all right another word for shape is
anatomy and it’s crucially important for
me as a sergeant that I can identify
abnormal Anatomy but it’s even more
important for me that I can identify
normal Anatomy and that I understand
normal Anatomy now another word for
understanding is modeled and generally
speaking anatomist and surgeons we
rarely use the term model but hopefully
we’ll change that here this morning
now Michael as a surprise to you that
although I am an intestinal surgeon
which means I operate on the bowel for
cancer of the colon or the rectum or
inflammatory bowel disease I spend most
of my time avoiding the intestine okay
and I operate deviously painstakingly
preparing a structure called the
mesentery and the mesentery connects all
of your intestine with the rest of your
body with the systems of your body now
it also come as a surprise to you that
the understanding and the teaching that
we have had in relation to the mesentery
is incorrect at many different points
and this has been the teaching that we
have had over the last hundred years
remarkable when you consider it now this
animation is going to show you the
understanding or the teaching that we
have had of the mesentery and you’re
going to see the intestine come in here
next and you will see the mesentery
which is going to be in yellow come into
the picture there you see it there are
two really important points to bear in
mind here the first is that according to
this model there are multiple Mezen
trees several Mezen trees it’s a complex
model it’s not quite how nature
generally does things the other thing
you recognize is that on the right side
in others the right side of my intestine
there’s no mesentery and on the left
side there’s no mesentery accord
to this particular model okay in 2008 I
was working as a trainee in search in
surgical trainee I was doing an observer
ship where you just watch and I noticed
the surgeon who was operating who was a
world-renowned surgeon was operating on
the right :
and on the left : and he was operating
on a mesentery so when he was operating
on the right removing it he was
operating on a right mesentery and
similarly on the left whenever he was
operating there he was operating on a
mesentery so structures which according
to our anatomic texts should not exist
then I went to the Cleveland Clinic and
spent a year training there were some
truly wonderful people we asked the
question as to whether the mesentery is
present on the right side or on the left
side and we proved in studies that yes
it is actually present on the right hand
it’s on the left now if it’s present on
the right side and it’s present on the
left side and we already know that it’s
there in the middle then it’s not a huge
leap of the imagination to wonder could
this be one structure is it just simply
one structure and not the complex
multiplicity of structures that we were
previously thought and when I came back
to Limerick we did a collaborative study
with the department of anatomy and
Galway and we proved that yes the
mesentery is just one structure and this
animation will show you the new
mesentery as we understand it the
mesentery is the structure in yellow and
you will see that it is a big structure
it fans out from its origin it
intersects the entire length of the
intestine all six feet of intestine so
this is a huge structure biologically if
you were on your holidays and if you
were swimming in the ocean and a six
foot long shadow went underneath you you
wouldn’t be long getting out of the
water so six feet in biological terms is
quite frankly enormous and it’s
remarkable to think that there was a
structure within us that was six feet
long almost hidden in plain sight
okay so it was features such as this
it’s size its continuity its
distinctiveness that led us to make the
bold suggestion in November last year
that perhaps the mesentery should be
redesignated as an organ in itself now
importantly I’m not saying a new organ
because we’re not the first to have
suggested as some we’re not the first to
have described it as an organ and the
history of the mesentery the story of it
is truly remarkable not least because of
the individuals who were involved in it
but because in essence were right back
where we started from over 500 years ago
in 1888 a world-renowned surgeon called
Frederick Treves put down the
description that was indoctrinated in
literature and which became what we were
taught over the next 120 130 years and
he described multiple Mezen trees but
Treves in 1888 was really only echoing
none other than a guy called henry gray
of Grey’s Anatomy not the film not the
series the actual book and Henry gray in
1858 introduced a very simple term Mezen
Therese plurality in other words there
were multiple messin trees according to
Henry grey we don’t know why he used
this word unfortunately as he died young
as a surgeon and his reference
bibliography is relatively deficient in
addition there was little interest in
the mesentery it seemed to lack order
