Mesorectal Fascia

fascia mesorectalis

The mesorectal fascia, or fascia propria of the rectum, is a thin envelope surrounding the rectum and the fatty mesorectum that holds its blood vessels and lymph nodes. Behind it lies the presacral space and the presacral fascia, giving surgeons a clean, nearly bloodless plane.

Anatomical Data

Boundaries & Contents

Location	Around the rectum and mesorectum in the pelvis.
Boundaries	Presacral fascia and space behind Denonvilliers fascia or rectovaginal septum in front Pelvic side wall fascia laterally
Contents	Rectum Mesorectal fat Superior rectal vessels Mesorectal lymph nodes

Biomechanics

Function & Actions

Encloses the rectum with its blood supply and lymphatic drainage, defining the surgical plane for rectal resection.

Clinical Relevance

Clinical Notes

This fascia is the key landmark of total mesorectal excision, the standard operation for rectal cancer, in which the rectum is removed inside an intact fascial envelope to lower local recurrence. On MRI, the distance between tumour and the mesorectal fascia (the circumferential resection margin) guides whether chemoradiotherapy is needed before surgery.

Pathology

Common Injuries & Conditions

Rectal Cancer With Threatened Margin

A rectal tumour that reaches or lies within 1 mm of the mesorectal fascia has a high risk of local recurrence and is usually treated with preoperative chemoradiotherapy.

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