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Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Abdomen: Inferior Mesenteric Artery

Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Abdomen

Inferior Mesenteric Artery

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD

Peer Review Status: Internally Peer Reviewed


According to Poynter, this artery has not been extensively studied (i.e., before 1922) and the literature is not very extensive. The artery would appear to be rather stable and not subject to much variation. Cavasse (1856) found an accessory hepatic as one of its branches and noted that it occasionally furnishes renal branches. Vicq D'Azyr reported the absence of a connection (anastomosis) between the the middle colic and the left colic arteries. Poynter observed a middle colic that arose as a large branch from the left colic near its origin.

Duplication of this artery has been reported.

The artery may arise from the left common iliac artery.

Its left colic branch may be absent.

The inferior mesenteric occasionally encroaches on the territory of the superior mesenteric artery, or is replaced by the superior mesenteric artery.

In the place of a single inferior mesenteric trunk two arteries originated from the aorta 2.6 cm apart, the inferior one located 3cm superior to the bifurcation of the aorta. The superior of the two was directed superiorly and gave rise to two branches.

On to the superior portion of the descending colon and another that supplied the entire transverse colon. The inferior artery also gave rise to two branches: one to the inferior portion of the descending colon and the other to the sigmoid colon and rectum. The superior mesenteric artery gave rise to one major trunk to the colon, which divided into ileocolic and right colic branches only. The authors, Benton and Cotter, could not find any reference to doubled inferior mesenteric artery. They report that two references were found where the inferior mesenteric gave rise to a branch corresponding to the middle colic artery. The available literature on the inferior mesenteric is not extensive, consequently it is uncertain whether the present observation is due to a lack of adequate study. In their literature search, the authors reported the the inferior mesenteric artery has been reported absent by Fleischman in 1815 (Henle) and by Adachi. The absence of the left colic branch has been reported by Dubreuil in 1847 and Sonneland, et al. in 1958. Petsche in 1736, reported finding the inferior mesenteric artery arising from the left common iliac artery.

The inferior mesenteric artery may be absent entirely, its branches being given by the superior mesenteric artery or it may be just absent from its usual location. This artery sometimes arises from the superior mesenteric by a common trunk with the middle colic or the left common iliac artery. On the other hand, the inferior mesenteric may give rise to the middle colic or to an accessory right hepatic, "accessory" renal artery, or a common artery for both umbilical arteries when it arises from its usual position from the aorta.

It has also been reported that an "accessory" renal artery and the inferior mesenteric artery may arise from a common trunk from the aorta.

In a study of 115 inferior mesenteric arteries, Zebrowski, Augustyniak and Zajac (1971) reported the following variations: In all their cases the inferior mesenteric artery was present, arising from the anterior wall of the aorta in 112 cases. In two cases it arose from the left side, and in one case from the right side of the aorta.They provide information regarding the point of origin of the main trunk of the artery, its course and length, and the course and anastomoses of its main branches (i.e., left colic, sigmoid, and superior rectal arteries).

Usually, the origin of the artery from the aorta was at the level of L3 (77 cases), in a few cases at the level of the intervertebral disc between L3-L4 (23 cases), or at the level of L4 (9 cases). In a smaller number of cases, origin of the artery at the level of the intervertebral disc between L2-L3 (4 cases) or L4-L5 (2 cases) was observed.

The distance from the point of origin of the artery to its first branch, called the length of the trunk, ranged between 1.0 - 7 cm. Arteries 6 - 7 cm long predominated in both sexes; arteries with intermediate length of the trunk, 4 - 5 cm, were least frequent.

In the specimens studied, four forms of the inferior mesenteric artery were formed:

Form I After leaving the aorta and a long obliquely downward course, the inferior mesenteric artery divided into the left colic artery and common rectal-sigmoid trunk. This form had two varieties of branching:

Variety A (A) Two sigmoid arteries arising from the common rectal-sigmoid trunk independently, dividing dichotomously into secondary branches running to the sigmoid colon.

A few anastomoses were present between the branches of the sigmoid arteries and descending branch of the left colic artery, and numerous anastomoses between the branches of the left colic and middle colic arteries.

Variety B (B) Two sigmoid arteries arose by a common sigmoid trunk and then divided dichotomously into secondary branches running to the walls of the sigmoid colon. Secondary divisions and numerous anastomoses between these branches and with the descending branch of the colic artery and branches of the superior rectal artery were present.

Form II The inferior mesenteric artery divided into the superior rectal and colosigmoid trunk. Two varietes of this form were described:

Variety A (C) The trunk of the colosigmoid artery ran to the left, giving off a common sigmoid trunk in the downward direction and continued as a separate left colic artery, which divided near the wall of the descending colon into an ascending and a descending branch. The common sigmoid trunk divided dichotomously into two sigmoid arteries, which formed numerous anastomoses between themselves and weak anastomoses between themselves and weak anastomoses between the sigmoid arteries and the superior rectal artery.

Variety B (D) The thick trunk of the inferior mesenteric artery divided into the superior rectal artery and the colosigmoid trunk, which continued to the left and gave rise to two sigmoid arteries. These broke up into smaller branches forming various anastomoses among themselves and between the sigmoid arteries and descending branch of the left colic artery and branches of the superior rectal artery. In this group, numerous internal connections were observed not only among the branches of the inferior mesenteric artery, but also with the left branch of the middle colic and middle and inferior rectal arteries.

Form III This was the most numerous group of arteries and was subdivided into three varieties:

Variety A (E) The inferior mesenteric artery divided into two large arterial trunks: rectal-sigmoid and colosigmoid, each of which gave off one large sigmoid artery. The arteries ran to the walls of the sigmoid colon where they divided into a number of branches, usually 5 - 6, producing typical arcades.

Variety B (F) In this variety, the colosigmoid trunk gave off one large sigmoid artery, and the rectal-sigmoid trunk two large sigmoid arteries anastomosing similarly to the preceding form.

Variety C (G) In this variety, the common colosigmoid trunk gave off two sigmoid arteries, and the rectal-sigmoid trunk one sigmoid artery, which anastomosed as in varieties A and B, above, (or E and F).

Form IV (H) In this group the inferior mesenteric artery differed fundamentally from the other forms, its main trunk constituting a common colosigmoid-rectal trunk. The trunk of the inferior mesenteric artery was short, in the form of a characteristic tripod, dividing simultaneously into the left colic and superior rectal arteries and the common sigmoid trunk. This trunk, after a short course, divided into two sigmoid arteries, which near the wall of the sigmoid colon broke up into a large number of secondary sigmoid branches running to the intestinal walls. Anastomoses with the left colic and with the middle rectal artery, of some interest to the surgeon, were present. From Zebrowski, Augustynaik and Zajac (1971).

Image 24, Image 25, Image 254A, Image 254B, Image 333, Image 333A

Doubled:

See Images 24, 241, 349

Middle Colic

Image 101


References

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