ANATOMICAL VARIATIONS OF RIGHT COLIC ARTERY, THE MIDDLE COLIC ARTERY ORIGINATING DIRECTLY FROM AORTA: CASE REPORT AND LITERATURE REVIEW
Main Article Content
Abstract
Study aim:
1. Case report of anatomical variations of Right Colic Artery and Middle Colic Artery.
2. Literature Review.
Result:
Female 80 year old patient.
Medical history: Diabetes mellitus.
Hospitalization for subobstruction of right colic cancer.
Symptoms: Abdominal pain in right upper and lower abdominal areas without vomiting and fever.
Physical examination revealed mass palpable in right upper area of abdomen
CTScan revealed: Tumor measuring 60-87 mm at hepatic flexure of right colon.
Colonoscopy showed: Intra luminal tumor of right colon that makes stricture of colic lumen .
Laboratory findings: Normal limits excepted high blood glucose.
Intra operating findings: Tumor at hepatic flexure of colon measuring 8-8 cm in diameter (T4N2M0 grade). There were no right colic artery. The Middle colic artery (MCA) did not originate from a superior mesenteric artery. This Middle colic artery arise from post pancreatic aorta, running down and divided into 2 branches (left and right). The right branch anastomosed with ascending branches of ileocolic artery and the left branch anastomosed with ascending branches of left colic artery.
Surgical procedure: Right hemicolectomy, lymph node dissection, side to side anastomosis (2 layer).
Complication post operation: No complication
Histopathologic result: Mucinous adenocarcinoma (gradeT4aN0M0).
Conclusion: By special case report and Literature Review, we conclude that
Ileocolic artery was constantly present (100%) while the middle colic artery was present in 98-100% of cases. In contrast the rate of right colic artery presence was highly variable, ranging from 10,7%-63,3%.
The middle colic artery may arise from superior mesenteric artery and may originate from coeliac trunk, splenic artery, common hepatic artery or directly arise from aorta (post pancreas) or from aorta between superior mesenteric artery and inferior mesenteric artery (as middle mesenteric artery). The findings (in this review) will strongly support the ileocolic pedicle as a landmark for starting laparoscopic safe dissection of mesocolon in medial to lateral technique.
Keywords
Right colic artery variation, middle colic artery variation
Article Details
References
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