Anatomical Science International

, Volume 93, Issue 4, pp 559–562 | Cite as

The middle rectal artery arising from the lateral sacral artery

  • Satoru HonmaEmail author
  • Takahiro Sonomura
Case Report


A middle rectal artery arising from the lateral sacral artery (MRAls) in the right pelvis of a 99-year-old male was observed. Although variations of the origin of the middle rectal artery have been reported on many occasions, there are few descriptions of the trajectory in the literature. In our case, the MRAls branched from the lateral sacral artery on the sacral surface close to the third sacral sympathetic ganglion and immediately penetrated the third sacral splanchnic nerve and the parasympathetic pelvic splanchnic nerve from the ventral ramus of the forth sacral nerve. The MRAls entered in the lateral wall of the rectal ampulla without giving off a prostatic branch. Preservation of the pelvic autonomic nerves are crucial in rectal cancer excision to preserve the autonomic functions. The close topography of the MRAls to the origin of the fine autonomic nerves should be noted.


Arterial variation Autonomic nerves Lateral sacral artery Middle rectal artery Pelvic plexus 



This study is supported by Grants-in-Aid from the Japan Society for the Promotion of Science #26350592.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Adachi B (1928) Das Arteriensystem der Japaner, vol II. Maruzen, KyotoGoogle Scholar
  2. Bilhim T, Pereira JA, Tinto HR et al (2013) Middle rectal artery: myth or reality? Retrospective study with CT angiography and digital subtraction angiography. Surg Radiol Anat 35:517–522CrossRefPubMedGoogle Scholar
  3. Borley NR (2008) Abdomen and pelvis. In: Standring S (ed) Gray’s anatomy, 40th edn. Elsevier Churchill Livingstone, London, pp 1087–1137Google Scholar
  4. DiDio LJA, Diaz-Franco C, Schemainda R, Bezerra AJC (1986) Morphology of the middle rectal arteries. A study of 30 cadaveric dissections. Surg Radiol Anat 8:229–236CrossRefPubMedGoogle Scholar
  5. Dubreuil-Chambardel L (1925) Traité des variations du système artériel. Variations des artères de pelvis et du membre inférieur. Masson et Cie, ParisGoogle Scholar
  6. Havenga K, De Ruiter MC, Enker WE, Welvaart K (1996) Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer. Br J Surg 83:384–388CrossRefPubMedGoogle Scholar
  7. Kiyomatsu T, Ishihara S, Murono K et al (2017) Anatomy of the middle rectal artery: a review of the historical literature. Surg Today 47(1):14–19CrossRefPubMedGoogle Scholar
  8. Moore KL, Persaud TVN, Torchia MG (2016) The developing human, 10th edn. Elsevier, PhiladelphiaGoogle Scholar
  9. Parsons FG, Keith A (1897) Sixth annual report of the committee of collective investigation of the Anatomical Society of Great Britain and Ireland, 1895–1896. J Anat Physiol 31:31–44Google Scholar
  10. Sato K, Sato T (1991) The vascular and neuronal composition of the lateral ligament of the rectum and the rectosacral fascia. Surg Radiol Anat 13:17–22CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Association of Anatomists 2018

Authors and Affiliations

  1. 1.Department of Anatomy, School of MedicineKanazawa Medical UniversityKahokuJapan
  2. 2.Department of Oral AnatomyAsahi University School of DentistryMizuhoJapan

Personalised recommendations