Variations in the branching pattern in inferior mesenteric artery: a series of five cases

Abstract Introduction: Inferior mesenteric artery arises from abdominal aorta just below the third part of duodenum at the level of L3-L4 vertebra. It supplies left colon and rectosigmoid colon through its branches namely- left colic artery, two-three sigmoid arteries and superior rectal artery. The branching pattern of inferior mesenteric artery is of immense use in colon surgery. Material and Methods: The study was carried out in the department of anatomy by dissecting seven embalmed cadavers. The inferior mesenteric artery and its branches were identified; its vertebral level was analysed. The length and diameter of inferior mesenteric artery were measured by vernier callipers. Results: In first case, bifurcation of inferior mesentric artery into common trunk and main artery then trifitrcation of main artery and bifurcation of common trunk belong to anomalous configuration. In second case, this artery gave a tetrafitrcated common trunk and main artery which continued as superior rectal artery. In third case, the same artery trifurcated into left colic, superior rectal artery and bifurcated common trunk. In fourth case, the artery bifurcated into common trunk further dividing into left colic and sigmoid arteries and main artery into superior rectal and sigmoid arteries. In fifth case, this artery trifitrcated into three branches namely, sigmoid, rectosigmoid, and superior rectal arteries. Left colic artery arose from superior mesenteric artery. Conclusion: The knowledge of branching pattern of inferior mesenteric artery will be of paramount importance to colon surgeons during colectomy, to radiologists in avoiding misinterpretation of radiographs and anatomists for new variants.

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Branching Pattern of Inferior Mesenteric Artery in a Black African Population: A Dissection Study

ISRN Anatomy ◽

10.5402/2013/962904 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Simeon Sinkeet ◽

Philip Mwachaka ◽

Johnstone Muthoka ◽

Hassan Saidi

Keyword(s):

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Colon Surgery ◽

Vascular Supply ◽

African Population ◽

Branching Pattern ◽

Left Colic Artery ◽

Angiographic Study ◽

Black African ◽

Weak Points

Background. Branching pattern of inferior mesenteric artery (IMA) and pattern of vascular supply to the left colon and rectosigmoid areas, though important during colorectal surgery, display interethnic variations. Further, these regions have notable vascular “weak points” reported to be highly susceptible to ischemic colitis. This study aimed at evaluating the branching pattern of IMA in a black African population. Materials and Methods. Fifty-seven formalin-embalmed cadavers (28 Male, 27 Female) were studied. The length, branching pattern, and diameter of IMA at its origin were recorded. Results. IMA mean length and diameter at origin were mm and mm, respectively. IMA most frequently branched into left colic artery and a common sigmoid trunk in 23 cases while the classical branching pattern was observed in only 7 cases. Colic marginal artery was absent at the splenic flexure and sigmoid colon in 7 and 5 cases, respectively. Arc of Riolan was observed in 9 cases. Conclusion. Branching pattern of IMA shows variations from the previously reported cases which might help account for some of the untoward outcomes observed following colon surgery. An angiographic study to further delineate functionality of the arterial anastomoses in this region is recommended.

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Vascular anatomy of inferior mesenteric artery in laparoscopic radical resection with the preservation of left colic artery for rectal cancer

World Journal of Gastroenterology ◽

10.3748/wjg.v24.i32.3671 ◽

2018 ◽

Vol 24 (32) ◽

pp. 3671-3676 ◽

Cited By ~ 5

Author(s):

Ke-Xin Wang ◽

Zhi-Qiang Cheng ◽

Zhi Liu ◽

Xiao-Yang Wang ◽

Dong-Song Bi

Keyword(s):

Rectal Cancer ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Vascular Anatomy ◽

Radical Resection ◽

Colic Artery ◽

Left Colic Artery

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Three-dimensional reconstruction of the vascular arrangement including the inferior mesenteric artery and left colic artery in laparoscope-assisted colorectal surgery

Surgical Endoscopy ◽

10.1007/s00464-016-4758-4 ◽

2016 ◽

Vol 30 (10) ◽

pp. 4400-4404 ◽

Cited By ~ 14

Author(s):

Ryoichi Miyamoto ◽

Kentaro Nagai ◽

Akira Kemmochi ◽

Satoshi Inagawa ◽

Masayoshi Yamamoto

Keyword(s):

Colorectal Surgery ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Three Dimensional ◽

Colic Artery ◽

Three Dimensional Reconstruction ◽

Left Colic Artery ◽

Dimensional Reconstruction

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A three-dimensional computed tomography angiography study of the anatomy of the accessory middle colic artery and implications for colorectal cancer surgery

Surgical and Radiologic Anatomy ◽

10.1007/s00276-020-02511-w ◽

2020 ◽

Vol 42 (12) ◽

pp. 1509-1515

Author(s):

Mitsuhiro Yano ◽

Shinji Okazaki ◽

Ichiro Kawamura ◽

Shunichiro Ito ◽

Shintaro Nozu ◽

...

