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Arterial vascularization of the right colon with implications for surgery

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Abstract

Purpose

During right-sided colectomies, surgeons encounter major anatomical variations at the level of the right colon, leading to morbidity. Due to the confusion surrounding the colonic arterial vessels emerging from the superior mesenteric artery (SMA) to vascularize the right part of the colon, this review aimed to describe the arterial vessels found in the mesocolic structures of the ascending colon, the hepatic flexure and the right transverse colon.

Methods

A review of the literature was performed using the MEDLINE database. Only human studies were included. All dissection, angiographic, arterial cast and corrosion studies were analyzed.

Results

This review demonstrates that the right colon, the hepatic flexure and the right transverse colon are vascularized by three significant arteries emerging from the SMA and forming one peripheral paracolic arc: (1) the ileocolic artery (ICA), the most constant vessel (99.8%) with low variability; (2) the right colic artery (RCA), the most inconstant vessel (2/3 of cases) with high variability in its origin; and (3) the middle colic artery (MCA), a constant vessel (95%) with variation in its origin and its number. The marginal artery is almost constant (100%) and represents the only peripheral arterial arc at the level of the right side of the colon.

Conclusions

Three arteries emerging from the superior mesenteric artery exist: the ICA, the RCA and the MCA. The ICA and the MCA are the most constant. Knowledge of this vascular anatomy is essential for performing right-sided colectomies.

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Authors and Affiliations

  1. General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France

    Matthieu Bruzzi, Leila M’harzi, Tigran Poghosyan, Argyri Papadimitriou, Emilia Ragot, Jean-Marc Chevallier & Richard Douard

  2. Paris Descartes Faculty of Medicine, Paris, France

    Matthieu Bruzzi, Leila M’harzi, Tigran Poghosyan, Iannis Ben Abdallah, Salma El Batti, Vincent Balaya, Julien Taieb, Jean-Marc Chevallier & Richard Douard

  3. INSERM 970, Équipe 2, PARCC, HEGP, Paris, France

    Matthieu Bruzzi, Leila M’harzi & Tigran Poghosyan

  4. Digestive Oncology Unit, Georges Pompidou AP-HP University Hospital, Paris, France

    Julien Taieb

  5. Service de Chirurgie générale et digestive, Hôpital européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France

    Matthieu Bruzzi

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  1. Matthieu Bruzzi
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Contributions

MB, J-MC, RD: project development. MB, LM, TP: data collection. MB, LM, RD wrote the manuscript with comments from IBA, AP, ER, SEB, VB, JT, J-MC.

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Correspondence to Matthieu Bruzzi.

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Bruzzi, M., M’harzi, L., Poghosyan, T. et al. Arterial vascularization of the right colon with implications for surgery. Surg Radiol Anat 42, 429–435 (2020). https://doi.org/10.1007/s00276-019-02359-9

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  • DOI: https://doi.org/10.1007/s00276-019-02359-9

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