Anomalous origins of colic arteries

The topography of the celiac trunk and superior and inferior mesenteric arteries was studied by dissection in 27 embalmed cadavers. Variant vascular patterns were noted in four subjects. These consisted of: (1) an accessory right hepatic artery from the superior mesenteric artery, (2) an anomalous middle colic artery from the proximal segment of the splenic artery, and (3) two instances of an accessory left colic artery originating from the superior mesenteric artery. The precarious course of the middle colic artery (coming from the splenic artery) and its dominance in the formation of the marginal artery were thought to predispose the ascending and transverse colon to an increased risk of vascular damage. These cases also illustrate two variant patterns of formation of the marginal artery. In the case of the anomalous middle colic artery, the only contribution of the superior mesenteric artery to the marginal artery was through the anastomosis of its ileocolic branch with the right branch of the aberrant middle colic artery. In subjects with accessory left colic arteries, the superior mesenteric artery played a dominant role in the formation of the marginal artery by contributing the accessory left colic artery, which supplied the splenic flexure and the proximal part of the descending colon. These arterial variations underscore the importance of doing vascular studies prior to major abdominal surgery. © 1995 WiIey-Liss, Inc.     

Anomalous inferior mesenteric artery supplying the ascending,transverse, descending,and sigmoid colons

We have encountered in our anatomical practice the first case and an extremely rare second case in which the ascending, transverse, descending, and sigmoid colons were supplied by the inferior mesenteric artery. The causes of colic artery anomalies are generally explained in conjunction with the development of the superior mesenteric artery, which is intimately related to embryonic elongation and midgut rotation. However, this embryological model was inapplicable to both cases. This difficulty motivated us to seek possible relationships with reported anomalous inferior mesenteric arteries in adults as well as their embryological causes. We consider that the aberrant right colic artery found in 2009 is an “intermesenteric artery” which anastomoses the superior (or its middle colic branch) and inferior mesenteric artery, but secondarily lost its origin from the superior mesenteric artery. The aberrant colic artery found in 2010 is a “middle–inferior mesenteric artery” in which the inferior mesenteric artery formed a common trunk with remnant middle mesenteric artery.     

A case of celiacomesenteric trunk with some other arterial anomalies in a Japanese woman

We found a case of multiple arterial anomalies in a Japanese female cadaver during a routine dissection course. In the present case, a combination of three arterial anomalies was recognized in the abdominal digestive organs: (i) a celiacomesenteric trunk; (ii) a right accessory hepatic artery; and (iii) a left colic artery arising from a portion corresponding to the superior mesenteric artery. The typical celiacomesenteric trunk can be regarded as a variation of the arterial convergence at its origins progressing further between the celiac trunk and the superior mesenteric artery. The celiacomesenteric trunk in the present case included the left colic artery, which is usually one branch of the inferior mesenteric artery. Previously, a case had been reported in which all three arteries supplying the abdominal digestive organs had converged into one trunk, the celiac-bimesenteric trunk. Therefore, the celiacomesenteric trunk in the present case showed an intermediate degree of arterial convergence between that of the typical celiacomesenteric trunk and the celiac-bimesenteric trunk.     

A rare case of the inferior mesenteric artery and some colic arteries in man

The case in which the inferior mesenteric artery (MI) arose from superior one (MS), the common mesenteric artery (MC) of Kitamura et al. (1987), was observed in a 61-year-old female cadaver. This is the 6th report on this anomaly and the only one on the female. The MS arising normally from abdominal aorta sent the MI as the first colic artery, this condition being common in 4 among 5 cases of this anomaly. The MI, however, did not send left colic artery (CS) which arose from a common trunk with right (CD) and middle colic (CM) arteries, which pattern has not been reported. 3 cases of this anomaly may be led from either of 3 kinds of intermesenteric artery (IM) reported by Williams and Klop (1957); the actual IM, an anastomotic artery between CM and CS and the one between MS and CS. The present case is extremely rare, being a compound type led from the first 2 IMs and another case with the common trunk composed of CM and CD, the last of which is collected in Lippert and Pabst (1985). From these examination, formation of MC is discussed with special reference to the inferior pancreatico-duodenal artery.     

