The Rectal Wings-Highlighting by Dissection, Contents and Clarifications Regarding the Terminology

The rectum is stabilized within the pelvis by connective condensations traditionally termed rectal wings or ligaments, classically divided into lateral and posterior components. Their anatomical definition, composition, and relationship with the mesorectum and pelvic fasciae remain controversial, despite their surgical significance during total mesorectal excision (TME). This study aims to clarify the structure, contents, and topographical relationships of the rectal wings through cadaveric dissection.

A descriptive anatomical dissection was conducted on four formalin-fixed adult cadavers at the Anatomy Laboratory of "Carol Davila" University of Medicine and Pharmacy, Bucharest. The rectum and mesorectum were mobilized according to the TME standard. Dissections were performed under direct vision, preserving the pelvic autonomic nerves. Macroscopic findings were photographed and analyzed to determine the composition and limits of the lateral and posterior rectal wings.

The lateral rectal wings were identified as subperitoneal condensations of pelvic connective tissue connecting the mesorectal fascia with the presacral fascia. They enclosed branches of the inferior hypogastric plexus and, occasionally, the middle rectal vessels (absent in all four cases). The posterior rectal wings appeared as sagittal condensations surrounding branches of the middle sacral vessels. Both types of wings merged with the mesorectal fascia at sites where neurovascular elements traversed toward the rectal wall, representing extensions of the sacro-recto-genito-pubic laminae.

Both lateral and posterior rectal wings represent regional specializations of the pelvic subperitoneal connective tissue. Their recognition harmonizes anatomical terminology with surgical reality, refining the understanding of pelvic fascial planes critical for nerve-sparing TME.