute left lower quadrant , fever, , and changes in bowel habits. The condition is more prevalent in older adults in Western populations, with complications including formation or if untreated. Sigmoid volvulus involves the twisting of the sigmoid colon around its , resulting in mechanical obstruction and potential ischemia, particularly in elderly individuals with chronic , a redundant sigmoid colon, or institutionalization. This anatomical mobility of the sigmoid predisposes it to such torsion, especially in males over 60 with neuropsychiatric conditions. Symptoms typically include sudden-onset colicky , marked distension, obstipation, and , often mimicking other forms of . Colorectal cancer in the sigmoid colon most commonly manifests as adenocarcinoma, arising from adenomatous polyps that undergo malignant transformation through genetic mutations in the epithelial lining. Approximately 20-30% of colorectal cancers occur in the sigmoid region, reflecting its exposure to fecal carcinogens and higher polyp prevalence in the distal colon. Early symptoms may be absent, but advanced cases present with rectal bleeding, altered bowel habits, and left lower quadrant pain due to partial obstruction. Inflammatory bowel disease, particularly ulcerative colitis, frequently involves the sigmoid colon with continuous mucosal inflammation starting from the rectum and extending proximally, driven by immune dysregulation and environmental triggers. This leads to crypt abscesses, ulceration, and friable mucosa in the sigmoid, contributing to symptoms like bloody , tenesmus, and crampy . The sigmoid's involvement is common in left-sided , affecting up to 50% of cases with this pattern. Ischemic colitis affects the sigmoid colon due to its location at the watershed area between the superior and inferior mesenteric arterial supplies, where reduced blood flow from , , or low-flow states causes mucosal and . The rectosigmoid junction, known as Sudek's point, is particularly vulnerable to hypoperfusion. Symptoms include sudden left lower quadrant pain, urgency to defecate, and bloody diarrhea, often in older patients with cardiovascular risk factors.

Diagnostic and surgical aspects

Diagnosis of sigmoid colon conditions often begins with imaging modalities to visualize structural abnormalities. Computed tomography (CT) colonography, also known as virtual colonoscopy, is a minimally invasive technique that uses CT scans to generate two- and three-dimensional images of the colon after bowel preparation and insufflation with air or carbon dioxide. It is effective for detecting polyps, cancers, and diverticula in the sigmoid colon, with the added benefit of identifying extracolonic abnormalities such as aneurysms. Barium enema, involving the instillation of contrast material into the rectum, has traditionally been used to diagnose sigmoid volvulus by revealing the characteristic "bird's beak" sign at the site of torsion, and it can also serve a therapeutic role by aiding detorsion in select cases. Flexible sigmoidoscopy provides direct endoscopic visualization of the sigmoid colon and rectum, allowing for the identification of polyps, tumors, ulcers, inflammation, diverticula, and strictures, often performed without sedation to evaluate symptoms like rectal bleeding or changes in bowel habits. For suspected malignancies in the sigmoid colon, is obtained endoscopically during or to confirm the diagnosis through histopathological examination. Staging of sigmoid colon cancer employs the American Joint Committee on Cancer (AJCC) TNM classification system, which assesses tumor depth (T: invasion into colon wall layers), regional involvement (N: number of affected nodes), and distant (M: spread to other sites). This staging guides treatment decisions, with sigmoid colon tumors following the same criteria as other colorectal cancers due to similar anatomical wall structure. Surgical interventions for sigmoid colon pathologies include sigmoid colectomy, which involves resection of the affected sigmoid segment and primary , commonly performed for localized cancer or recurrent to remove diseased tissue and restore continuity. In emergencies such as perforated or obstructing cancer, Hartmann's procedure is indicated, entailing sigmoid resection, closure of the distal rectal stump to form a pouch, and creation of an end to divert fecal flow, often as a life-saving measure in cases of or ischemia. For acute sigmoid volvulus without perforation, endoscopic stenting with a can decompress the obstruction and serve as a bridge to , particularly in high-risk patients. As of 2025, advancements in minimally invasive techniques have enhanced outcomes for sigmoid colon procedures. Robotic-assisted , utilizing platforms like the da Vinci Xi system, offers improved precision, three-dimensional visualization, and dexterity for sigmoid colectomies, resulting in lower conversion rates (around 3%), shorter hospital stays (mean 4.2 days), and higher yields compared to traditional methods. These approaches reduce postoperative pain and while maintaining oncologic efficacy, with structured training programs accelerating surgeon proficiency.

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