Re-appraisal of surgical anatomy of arterial supply of the right colon

ABSTRACT

Hemorrhagic complications can be a major cause of conversion and/or morbidity during laparoscopic intestinal surgery. The limited exposure currently provided in laparoscopic intestinal resection demands a precise knowledge of mesenteric vascular anatomy to avoid such complications and to expedite the procedure. Most surgical texts depict a "normal pattern" of arterial supply to the right colon consisting of three arterial branches [middle colic artery, right colic artery and ileocolic atery] arising independently from the superior mesenteric artery [SMA]. We performed detailed dissection of the SMA in thirty adult cadavers. We found the ileocolic artery in all of our cases and the middle colic artery in 29 of 30 cadavers but only three cases of a right colic artery arising directly from SMA. Our data, combined with review of published anatomic studies, lead us to conclude that in the vast majority of cases there are only two independent branches arising from SMA that supply the large intestine, the ileocolic and the middle colic arteries. The right colic artery directly arising from SMA is unusual [10%]. This knowledge may help lower the risk of vascular complications during laparoscopic intestinal surgery