The large intestine, also known as the large bowel, is the last part of the gastrointestinal tract and of the digestive system in tetrapods. Water and salts are absorbed here and the remaining waste material is stored in the rectum as feces before being removed by defecation. Although it is shorter than the small intestine, it is called the large intestine because it is wider in diameter. In humans, the large intestine begins in the right iliac region of the pelvis, just at or below the waist, where it is joined to the end of the small intestine at the cecum, via the ileocecal valve. It then continues as the colon ascending the abdomen, across the width of the abdominal cavity as the transverse colon, and then descending to the rectum and its endpoint at the anal canal. Overall, in humans, the large intestine is about 1.5 metres (5 ft) long, which is about one-fifth of the whole length of the human gastrointestinal tract. In human medicine, the terms "large intestine" and "colon" are often used interchangeably, but most sources define the large intestine as the combination of the cecum, colon, rectum, and anal canal. Some other sources exclude the anal canal.
Structure
The colon of the large intestine is the last part of the digestive system. It has a segmented appearance due to a series of saccules called haustra. It extracts water and salt from solid wastes before they are eliminated from the body and is the site in which the fermentation of unabsorbed material by the gut microbiota occurs. Unlike the small intestine, the colon does not play a major role in absorption of foods and nutrients. About 1.5 litres (53 imp fl oz; 51 US fl oz) of water arrives in the colon each day. The colon is the longest part of the large intestine and its average length in the adult human is 166 centimetres (65 in) (range of 80 to 313 cm) for males, and 155 cm (range of 80 to 214 cm) for females.
Sections
In mammals, the large intestine consists of the cecum (including the appendix), colon (the longest part), rectum, and anal canal. The four sections of the colon are: the ascending colon, transverse colon, descending colon, and sigmoid colon. These sections turn at the colic flexures. The parts of the colon are either intraperitoneal or behind it in the retroperitoneum. Retroperitoneal organs, in general, do not have a complete covering of peritoneum, so they are fixed in location. Intraperitoneal organs are completely surrounded by peritoneum and are therefore mobile. Of the colon, the ascending colon, descending colon and rectum are retroperitoneal, while the cecum, appendix, transverse colon and sigmoid colon are intraperitoneal. This is important as it affects which organs can be easily accessed during surgery, such as a laparotomy. In terms of diameter, the cecum is the widest, averaging slightly less than 9 cm in healthy individuals, and the transverse colon averages less than 6 cm in diameter. The descending and sigmoid colon are slightly smaller, with the sigmoid colon averaging 4–5 cm (1.6–2.0 in) in diameter. Diameters larger than certain thresholds for each colonic section can be diagnostic for megacolon.
Cecum and appendix
The cecum is the first section of the large intestine and is involved in digestion, while the appendix which develops embryologically from it, is not involved in digestion and is considered to be part of the gut-associated lymphoid tissue. The function of the appendix is uncertain, but some sources believe that it has a role in housing a sample of the gut microbiota, and is able to help to repopulate the colon with microbiota if depleted during the course of an immune reaction. The appendix has also been shown to have a high concentration of lymphatic cells.
Ascending colon
The ascending colon is the first of four main sections of the large intestine. It is connected to the small intestine by a section of bowel called the cecum. The ascending colon runs upwards through the abdominal cavity toward the transverse colon for approximately eight inches (20 cm). One of the main functions of the colon is to remove the water and other key nutrients from waste material and recycle them. As the waste material exits the small intestine through the ileocecal valve, it will move into the cecum and then to the ascending colon where this process of extraction starts. The waste material is pumped upwards toward the transverse colon by peristalsis. The ascending colon is sometimes attached to the appendix via Gerlach's valve. In ruminants, the ascending colon is known as the spiral colon.
Transverse colon
The transverse colon is the part of the colon from the hepatic flexure, also known as the right colic, (the turn of the colon by the liver) to the splenic flexure also known as the left colic, (the turn of the colon by the spleen). The transverse colon hangs off the stomach, attached to it by a large fold of peritoneum called the greater omentum. On the posterior side, the transverse colon is connected to the posterior abdominal wall by a mesentery known as the transverse mesocolon. The transverse colon is encased in peritoneum, and is therefore mobile (unlike the parts of the colon immediately before and after it). The proximal two-thirds of the transverse colon is perfused by the middle colic artery, a branch of the superior mesenteric artery (SMA), while the latter third is supplied by branches of the inferior mesenteric artery (IMA). The "watershed" area between these two blood supplies, which represents the embryologic division between the midgut and hindgut, is an area sensitive to ischemia.
Descending colon
The descending colon is the part of the colon from the splenic flexure to the beginning of the sigmoid colon. One function of the descending colon in the digestive system is to store feces that will be emptied into the rectum. It is retroperitoneal in two-thirds of humans. In the other third, it has a (usually short) mesentery. The arterial supply comes via the left colic artery. The descending colon is also called the distal gut, as it is further along the gastrointestinal tract than the proximal gut. Gut flora are very dense in this region.
Sigmoid colon
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