Unusual blood supply to the pancreas by a dorsal pancreatic artery

A variation of the blood supply to the pancreas was observed in an 89-year-old female, in which the celiac trunk gave off four arteries the hepatic, splenic, left gastric arteries and an additional dorsal pancreatic artery. One of the branches the dorsal pancreatic artery joined with the superior mesenteric artery to form a longitudinal anastomosis. The anterior and posterior pancreaticoduodenal arcades arose from branches of the superior pancreaticoduodenal and the dorsal pancreatic arteries. The inferior pancreaticoduodenal artery, a branch of the superior mesenteric artery, was missing. The majority of the pancreas was, therefore supplied by the dorsal pancreatic artery. The clinical implications of this finding are that the size, location and course of a dorsal pancreatic artery should be established given its central role in the blood supply to the pancreas observed in the present study.     

Atypical coeliomesenteric anastomosis: The presence of an anomalous fourth coeliac trunk branch

The presence of more than three coeliac trunk branches is a commonly encountered variant. Literature occasionally describes cases of middle or left colic arteries originating from the celiac trunks or its branches; however, the presence of an anomalous arterial connection between the celiac trunk and both the superior and inferior mesenteric arteries (SMA and IMA, respectively) has yet to be reported. Routine abdominal dissection of a male Caucasian cadaver, revealed the presence of an anomalous fourth arterial branch on the 4‐cm long coeliac trunk. The course of this artery was traced, and it terminated by anastomosing with the marginal artery of the mesenteric circulation. The distal termination point of this anomalous fourth coeliac branch was the marginal artery, 5 cm medial of the splenic flexure, anastomosing almost perpendicularly. The diameter of this anomalous artery was comparable with the left gastric artery at their origins. The artery coursed inferiorlaterally toward the splenic flexure, passing immediately posterior to both the pancreas and the splenic vein. The anastomosis point of this artery, near Griffith's Point, is normally considered a watershed region with dual arterial supply from both the SMA and IMA, allowing collateral circulation. This region has a relatively higher susceptibility to irreversible damage in ischemic diseases because of lower perfusion, thus, the anastomosis of atypical coeliac branches represents a rare case for consideration. Awareness of the possibility of embryological variants will minimize the risk of complications in surgical or clinical procedures, and exploration of rare variants will benefit the understanding of vascular embryology. Clin. Anat., 2010. © 2010 Wiley‐Liss, Inc.     

术前三维CT血管成像评估肠系膜下动脉解剖特征

目的 通过三维CT血管成像（CTA）评估分析直肠癌患者肠系膜下动脉（IMA）分型及解剖特点,为直肠癌手术血管处理提供参考。 方法 回顾分析2018年1月至2019年12月华中科技大学同济医学院附属协和医院接受IMA CTA检查的直肠癌患者临床及影像学资料。通过三维CT血管成像重建IMA图像。对IMA进行分类并测量统计肠系膜下血管各解剖参数。 结果 266例研究对象中男性187例,女性79例。111例（41.7%）左结肠动脉（LCA）从主干独立发出,112例（42.1%）LCA和乙状结肠动脉（SA）共干发出,33例（12.4%）LCA、SA及直肠上动脉（SRA）共干,10例（3.8%）缺乏LCA。全组IMA主干长度（LIMA）为（39.1±10.1）mm、IMA根部至髂血管分叉距离（DIMA）为（44.1±7.4）mm、IMA根部与肠系膜下静脉（IMV）水平距离为（24.6±8.9）mm、IMA分支点与IMV水平距离为（13.0±5.3）mm。LCA走行包括：122例（47.6%）高位型,88例（34.4%）中位型,46例（18.0%）低位型。65例（25.4%）LCA紧贴IMV内侧,136例（53.1%）LCA紧贴IMV外侧,55例（21.5%）LCA外侧远离IMV。 结论 术前利用三维CT血管成像可准确评估IMA分型及肠系膜下血管的形态走行关系,为直肠癌手术中血管处理提供指导。     

Detailed anatomy of a left accessory aberrant colic artery

In an aged human female cadaver a left accessory aberrant colic artery (LAACA) was observed and studied. It originated from the superior mesenteric artery at 3 cm proximal to the middle colic artery, at the inferior border of pancreas, passing over Treitz’s muscle and continued covered by the superior duodenal fold where it crossed the inferior mesenteric vein. Further, it continued with a satellite vein anterior to the left renal vein and the anterior branch of the renal artery. The LAACA divided into an ascending branch and a descending one, anastomosed with the middle colic and proper left colic arteries; between its two primary branches and the splenic flexure of colon, a hypovascular area was observed. The surgical relevance of the LAACA detailed anatomy mainly relates to specific procedures performed in left colectomies and nephrectomies.     

