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SURGICAL SIGNIFICANCE of INFERIOR MESENTERIC ARTERY and ITS BRANCHING PATTERN Raja Reddy Gangam *1, Sindhura Sadanandam Sharon 2

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SURGICAL SIGNIFICANCE of INFERIOR MESENTERIC ARTERY and ITS BRANCHING PATTERN Raja Reddy Gangam *1, Sindhura Sadanandam Sharon 2 International Journal of Anatomy and Research, Int J Anat Res 2016, Vol 4(1):2062-68. ISSN 2321-4287 Original Research Article DOI: http://dx.doi.org/10.16965/ijar.2016.141 SURGICAL SIGNIFICANCE OF INFERIOR MESENTERIC ARTERY AND ITS BRANCHING PATTERN Raja Reddy Gangam *1, Sindhura Sadanandam Sharon 2. *1 Associate Professor, Department of Anatomy, Rajiv Gandhi Institute of Medical Sciences (RIMS), Adilabad, Telangana, India. 2 Assistant Professor, Department of Anatomy, Rajiv Gandhi Institute of Medical Sciences (RIMS), Adilabad, Telangana, India. ABSTRACT Introduction: Inferior Mesenteric Artery (IMA) is a major anterior branch of the abdominal aorta and is responsible for supplying arterial blood to the organs of the hind gut. The present study was conducted to emphasize branching pattern of the inferior mesenteric artery, anatomical variations and its surgical significance. Knowledge of the arterial supply of the gut is essential for anatomists and surgeons for the safety and survival of patients in standard operative procedures. Materials and Methods: This study was conducted on 100 cases out of which seventy five were adult cadavers (40 - 70 years) and 25 fetuses (28 – 38 weeks) in the Dept. of Anatomy, Gandhi Medical College, Musheerabad, Secunderabad, Telangana, India. Results: the most common branching pattern of inferior mesenteric artery was into LCA in 74 (98.66%) cadavers and common sigmoid trunk gave off 3-4 sigmoid arteries. LCA was absent in one (1.33%) case of adult and one (4%) case of fetuses. Bifurcation of LCA has taken place close to its origin in 20% cases and in another 80% of the cases close to its splenic flexure. In 10.67% cases 1st sigmoid has taken origin from LCA and formed loop of anastomoses with ascending branch of LCA. Sigmoid arteries were 1-4 in number with variations observed in the mode of origin and their number. In 20% of cases one sigmoid has taken origin directly from IMA which later continued as superior rectal artery. Conclusion: The detailed knowledge of anomalous branching pattern of IMA and its distribution is of immense significance for surgeons particularly, when performing laparoscopic abdominal surgery. Knowledge of the arterial supply of the gut is essential for anatomists and surgeons for the safety and survival of patients in standard operative procedures. KEY WORDS: Abdominal Aorta, Inferior Mesenteric Artery, Sigmoid Arteries, Superior Rectal Artery. Address for Correspondence: Dr. Raja Reddy Gangam, M.D. Associate Professor, Department of Anatomy, Rajiv Gandhi Institute of Medical Sciences (RIMS), Adilabad-504001. Telangana, India. Mob: 91 9441490535 E-Mail: [email protected] Access this Article online Quick Response code Web site: International Journal of Anatomy and Research ISSN 2321-4287 www.ijmhr.org/ijar.htm Received: 08 Feb 2016 Accepted: 20 Feb 2016 Peer Review: 09 Feb 2016 Published (O): 31 Mar 2016 DOI: 10.16965/ijar.2016.141 Revised: None Published (P): 31 Mar 2016 INTRODUCTION mesenteric artery, often abbreviated as IMA, is Inferior Mesenteric Artery (IMA) is a major the third main branch of the abdominal aorta. anterior branch of the abdominal aorta that The IMA is responsible for supplying blood flow supplies arterial blood to the organs of the hind to the large intestine from the left (or splenic) gut. It is the smallest of the three anterior flexure to the upper part of the rectum. These branches of the abdominal aorta. The inferior include the distal one third of the transverse Int J Anat Res 2016, 4(1):2062-68. ISSN 2321-4287 2062 Raja Reddy Gangam, Sindhura Sadanandam Sharon. SURGICAL SIGNIFICANCE OF INFERIOR MESENTERIC ARTERY AND ITS BRANCHING PATTERN. colon, descending colon, sigmoid colon, as well surgery. Further, colonic vascular supply has as most of rectum [1,2]. some weak areas which have been reported to Branches of IMA: There are three major be highly predisposed to ischemic colitis [4-6]. branches that arise from the IMA. These branches Notable examples are Griffths’ point at the left include [3]: colic flexure [7, 8] and the Sudeck’s point at the rectosigmoid region [8-10]. 