The superior rectal vein drains the rectum and upper anal canal into the portal venous system through the inferior mesenteric vein. It begins in the internal rectal venous plexus and ascends with the superior rectal artery. Its connections with the middle and inferior rectal veins form an important portosystemic anastomosis.
| Origin | Internal rectal venous plexus in the submucosa of the upper anal canal and rectum |
|---|---|
| Course | Ascends with the superior rectal artery in the mesorectum and the root of the sigmoid mesocolon, crosses the left common iliac vessels and continues as the inferior mesenteric vein |
| Branches |
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In portal hypertension, the anastomosis between the superior rectal vein and the middle and inferior rectal veins can open up to form anorectal varices, which differ from ordinary haemorrhoids. Rectal cancer spreads to the liver through this portal venous drainage. The vein is divided with the artery during anterior resection and total mesorectal excision.
Dilated portosystemic collaterals at the rectal anastomosis in portal hypertension, which may cause lower gastrointestinal bleeding and are treated by addressing the portal pressure.
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