but if you go back a further 300 years
back to the 1550s and back even further
to two times of da vinci Vesalius and
Eustatius and you will find that the
mesentery was drawn as one single
structure and it was referred to as the
mesentery ‘m one organ 500 years ago
and perhaps the best illustration that
we have of that is this particular image
by Eustatius and Eustatius produce this
image in the 1550s and you’ll see from
his image that the mesentery is one
structure and interestingly if you look
at it it has a spiral shape starts in
the middle goes over to the right up and
around and down into the pelvis
now remarkably Eustatius book fell out
of circulation in the 1550s only to be
recirculated in the 1700s but by then
the game was over I’m afraid for
Eustatius but compare the image of
Eustatius with the image that was
produced in November last year by our
medical illustrator Darryl Walsh boat
Mezen trees on the right in the left
here are continuous they’re one
structure and both have a spiral
conformation a spiral shape now I know
that Eustatius couldn’t have known
Darryl watch and Dara Welch I can tell
you didn’t know Eustatius so there’s a
phenomenal overlap here in what was
depicted 500 years ago and what was
drawn in November last and that brings
me to perhaps one of the most important
aspects of this story in November of
last year Darryl Walsh a medical
illustrator in the University Hospital
Limerick overcame one of the major
problems that we had with the mesentery
it’s a fatty structure if you take it
out of the abdomen and throw it against
the wall it’ll splash against the wall
and its shape will have no resemblance
to the shape that it had when it was in
the abdomen and that is an anatomist and
a surgeons nightmare because when we
take it out we can’t make conclusions in
relation to its shape because on the
inside it’s very different and Dara
overcame this problem by using 3d
digital sculpting technologies and he
drew the image that you see here from
2016
and this image has gone viral all over
the world so as I said we’re not first
to suggest that the mesentery is an
organ
but historically we are right back where
we started from with one important
difference and the difference is that
science has evolved enormous ly over the
last 500 years and we can now ask the
same questions of the mesentery as we
would have any organ what is its
function what’s it made up of are there
diseases associated with can we treat
these diseases do abnormalities of the
mesentery affect the rest of the body
and what I’d like to do in the second
half of this talk now is just
demonstrate exactly how the mesentery
does fulfill the criteria of an organ
and I would hope that whilst I’m going
through these questions and answering
them that you will see the wondrous
grandeur of nature at work at the level
of the mesentery so the first question
what does it do okay well if you
remember I drew an image I will showed
you an image from Dara Walsh and you
could see that the mesentery was spiral
starts in the middle goes over to the
right side up the top of her abdomen and
back down into the pelvis now why on
earth would nature work against gravity
which is what it’s doing here its
propelling intestinal contents down the
middle over the right up against gravity
and again across the top for abdomen why
would it do that
we don’t know but what we do know is
that if you look at animals that walk on
all four the mesentery in these animals
has a very different shape and it’s just
simply folded back and forth and it
flops down in their abdomen as they walk
along and you have to go up along the
order of species up to chimpanzees and
to gorillas until you actually begin to
see the shape of the mesentery that we
have as humans raising the tantalizing
possibility and suggestion that
somewhere along the evolutionary tree a
change occurred in the shape and the
confirmation of the mesentery that meant
that we could stand upright we could
walk upright I could give this talk here
today and we could do everything that we
do in the upright position other
functions there are
numerous functions the mesentery is the
first structure to develop within the
embryo so when we’re less than a
millimeter in size the mesentery
develops first the liver the spleen the
pancreas the intestine and all aspects
of it develop within the mesentery
almost like a womb cocooned within the
mesentery the liver the spleen and all
of these organs develop so no mesentery
no liver no spleen no intestine no us so
it is a crucially important structure
embryologically it’s positioned between
the intestine and the rest of the body
why is that important well all of the
signals that come down through the
intestine are sampled within the
mesentery and then the mesentery tells
the body what to do in response to those
signals so that’s like a kind of a
signal box centrally positioned within
your abdomen what if we didn’t have a
mesentery that’s always a good point to
start out when you’re asking about the
function of an organ