腹腔镜右半结肠切除术相关血管的活体解剖学观察

目的阐明腹腔镜右半结肠切除术(laparoscopic right hemicolectomy,LRH)相关血管的活体解剖学特点。方法对36例接受LRH的肿瘤病人进行术中观察和术后录像复习。结果肠系膜上静脉(superior mesenteric vein,SMV)为起于右髂窝上缘,位于小肠系膜和升结肠系膜交界部的蓝色条纹。肠系膜上动脉在系膜内难以目视辨认,走行于SMV左侧。回结肠血管出现率100%,为升结肠系膜内、十二指肠水平部下缘附近、搏动的条索。胃结肠干出现率77.8%(28/36),包含上右结肠静脉/右结肠静脉者占比为89.3%(25/28);后者亦可直接注入SMV。胃结肠干于胰切迹右缘的横结肠后间隙汇入SMV右壁。右结肠动脉在胰颈下缘起始,常与胃结肠干伴行或交叉。结论正确的间隙(肠系膜内间隙)、标志和线索(肠系膜上静脉),是LRH中血管定位的解剖学基础。     

Radiologic anatomy of the superior mesenteric vein and branching patterns of the first jejunal trunk: evaluation using multi-detector row CT venography

The purpose of this study was to describe radiologic anatomy of the superior mesenteric vein (SMV) and to evaluate branching patterns of the first jejunal trunk on axial CT images and multi-detector row CT (MDCT) venography in adults. Two hundred and twenty consecutive patients who underwent abdominal CT examinations were enrolled in this study. Appearance of the SMV, branching patterns of the first jejunal trunk, and drainage site of the inferior mesenteric vein (IMV) were assessed on axial CT images and MDCT venography. The SMV and first jejunal trunk were identified in all patients. A single trunk of the SMV was present in 95% (210/220) and absent in 5% (10/220). First jejunal trunk crossed dorsal to the superior mesenteric artery (SMA) towards the left abdomen in 64% (141/220) and first jejunal trunk crossed ventral to the SMA in 19% (41/220). First jejunal trunk crossed dorsal to the SMA and abruptly turned towards the right abdomen in 17% (38/220). Among these 38 patients, biliary-enteric bypass surgery (n = 9) and large hematoma in left abdomen (n = 1) were present. The IMV was identified in 213 patients and was observed to drain into splenic vein in 112 patients (53%), SMV in 67 (31%), splenoportal confluence in 26 (12%), and first jejunal trunk in 8 (4%). In conclusion, the first jejunal trunk, abruptly turning toward the right abdomen, may be an anatomic variant or indirect finding of biliary-enteric anastomosis. The IMV may drain into the first jejunal trunk as well as splenic vein, splenoportal confluence, and SMV.     

Clinical interest of digestive arterial trunk anastomoses

Arterial vascularization of the gastrointestinal tract is a three-level system composed of the coeliac trunk, and both superior and inferior mesenteric arteries. The three levels are joined together via arterial trunk anastomoses such as the so-called and well-known Riolan arcade or supramarginal arcade. The aim of this study was to review the embryology of the digestive arteries in order to understand the anatomic variations, the development of the arterial trunk anastomoses and the potential collateral circulation in the case of obstruction of one or several arterial trunks. The arch theory by Mac Kay and Tandler longitudinal arterial anastomosis account for the genesis of the arterial trunk anastomoses and the main anatomic variations. The coeliac trunk and the superior mesenteric artery are joined together via the pancreaticoduodenal arcades and the Bühler arcade. These anastomoses are divided during pancreatic resections but developed in the case of coeliac trunk stenosis. The mesenteric arteries are joined together by the Riolan, Villemin arcades and by the marginal artery of Drummond. This collateral circulation and the Riolan arcade in particular, is utilized during left colonic resection. In the case of this collateral circulation insufficiency, inferior mesenteric artery reimplantation is necessary during abdominal aortic aneurysmectomy. Arteriopathy, more and more frequent due to population ageing is responsible for frequent obliteration of one or several digestive arterial trunks with subsequent development of collateral circulation. For such reasons, a sound knowledge of digestive arterial anatomy is an absolute prerequisite for surgical practice.     