Keyword(s):

Colorectal Cancer ◽

Computed Tomography ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Three Dimensional ◽

Middle Colic Artery ◽

Inferior Mesenteric Vein ◽

Colic Artery ◽

Left Colic Artery ◽

Colorectal Cancer Surgery

Abstract Purpose In the present study, we focused on the accessory middle colic artery and aimed to increase the safety and curative value of colorectal cancer surgery by investigating the artery course and branching patterns. Methods We included 143 cases (mean age, 70.4 ± 11.2 years; 86 males) that had undergone surgery for neoplastic large intestinal lesions at the First Department of Surgery at Yamagata University Hospital between August 2015 and July 2018. We constructed three-dimensional (3D) computed tomography (CT) angiograms and fused them with reconstructions of the large intestines. We investigated the prevalence of the accessory middle colic artery, the variability of its origin, and the prevalence and anatomy of the arteries accompanying the inferior mesenteric vein at the same level as the origin of the inferior mesenteric artery. Results Accessory middle colic artery was observed in 48.9% (70/143) cases. This arose from the superior mesenteric artery in 47, from the inferior mesenteric artery in 21, and from the celiac artery in two cases. In 78.2% (112/143) cases, an artery accompanying the inferior mesenteric vein was present at the same level as the origin of the inferior mesenteric artery; this artery was the left colic artery in 92, the accessory middle colic artery in 11, and it divided and became the left colic artery and the accessory middle colic artery in 10 cases. Conclusion 3D CT angiograms are useful for preoperative evaluation. Accessory middle colic arteries exist and were observed in 14.9% of cases.

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Anatomic variations of inferior mesenteric artery and left colic artery evaluated by 3-dimensional CT angiography: Insights into rectal cancer surgery – A retrospective observational study

International Journal of Surgery ◽

10.1016/j.ijsu.2017.03.012 ◽

2017 ◽

Vol 41 ◽

pp. 106-111 ◽

Cited By ~ 7

Author(s):

Jia Ke ◽

Jiawei Cai ◽

Xiaofeng Wen ◽

Xianrui Wu ◽

Zhen He ◽

...

Keyword(s):

Rectal Cancer ◽

Observational Study ◽

Ct Angiography ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Rectal Cancer Surgery ◽

Colic Artery ◽

Anatomic Variations ◽

Left Colic Artery ◽

3 Dimensional

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Preservation of the Arterial Arc Formed by Left Colic Artery, Proximal Inferior Mesenteric Artery, and the First Branch of Sigmoid Arteries in Anus Saving Treatment of Low Rectal Cancer

The American Surgeon ◽

10.1177/0003134820983188 ◽

2020 ◽

pp. 000313482098318

Author(s):

Zakari Shaibu ◽

Zhi-hong Chen ◽

Acquah Theophilus ◽

Said A. S. Mzee

Keyword(s):

Rectal Cancer ◽

Blood Supply ◽

Mesenteric Artery ◽

Inferior Mesenteric Artery ◽

Leakage Rate ◽

Low Rectal Cancer ◽

Mesenteric Arteries ◽

Colic Artery ◽

Left Colic Artery ◽

Number Of Patients

Background Low anterior, ultralow anterior, and intersphincteric resection are conventional, elective anus-sparing techniques for low rectal cancer, and good prognosis depends on a good blood supply and tension-free anastomosis. Aim The goal is to assess the effect of preserving the arc formed by the left colic and proximal inferior mesenteric arteries (IMAs), and first branch of the sigmoid arteries on the anastomotic blood supply, tension, and leakage rate in anus-sparing surgery for low rectal cancer. Method From 2011 to 2020, a patient with low rectal cancer resection was distributed into the ligation group (42 cases with inferior mesenteric artery ligation) and the preservation group (61 cases with preservation of the left colic and proximal IMAs and first branch of the sigmoid artery). Results We evaluated patient characteristics, operative results, morbidity, and postoperative follow-up results. There were comparable outcomes between ligation and preservation groups in relations to the number of patients in each operative procedure, duration of surgery, operative blood loss, postoperative hospital stay, and the number of patients with protective stoma ( P >.05). In postoperative morbidity, there were similar outcomes between ligation and preservation groups in terms of anastomotic subclinical dehiscence, bleeding and stricture, and urinary retention ( P >.05). There were significant differences in anastomotic leakage and intra-abdominal abscess ( P < .05). Conclusion Preservation of the arterial arc formed by left colic artery, proximal IMA, and the first branch of sigmoid arteries with apical lymph node dissection could increase anastomotic blood supply, reduce anastomotic tension, and leakage rate in anus-saving treatment of low rectal cancer.

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