if we didn’t have a mesentery than all
six feet of our intestine and in some
people it’s up to eight feet or greater
than two meters in length
we’d have to be directly attached to the
inside of our abdomen it would be
up-and-down fold it to the inside of our
abdominal wall instead of hanging in the
tree dimensional space of our abdomen
now if the intestine were directly
attached it’s hard to see how it could
contract and relax and propel its
contents forward from the top to the
bottom it simply couldn’t no it’s
feasible that it might but we would be
extremely small as a species if it were
and we probably would have been eaten
somewhere in evolution by a large animal
such as an ant or we would have been
lost in a flood caused by a gentle
drizzle so the development of the
mesentery is crucially important in the
development of man as we know are there
diseases associated with the mesentery
there are multiple diseases there’s over
40 diseases that either arise in the
mesentery are spread to involve the
mesentery
and in the recent paths were starting to
develop technologies and clinical
approaches that exploit the mesentery
and the best surgeons are the surgeons
who can exploit the shape of the
mesentery in removing a colon or a
rectal cancer and in the more recent
past we’ve demonstrated that for
patients with inflammatory bowel disease
Crohn’s disease a debilitating disease
that affects people at the prime of
their life that by inclusion of the
mesentery as part of the surgical
approach we can improve the outcomes for
these patients what’s it made up of this
is truly fascinating astronomers are
looking at frontiers and exploring
frontiers galaxies after galaxies on an
enormous scale particle physicists are
smashing atoms together and looking
what’s coming out about a kilometer
under the surface of Europe but there
are frontiers in us that are entirely
unchartered and many of them are in the
mesentery if you think about it it has
to fan out and it has to intersect the
entire intestine and that intersection
is over six feet in length every single
signal bacterial immunological viral
every signal that goes from the
intestine to the body and the body to
the intestine has to go through that
area but there isn’t a single study in
the entire body of literature anywhere
that has characterized that particular
intersection remarkable okay if it’s an
organ then like any organs can it affect
the rest of the body and yet that is yes
and there are multiple examples how
before I explain that though I must
explain one term and that term is
visceral adiposity it’s a fancy clinical
term and what it effectively means is
bare belly fat we all know that beer
belly fat and increases in bare belly
fat predisposed us to the development of
type 2 diabetes high blood pressure
ischemic heart disease stroke and
various other manifestations but if you
look at CT scans of the abdomen and if
you reconstruct these then you will see
that the mesentery is this
largest component of beer belly fat the
mesentery is the reason I look like I do
and it’s the reason why my wife gives
out to me repeatedly for looking like
this as the reason why I’m wearing a
loose-fitting jacket here today to hide
my abdominal contours but it’s the
mesentery that is primarily responsible
for that in men and sorry ladies but it
catches up with ye too because it
happens in their postmenopausal phase of
life
so the mesentery effects systemic
diseases and it predisposes us to
variations of diabetes high blood
pressure ischemic heart disease and
others now at the start of this talk I
asked you or I asked if you could ask
yourselves a question and the question
is what aspect of the mesentery occupies
your thoughts what aspect of the
mesentery stimulates your imagination or
potentially evokes an emotional response
in you I’d like you to do that now again
is it the fact that an eeveelution Airy
change in the mesentery was probably
crucial in acid opting an upright
position and me giving this talk in a
vertical position today is it the fact
that there are diseases in the mesentery
that we’re now able to counteract and
develop strategies and treat in a much
more effective manner is it the fact
that there are regions in the mesentery
frontiers that are entirely unchartered
from a scientific perspective there are
multiple aspects of the mesentery that
now remain to be discovered
perhaps the most important point is the
following we know for the first time
fully understand its shape because we
understand its shape we can understand
this function and a similar event
occurred not so long ago when we
understood the shape of DNA and you had
the birth of genomics and I would argue
that because we now understand the shape
of the mesentery we can systematically
investigate it and the systematic
investigation of any organ is called the
science of that organ and mankind is at
a very very exciting point in its
history because we are at the start of
the science of
the mesentery thank you for listening
[Applause]