Variations in the source of origin of inferior phrenic artery: a cadaveric study

Introduction: The right and left inferior phrenic arteries perfuse the diaphragm. They may originate either from the aorta, celiac trunk, or from the renal artery. Most textbooks of human anatomy give little information regarding the functional anatomy of the inferior phrenic artery. In the past few years, however, more articles have been published regarding the arterial supply in cases of hepatocellular carcinoma. The inferior phrenic artery is seen as an important source of collateral arterial supply to hepatocellular carcinoma, the hepatic artery being the main source. Materials and methods: A cadaveric study was conducted in the Anatomy Department of Bangalore Medical College during the years 2009–2011. Manual dissection was done to identify the inferior phrenic arteries, and their origins were traced. Results: The inferior phrenic artery arose from the aorta in 53.125%, celiac trunk in 28.125%, renal artery in 15.625%, and the superior mesenteric artery in 3.125% of the 32 cadavers studied. The right inferior phrenic artery arose from aorta in 56.25%, celiac trunk in 18.75%, renal artery in 18.75%, and superior mesenteric artery in 6.25% cases. The left inferior phrenic artery arose from aorta in 50%, from celiac trunk in 37.5%, and the rest arose (12.5%) from the renal artery. Discussion: The results were compared with those of earlier studies so that such findings could be applied in the treatment of hepatocellular carcinoma. The significance of this information is due to the fact that an unresectable hepatocellular carcinoma can be treated by transcatheter embolization of the right inferior phrenic artery, in case it is involved.     

The third time is the charm--anastomosis between the celiac trunk and the left colic artery

An atypical case of abdominal vasculature, found in a 58-year-old woman is presented. The multidetector computed tomography angiogram revealed a large tortuous anastomotic vessel between the stem of the celiac trunk and the left colic artery, supplying branches for the left colon and pancreatic body and tail. We propose a simple embryological explanation for the development of this aberrant artery--the longitudinal ventral anastomosis, which connects the precursors of principal visceral arteries in a loop-like manner, loses its direct communication with the superior mesenteric artery but maintains its continuity above and below this level. This variation could pose a problem for radiological interpretation and affect surgical approaches to the aorta, left colon, and the pancreas.     

Coexistence of multiple anomalies in the celiac-mesenteric arterial system

The origins and distribution of arteries of the celiac-mesenteric system were examined by dissection of 52 formalin-fixed human cadavers. Seventy-five percent of the cadavers exhibited the classic Michels' Type I hepatolienogastric pattern; 25% had different branching patterns. Multiple anomalies of the celiac-mesenteric arterial system were observed in one Caucasian female cadaver: a short lienogastric trunk; a common hepatic artery arising directly from the abdominal aorta; an anomalous course of the hepatic arteries; an accessory left hepatic artery arising from the left and right gastric arterial anastomosis along the lesser curvature of the stomach; a double cystic artery; a common inferior phrenic trunk arising from the celiac trunk; and an aberrant arterial channel connecting the proximal segments of the splenic and gastroduodenal arteries. A patent ductus venosus and an anomalous formation of the portal vein by the confluence of the splenic and superior and inferior mesenteric veins was also observed. Although single anomalies of the celiac-mesenteric arterial system are common, complex combinations, such as were observed in the present case, represent a significant deviation from the normal developmental pattern. There seems to be no report in the literature of such a combination of anomalies coexisting in one individual. The developmental and clinical significance of these anomalous vessels is discussed.     

Anatomical study on the branches of the celiac trunk (IV). Comparison of the findings with Adachi's classification]

The authors studied the mode of branching of the celiac trunk in 184 Japanese cadavers during dissecting practice at Gifu University from 1985 to 1988. The findings were as follows; 1) One hundred and sixty-six of the 184 cases belonged to Type I of Adachi's classification of variation in the arrangement of the branches of the celiac trunk. One hundred and twenty-nine cases belonged to Group 1, one case to Group 2, 10 cases to Group 3, 9 cases to Group 4, one case to Group 6, 2 cases to Group 7, 8 cases to Group 8 and 4 cases to Group 11. Two cases did not belong to any group. One of them had an anastomosis between the hepatic artery and the superior mesenteric artery. The other one had the middle colic artery arising from the hepatic artery. 2) Seven cases belonged to Type II, Group 12. 3) Two cases belonged to Type III. One belonged to Group 18. The other one had an accessory right hepatic artery arising from the superior mesenteric artery. 4) One case belonged to Type IV, Group 20. 5) Three cases belonged to Type V, Group 23. 6) Two cases belonged to Type VI. One case had a gastrolienal trunk and an accessory right hepatic artery arising from the superior mesenteric artery. The other one had a gastrolienal trunk and an accessory right hepatic artery arising from the gastrolienal trunk. 7) Of the 184 cases, three could not be classified according to Adachi. Two cases had a gastrolienal trunk and the hepatic artery arising from the abdominal aorta. One case had a lienomesenteric trunk and a gastrohepatic trunk.     

