Lymphatic drainage

Lymphatic drainage

The lymphatics of the rectal mucosa communicate freely with those of the muscle layers. The usual drainage fl ow is upwards, and only to a limited extent laterally and downwards. For this reason, surgical clearance of malignant disease concentrates mainly on achieving wide resection of proximal lymph nodes. However, if the usual upward routes are blocked, for example by metastatic disease, the fl ow can reverse and it is possible to fi nd involved lymph nodes on the side walls of the pelvis (along the middle rectal vessels) or even in the inguinal region (along the inferior rectal artery).