anatomy and it’s crucially important for
me as a sergeant that I can identify
abnormal Anatomy but it’s even more
important for me that I can identify
normal Anatomy and that I understand
normal Anatomy now another word for
understanding is modeled and generally
speaking anatomist and surgeons we
rarely use the term model but hopefully
we’ll change that here this morning
now Michael as a surprise to you that
although I am an intestinal surgeon
which means I operate on the bowel for
cancer of the colon or the rectum or
inflammatory bowel disease I spend most
of my time avoiding the intestine okay
and I operate deviously painstakingly
preparing a structure called the
mesentery and the mesentery connects all
of your intestine with the rest of your
body with the systems of your body now
it also come as a surprise to you that
the understanding and the teaching that
we have had in relation to the mesentery
is incorrect at many different points
and this has been the teaching that we
have had over the last hundred years
remarkable when you consider it now this
animation is going to show you the
understanding or the teaching that we
have had of the mesentery and you’re
going to see the intestine come in here
next and you will see the mesentery
which is going to be in yellow come into
the picture there you see it there are
two really important points to bear in
mind here the first is that according to
this model there are multiple Mezen
trees several Mezen trees it’s a complex
model it’s not quite how nature
generally does things the other thing
you recognize is that on the right side
in others the right side of my intestine
there’s no mesentery and on the left
side there’s no mesentery accord
to this particular model okay in 2008 I
was working as a trainee in search in
surgical trainee I was doing an observer
ship where you just watch and I noticed
the surgeon who was operating who was a
world-renowned surgeon was operating on
the right :
and on the left : and he was operating
on a mesentery so when he was operating
on the right removing it he was
operating on a right mesentery and
similarly on the left whenever he was
operating there he was operating on a
mesentery so structures which according
to our anatomic texts should not exist
then I went to the Cleveland Clinic and
spent a year training there were some
truly wonderful people we asked the
question as to whether the mesentery is
present on the right side or on the left
side and we proved in studies that yes
it is actually present on the right hand
it’s on the left now if it’s present on
the right side and it’s present on the
left side and we already know that it’s
there in the middle then it’s not a huge
leap of the imagination to wonder could
this be one structure is it just simply
one structure and not the complex
multiplicity of structures that we were
previously thought and when I came back
to Limerick we did a collaborative study
with the department of anatomy and
Galway and we proved that yes the
mesentery is just one structure and this
animation will show you the new
mesentery as we understand it the
mesentery is the structure in yellow and
you will see that it is a big structure
it fans out from its origin it
intersects the entire length of the
intestine all six feet of intestine so
this is a huge structure biologically if
you were on your holidays and if you
were swimming in the ocean and a six
foot long shadow went underneath you you
wouldn’t be long getting out of the
water so six feet in biological terms is
quite frankly enormous and it’s
remarkable to think that there was a
structure within us that was six feet
long almost hidden in plain sight
okay so it was features such as this
it’s size its continuity its
distinctiveness that led us to make the
bold suggestion in November last year
that perhaps the mesentery should be
redesignated as an organ in itself now
importantly I’m not saying a new organ
because we’re not the first to have
suggested as some we’re not the first to
have described it as an organ and the
history of the mesentery the story of it
is truly remarkable not least because of
the individuals who were involved in it
but because in essence were right back
where we started from over 500 years ago
in 1888 a world-renowned surgeon called
Frederick Treves put down the
description that was indoctrinated in
literature and which became what we were
taught over the next 120 130 years and
he described multiple Mezen trees but
Treves in 1888 was really only echoing
none other than a guy called henry gray
of Grey’s Anatomy not the film not the
series the actual book and Henry gray in
1858 introduced a very simple term Mezen
Therese plurality in other words there
were multiple messin trees according to
Henry grey we don’t know why he used
this word unfortunately as he died young
as a surgeon and his reference
bibliography is relatively deficient in
addition there was little interest in
the mesentery it seemed to lack order
but if you go back a further 300 years
