The superior mesenteric artery (SMA) supplies irrigation to the small intestine, ascending and a variable area of the transverse colon. Although medical imaging and surgical procedures have been widely developed in the last decades, the anatomy of the SMA using advanced imaging technology remains to be elucidated. Previous studies have used small sample sizes of cadaveric or radiological samples to propose a number of classifications for the SMA. In this study, we aimed to provide a more detailed description and useful classification of the SMA and its main branches [middle colic artery (MCA), right colic artery (RCA), and ileocolic artery (ICA)]. Samples (n = 50, 28 males and 22 females) were obtained from the repository of human cadavers located at the Department of Human Anatomy and Embryology, Complutense University of Madrid. This sample was dissected by preclinical medical students and completed by two of the authors (Gamo and Jimenez). A second set of samples was obtained from a bank of computerized tomography (CT) (560 CTs, 399 males and 161 females) collected by the Radiology Department at the Clinico San Carlos Hospital, Spain. Based on the results obtained from these studies, we propose a new classification of four patterns for the SMA anatomy. Pattern I as the independent origin of the three main branches of the SMA (cadaveric 40 %; CT 73.69 %); Pattern II is subdivided in three sub-patterns based on the common trunks of origin: Pattern IIa, common trunk between RCA and MCA (cadaveric 20 %, CT 4.28 %); Pattern IIb, common trunk between RCA and ICA (cadaveric 32 %, CT 15 %); Pattern IIc, common trunk for the three main branches (cadaveric 0 %, CT 0.35 %); Pattern III, as the absence of RCA (cadaveric 8 %; CT 2.32 %) and Pattern IV, based on presence of accessory arteries (not found in any of the samples). Although the independent origin of the three colic arteries have been classically described as the most frequent, the right colic artery is responsible of major variations.

The superior mesenteric artery and the variations of the colic patterns. A new anatomical and radiological classification of the colic arteries

In this article we present a rare variant in which the large intestine was vascularized by the inferior mesenteric artery. It was encountered during macro and microscopic dissection of the cadaver of a 63-year-old woman at a university department of human anatomy. In this case, the ascending, transverse, descending, and sigmoid colon and rectum were vascularized by the inferior mesenteric artery, whereas the small intestine, cecum and appendix were supplied by the superior mesenteric artery.

/pdf/an-unusual-case-of-colon-vascularization-by-the-inferior-3cropw2974.pdf

An unusual case of colon vascularization by the inferior mesenteric artery

Variations in the branching patterns of the celiac trunk and superior mesenteric artery occur frequently. Detailed knowledge of anatomical variations of the abdominal arterial supply is important for the outcome of abdominal organ surgical intervention, abdominal aortic aneurysm repairs, liver resections, oncologic evaluations and chemoembolization of hepatic tumors. Familiarity with such variations is equally important for instructors teaching anatomy to students in the various medical disciplines. Case studies highlighting such vascular variations provide anatomical instructors and surgeons with accurate information on the types and prevalence of such alterations. This article highlights branching pattern variations of the celiac trunk and superior mesenteric artery involving the left and right hepatic arteries of a 72-year-old White Female cadaver. The left hepatic artery was one of the branches of the celiac trunk instead of the common hepatic artery, and the right hepatic artery was a branch of the superior mesenteric artery.

/pdf/branching-pattern-variations-of-the-celiac-trunk-and-11l6312v1q.pdf

Branching pattern variations of the celiac trunk and superior mesenteric artery in a 72-year-old white female cadaver

The arterial system of the gastrointestinal tract has many variations. However, variation in the inferior mesenteric artery (IMA) is less common than for the other abdominal arteries. The case in the present cadaver subject showed a variation in the anatomy of the IMA that differed from those seen in previous studies, because it did not originate from the abdominal aorta and had no branches. A single artery arising from branches of the inferior pancreaticoduodenal and middle colic arteries supplied the hindgut. This variation generated blood vessels along the digestive tract during the later stages of development. The marginal artery of the colon in this case probably was more highly developed instead of the IMA. It is clinically important to know the range of variations, as these data are used in the diagnosis and treatment of abdominal diseases. This hitherto unknown variation might affect the health of patients, and we recommend radiographic examinations for diagnosis and treatment.

A rare branching pattern of hindgut: absence of inferior mesenteric artery

Congenitally absent superior mesenteric artery in an asymptomatic adult

This paper aims to report the complete absence of the superior mesenteric artery (SMA) in an adult and to propose a new classification method for the superior–inferior mesenteric arterial variations (SIMAV). A 69-year-old female was referred for abdominal pain and change of stool habits and characteristics. Multi-detector computed tomography (MDCT) was performed. Based on the CT findings of the patient and previous reports on the abnormalities of the superior–inferior mesenteric arteries, attempt was made to propose a new classification method for SIMAV. MDCT with enhancement revealed complete absence of SMA and compensatory dilation of the inferior mesenteric artery (IMA). Aneurysm of the splenic artery and both inferior phrenic arteries aberrantly arising from the aorta at the same level of the celiac trunk were also noted. Based on our case and literature reports, we were able to propose a new classification method for SIMAV. Without considering the relationship with the celiac arteries, SIMAV can be divided into 4 types. Type I is the normal type or “textbook” type. In type II, SMA is defective and in type III, IMA is defective. In type IV, there is an aberrant middle mesenteric artery (MMA). Complete absence of SMA is extremely rare. However, awareness of such a variation is of great importance during operations for rectal and sigmoid cancer. In such patients, ligation of the trunk of IMA, which is the only artery for the entire intestine, will lead to disastrous consequence. The new classification method may be helpful in the scientific and systematic description of SIMAV.

Absence of the superior mesenteric artery in an adult and a new classification method for superior-inferior mesenteric arterial variations.

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Absence of the superior mesenteric artery in an adult and a new classification method for superior-inferior mesenteric arterial variations.