1. Left colic artery Knowledge of the arterial supply of the gut is 2. Sigmoid arteries essential for anatomists and surgeons for the 3. Superior rectal artery safety and survival of patients in standard All these arterial branches further divide into operative procedures. Therefore, the present arcades which then supply the colon at regular study was undertaken to emphasize inferior intervals. mesenteric artery, its branching pattern and its Left Colic Artery: The left colic artery (LCA) is surgical significance. The enlightenment and the first branch of the IMA supplies the distal proper knowledge of IMA and its branching one third of the transverse colon and the pattern as mentioned above will provide the descending colon. After arising from its parent surgeon with proper guidelines in ligating the artery, it travels anteriorly to the psoas major IMA and its branches during surgical resections muscle, left ureter and left internal spermatic in conditions like colorectal malignancies at vessels, before dividing into ascending and proper levels to prevent postoperative descending branches. gangrenous changes in the leftover viable large gut. A thorough knowledge of the anatomy of The ascending branch anastomoses with left the celiac, superior mesenteric, and inferior branch of the middle colic artery. The descending mesenteric arteries and their variants is branch anastomoses with the superior sigmoid necessary to accomplish a successful, uncompli- artery. From the arches formed by these cated abdominal operation. anastomosis branches are distributed to the distal one third of the transverse colon, and the Therefore, this paper is aimed to study the upper aspect of the descending colon. branching and distribution pattern of inferior mesenteric artery. The objectives of which Sigmoid (Inferior Left Colic) Arteries: The include: To trace the origin of IMA and identify sigmoid arteries supply the distal descending their branches, to study the course of inferior colon and the sigmoid colon. There are typically mesenteric artery, to observe the anatomical 2-4 branches, with the uppermost branch termed variations of IMA and to study the branching the superior sigmoid artery. It anastomoses pattern of IMA. superiorly with the left colic and inferiorly with the superior rectal artery. MATERIALS AND METHODS Superior Rectal (haemorrhoidal artery) Artery A total of seventy five human cadavers with age (SRA): The superior rectal artery is the principal ranging between 40 to 70 years (52 male and continuation of the IMA, supplying the rectum. 23 female cadavers) and 25 fetuses within the It descends into the pelvis, crossing the left range of 28 – 38 weeks were used in the study. common iliac artery and vein. At the third sacral Dead and unclaimed fetuses were obtained vertebra, the artery divides into two terminal mainly from the maternity wing of Gandhi branches. It descends one on either side of the Hospital, Musheerabad, Secunderabad, rectum and about 10 or 12cm from anus, breaks Telangana, India. The dissection was conducted up into several small branches. It forms as per Cunningham’s manual of practical collateral network with the middle rectal arteries anatomy [11]. The peritoneum and the visceras and inferior rectal arteries [1, 2]. were separated carefully and cleaned from the Detailed knowledge of the anatomical variations field of view. of the visceral branches of the abdominal aorta Approval of the ethical committee from Osmania is of extreme clinical importance, particularly, Medical College, Koti, Hyderabad, and Mediciti when performing laparoscopic abdominal Medical College, Hyderabad and including Int J Anat Res 2016, 4(1):2062-68. ISSN 2321-4287 2063 Raja Reddy Gangam, Sindhura Sadanandam Sharon. SURGICAL SIGNIFICANCE OF INFERIOR MESENTERIC ARTERY AND ITS BRANCHING PATTERN. parent institution Gandhi Medical College, ing origin to two small branches and continued Musheerabad, Secunderabad was taken and the as superior rectal artery (SRA). observations were made over the selected 75 Fig. 1: Branches of inferior mesenteric artery in the cadavers and 25 fetuses. The whole dissection cadavers studied. was carried out meticulously to locate the abdominal aorta which lies in the deeper plane from which the inferior mesenteric artery takes origin above the level of its bifurcation. After locating the abdominal aorta along with the origin of IMA, the branching pattern of IMA was neatly explored in all the fetuses. RESULTS Inferior mesenteric artery and its branches that originated from abdominal aorta were traced and identified in all the cadavers of the present Table 3: Branches given by inferior mesenteric artery. study. Branch Adult Fetus Origin: In all the 75 cadavers and 25 fetuses Percentage Number Percentage (%) Number studied, IMA was found to spring from (%) abdominal aorta (Table 1) a few cm proximal to LCA 74 98.66 24 96 the bifurcation of aorta (Table 2). The origin and Sigmoid 75 100 25 100 course of IMA has great surgical significance. Superior In the present study IMA showed normal pattern 75 100 25 100 Renal Artery in 56 (75%) cases. The abdominal aorta gave off IMA at the level of the third lumbar vertebra Left Colic Artery: The left colic artery (LCA) is (L3). IMA took origin from the aorta 2-5.2cm the first branch of the inferior mesenteric artery, proximal to its bifurcation (Table 2). and the normal pattern was seen in 70% of the Table 1: Origin of Inferior Mesenteric Artery from aorta present series. The LCA crosses the psoas major in adult cadavers and fetuses. and then divides into terminal branches the Adult Fetus ascending and descending branches. The Origin Aorta Other Aorta Other ascending branch travels in the transverse Number of 75 0 25 0 mesocolon and anastomoses with the left branch cadavers of middle colic. The ascending branch reached Percentage (%) 100 0 100 0 the splenic flexure where it bifurcated into two Table 2: Distance from origin of aorta to the bifurcation rami, the right and left.
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