back to the 1550s and back even further
to two times of da vinci Vesalius and
Eustatius and you will find that the
mesentery was drawn as one single
structure and it was referred to as the
mesentery ‘m one organ 500 years ago
and perhaps the best illustration that
we have of that is this particular image
by Eustatius and Eustatius produce this
image in the 1550s and you’ll see from
his image that the mesentery is one
structure and interestingly if you look
at it it has a spiral shape starts in
the middle goes over to the right up and
around and down into the pelvis
now remarkably Eustatius book fell out
of circulation in the 1550s only to be
recirculated in the 1700s but by then
the game was over I’m afraid for
Eustatius but compare the image of
Eustatius with the image that was
produced in November last year by our
medical illustrator Darryl Walsh boat
Mezen trees on the right in the left
here are continuous they’re one
structure and both have a spiral
conformation a spiral shape now I know
that Eustatius couldn’t have known
Darryl watch and Dara Welch I can tell
you didn’t know Eustatius so there’s a
phenomenal overlap here in what was
depicted 500 years ago and what was
drawn in November last and that brings
me to perhaps one of the most important
aspects of this story in November of
last year Darryl Walsh a medical
illustrator in the University Hospital
Limerick overcame one of the major
problems that we had with the mesentery
it’s a fatty structure if you take it
out of the abdomen and throw it against
the wall it’ll splash against the wall
and its shape will have no resemblance
to the shape that it had when it was in
the abdomen and that is an anatomist and
a surgeons nightmare because when we
take it out we can’t make conclusions in
relation to its shape because on the
inside it’s very different and Dara
overcame this problem by using 3d
digital sculpting technologies and he
drew the image that you see here from
2016
and this image has gone viral all over
the world so as I said we’re not first
to suggest that the mesentery is an
organ
but historically we are right back where
we started from with one important
difference and the difference is that
science has evolved enormous ly over the
last 500 years and we can now ask the
same questions of the mesentery as we
would have any organ what is its
function what’s it made up of are there
diseases associated with can we treat
these diseases do abnormalities of the
mesentery affect the rest of the body
and what I’d like to do in the second
half of this talk now is just
demonstrate exactly how the mesentery
does fulfill the criteria of an organ
and I would hope that whilst I’m going
through these questions and answering
them that you will see the wondrous
grandeur of nature at work at the level
of the mesentery so the first question
what does it do okay well if you
remember I drew an image I will showed
you an image from Dara Walsh and you
could see that the mesentery was spiral
starts in the middle goes over to the
right side up the top of her abdomen and
back down into the pelvis now why on
earth would nature work against gravity
which is what it’s doing here its
propelling intestinal contents down the
middle over the right up against gravity
and again across the top for abdomen why
would it do that
we don’t know but what we do know is
that if you look at animals that walk on
all four the mesentery in these animals
has a very different shape and it’s just
simply folded back and forth and it
flops down in their abdomen as they walk
along and you have to go up along the
order of species up to chimpanzees and
to gorillas until you actually begin to
see the shape of the mesentery that we
have as humans raising the tantalizing
possibility and suggestion that
somewhere along the evolutionary tree a
change occurred in the shape and the
confirmation of the mesentery that meant
that we could stand upright we could
walk upright I could give this talk here
today and we could do everything that we
do in the upright position other
functions there are
numerous functions the mesentery is the
first structure to develop within the
embryo so when we’re less than a
millimeter in size the mesentery
develops first the liver the spleen the
pancreas the intestine and all aspects
of it develop within the mesentery
almost like a womb cocooned within the
mesentery the liver the spleen and all
of these organs develop so no mesentery
no liver no spleen no intestine no us so
it is a crucially important structure
embryologically it’s positioned between
the intestine and the rest of the body
why is that important well all of the
signals that come down through the
intestine are sampled within the
mesentery and then the mesentery tells
the body what to do in response to those
signals so that’s like a kind of a
signal box centrally positioned within
your abdomen what if we didn’t have a
mesentery that’s always a good point to
start out when you’re asking about the
function of an organ
if we didn’t have a mesentery than all
