 Good day everybody. Dr. Sanjay Sanyal, Professor Department Chair. This is going to be a demonstration of the small intestine. This is a spanket ever. I'm standing on the right side and the camera person is also on the right side. So we have completely removed the small intestine from its attachment to the posterior abdominal wall. The small intestine is composed of the g-genome proximal two-fifths and the alium terminal three-fifths. This is about six to seven meters long. When we talk of the small intestine, we do not include the diodenum in that. Just to break up to speak, the small intestine is a derivative of the mid-cut. So therefore, all these blood vessels that we see in the mid-century of the small intestine, that is the g-general arteries and the alial arteries at all branches of the supramacentric artery. We have completely removed all the contents of the abdomen and we can see the blood vessels here. This artery that I have lifted up here, this is the supramacentric artery. This is the artery of the mid-cut and the branches that we can see here, these are all the colic arteries and the branches that we can see coming out in the terminal end, these are some of the g-general and the alial arteries. There are hundreds of them which supply the mid-cut. This artery that we see here, this is the inferior miscitering artery, which is the artery of the hindcut. The g-general and the alial arteries, they supply the small intestine, the other arteries of the mid-cut. Let us take a quick look at the parts of the g-genome and how they compare with the alium. If you take a look at the g-genome here, you find that it is thick, it is fleshy and it is pink in color. In contrast, if you were to take up a segment of the alium, which is located in the terminal part, we notice that it is thin, pale, so this is the alium. That is the first important difference between the g-genome and the alium. Now let us take a look at the miscentry. I am holding up a loop of the g-genome and we can see that the miscentry has got fat but not as much as will be present in the alium. In contrast, alium fat is extremely dense. It is very thick and the fat, miscentric fat is encroaching onto the miscentric side of the alium. So that is the second difference. The third difference, we have opened up the leaves of the miscentry to show you the blood vessels. And if you were to look very closely in the g-genome, this is the blood vessel pattern. We can see the vascular arcade here. There is only one series of arcade, maximum two series of arcades. And then from the arcades, we have these vessels running. These are referred to as the vasarecta. So therefore, there are very few vascular arcades and the vasarecta are long, which run to the miscentric side of the intestine. In contrast, we have opened up the leaves of the miscentry of a segment of the alium. And again, if you were to look closely, we find a considerable difference. We find that the vascular arcades are many. We have one series of arcades here, one here, one here, one here. And therefore, there are many series of arcades and the vasarecta are small and they go directly to the miscentric side of the intestine. These are the vasarecta, which are very small. So in a nutshell, in an alium, vascular arcades are many and the vasarecta are small. Now we have opened up a segment of the gigenum. And we can see a segment of the gigenum here. We can see that the mucosal folds are very prominent, dense and big. These mucosal folds are called pleica circularis or the valvilae conventis. These are the ones which give the feathery appearance in a burial meal follow through. This is the burial meal follow through to show this feathery appearance of the mucosal pattern of the small intestine proximal part. In contrast, when we open up a segment of the alium, which we have done here, we see that the alium is smooth. The mucosal folds are almost non-existent. This is the one which has been described by Wangenstein as characterless when we see a burial meal follow through. Not seen in this dissection, but if you want to take a microscopic view of the submucosa of the alium, you'll find multiple collections of lymphoid tissue, which are referred to as pairs patches. While these pairs patches will be absent in the ginginum. So these are the important differences between the ginginum and the alium and they help us during surgery. Now let me mention a few important clinical correlations. This what you see is the masonry and the root of the masonry is only 45 centimeters extending obliquely from the tip of the tracers process of the L2 vertebra on the left side to the upper end of the sacroiliac on the right side. So this is the length of the masonry and from a 45 centimeter masonry attachment 6 to 7 meters of small intestine are coiled inside the abdomen. Therefore the small intestine can undergo obstruction. It can undergo ischemic necrosis, especially the alium because of its relatively lack of blood supply. When we have a pathology of the small intestine, we have to do what is known as resection anastomosis and I have demonstrated the principle of the resection anastomosis in one segment here. Suppose this segment of the small intestine has become necrosed and we have to resect this. First thing what we do is we make a v-shaped incision on the masonry from the masonry side all to the root of the masonry and then we clap and ligate the blood vessels in sections all the way from the masonry side to the root of the masonry on both the ends and then we clap this segment of the intestine which has become gangrenous. We remove it and then we anastomose this end with this end end to end anastomosis by means of staples or by sutures whichever is available. So this is the principle of resection and end to end anastomosis of the small intestine. Now let me demonstrate yet another procedure that we do in the small intestine especially with regard to the terminal alium and that is called ileostomy. If for some reason we have had to remove the colon and we have to bring out a loop of ilium out to the abdominal wall and connect it to a bag that is called ileostomy. Here the skin has been removed but imagine the skin was present. We first make an opening in the skin a disc shaped portion of the skin is removed in the region of the right iliac fossa then a disc shaped portion of this external oblique aponeurosis is removed and the internal oblique aponeurosis and through this opening we pull out a segment of the terminal ileum which is exposed and that is what we are doing right now. We catch hold of it with a gentle artery forceps and pull it out from here and then we turn it out and we suture the walls of the intestine to the skin like this. This is called ileostomy and this projection about one inch projection that we see here is called the ileostomy spout. This is connected to an ileostomy bag which collects the fecal matter. So this is the principle and the principle of technique of ileostomy. So these are two commonly performed procedures in the small intestine that I wanted to demonstrate to all of you. Thank you very much for watching. Dr. Sanjay Sanyal signing out. Mr. Kendal Kambarbhaj is the camera person. If you have any questions or comments please put them in the comment section below. Have a nice day.