Rare case of the inferior mesenteric artery arising from the superior mesenteric artery

The authors observed a variation of the inferior mesenteric artery, which arose from the superior mesenteric artery, in a 69-year-old Japanese male cadaver during dissection in 1984. In this case, no rudiment of the ordinary inferior mesenteric artery could be found on the abdominal aorta. There are few reports of this variation, and an extensive search of the available literature revealed only four cases, including two in Japan. Such a variation had been somewhat inadequately described as an "absence of the inferior mesenteric artery" in the previous reports, but we avoided this terminology, because all of the cases possessed an artery, which, though arising from the superior mesenteric artery instead of the abdominal aorta, had the same branches as a normal inferior mesenteric artery. Consistent with findings observed in the previous cases, the unusual inferior mesenteric artery arose as the first branch of the superior mesenteric artery, with the common trunk of both mesenteric arteries originating from the abdominal aorta at a level at which an ordinary superior mesenteric artery would arise. It is for this reason that we did not adopt another acceptable name, that is, "the common mesenteric artery," for this variation. The variation can be explained as the result of an unusual development of the embryonic artery system, which comprises a number of ventral splanchnic arteries interconnected by longitudinal anastomotic channels to supply the primitive digestive tube.     

Rare case of the inferior mesenteric artery and the common hepatic artery arising from the superior mesenteric artery

We found a case in which inferior mesenteric artery and the common hepatic artery arose from the superior mesenteric artery, forming the common hepatomesenteric trunk, during a routine dissection carried out at Iwate Medical University in 2002. This variation is rare, but can be embryonically explained. A change in the positions of the disappearance of the ventral splanchnic arteries and the longitudinal anastomotic channel results in variations in the system of arteries distributed to the digestive organs. In the present case, the longitudinal anastomotic channel between the superior and the inferior mesenteric arteries survived to form the common mesenteric artery, which was joined by the common hepatic artery, forming the common hepatomesenteric trunk.     

肠系膜下动脉根部自主神经保护的解剖学基础

目的　观察肠系膜下动脉（IMA）根部与其周围自主神经的解剖学关系,为肠系膜下动脉根部自主神经保护提供解剖学证据。 方法　7例10%福尔马林固定标本进行大体解剖及显微解剖;2例新鲜标本模拟腹腔镜下直肠癌D3根治术中肠系膜下动脉根部自主神经的显露和保护。 结果　上腹下丛(SHP)的左、右侧束及束间交通支与肠系膜下动脉根部关系密切。右侧束距离肠系膜下动脉根部较远,位于肾前筋膜下。以左侧束降支为界,其近端,上腹下丛左侧束、肠系膜下丛、腹主动脉丛紧贴肠系膜下动脉根部左侧壁并相互延续,其远端左侧束走行于肾前筋膜下。左侧束降支距离IMA起点的距离不恒定。 结论　在肾前筋膜前平面分离可有效保护上腹下丛右侧束及侧束间交通支;以SHP左侧束降支作为肠系膜下动脉根部离断的解剖学标志可以有效保护左侧束。     

Variations of the celiac trunk branches in the fetus

The study was performed on 60 human foetuses, aged between 4 to 9 months, using as methods dissection and plastic and contrast substances injection. We studied the celiac trunk in what concerns the division into its terminal branches, insisting on the possible morphological variations, some rare collateral branches starting from the common arterial trunk, the dimensional relations between the branches at their origin and the level of the celiac trunk origin from the aorta, in relation with the vertebral column, the diaphragmatic passage of the aorta and with the superior mesenteric artery. We also assessed the dimensional relations (calibers at origin) between the branches of the celiac trunk. Ass possible variations of the division of the celiac trunk, we assessed: gastro-hepatic trunk, with the splenic artery directly from the aorta or from the hepatic artery; gastro-splenic trunk, with the hepatic artery originating from the aorta; hepato-splenic trunk, with origin of the left gastric artery either directly from the aorta or from the hepatic artery. Rare variations: celiaco-mesenteric trunk; two arterial trunks, hepato-splenic and hepato-gastric; separate aortic origin for all three "classic" branches of the celiac trunk; two hepatic arteries, one from the celiac trunk and the other from the aorta or superior mesenteric artery; celiac trunk that divides into several terminal branches; one or two suprarenal arteries originating from the celiac trunk.