six feet of our intestine and in some
people it’s up to eight feet or greater
than two meters in length
we’d have to be directly attached to the
inside of our abdomen it would be
up-and-down fold it to the inside of our
abdominal wall instead of hanging in the
tree dimensional space of our abdomen
now if the intestine were directly
attached it’s hard to see how it could
contract and relax and propel its
contents forward from the top to the
bottom it simply couldn’t no it’s
feasible that it might but we would be
extremely small as a species if it were
and we probably would have been eaten
somewhere in evolution by a large animal
such as an ant or we would have been
lost in a flood caused by a gentle
drizzle so the development of the
mesentery is crucially important in the
development of man as we know are there
diseases associated with the mesentery
there are multiple diseases there’s over
40 diseases that either arise in the
mesentery are spread to involve the
mesentery
and in the recent paths were starting to
develop technologies and clinical
approaches that exploit the mesentery
and the best surgeons are the surgeons
who can exploit the shape of the
mesentery in removing a colon or a
rectal cancer and in the more recent
past we’ve demonstrated that for
patients with inflammatory bowel disease
Crohn’s disease a debilitating disease
that affects people at the prime of
their life that by inclusion of the
mesentery as part of the surgical
approach we can improve the outcomes for
these patients what’s it made up of this
is truly fascinating astronomers are
looking at frontiers and exploring
frontiers galaxies after galaxies on an
enormous scale particle physicists are
smashing atoms together and looking
what’s coming out about a kilometer
under the surface of Europe but there
are frontiers in us that are entirely
unchartered and many of them are in the
mesentery if you think about it it has
to fan out and it has to intersect the
entire intestine and that intersection
is over six feet in length every single
signal bacterial immunological viral
every signal that goes from the
intestine to the body and the body to
the intestine has to go through that
area but there isn’t a single study in
the entire body of literature anywhere
that has characterized that particular
intersection remarkable okay if it’s an
organ then like any organs can it affect
the rest of the body and yet that is yes
and there are multiple examples how
before I explain that though I must
explain one term and that term is
visceral adiposity it’s a fancy clinical
term and what it effectively means is
bare belly fat we all know that beer
belly fat and increases in bare belly
fat predisposed us to the development of
type 2 diabetes high blood pressure
ischemic heart disease stroke and
various other manifestations but if you
look at CT scans of the abdomen and if
you reconstruct these then you will see
that the mesentery is this
largest component of beer belly fat the
mesentery is the reason I look like I do
and it’s the reason why my wife gives
out to me repeatedly for looking like
this as the reason why I’m wearing a
loose-fitting jacket here today to hide
my abdominal contours but it’s the
mesentery that is primarily responsible
for that in men and sorry ladies but it
catches up with ye too because it
happens in their postmenopausal phase of
life
so the mesentery effects systemic
diseases and it predisposes us to
variations of diabetes high blood
pressure ischemic heart disease and
others now at the start of this talk I
asked you or I asked if you could ask
yourselves a question and the question
is what aspect of the mesentery occupies
your thoughts what aspect of the
mesentery stimulates your imagination or
potentially evokes an emotional response
in you I’d like you to do that now again
is it the fact that an eeveelution Airy
change in the mesentery was probably
crucial in acid opting an upright
position and me giving this talk in a
vertical position today is it the fact
that there are diseases in the mesentery
that we’re now able to counteract and
develop strategies and treat in a much
more effective manner is it the fact
that there are regions in the mesentery
frontiers that are entirely unchartered
from a scientific perspective there are
multiple aspects of the mesentery that
now remain to be discovered
perhaps the most important point is the
following we know for the first time
fully understand its shape because we
understand its shape we can understand
this function and a similar event
occurred not so long ago when we
understood the shape of DNA and you had
the birth of genomics and I would argue
that because we now understand the shape
of the mesentery we can systematically
investigate it and the systematic
investigation of any organ is called the
science of that organ and mankind is at
a very very exciting point in its
history because we are at the start of
the science of
the mesentery thank you for listening
[Applause]
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