A Rare Case of Abnormal Inferior Mesenteric Artery.

Kakihara, Naoki; Takahishi, Shigeru; Tsuchihashi, Youji; Takenaka, Atsushi; Izumi, Hiroshi; Hujii, Koji; Ikawa, Osamu; Iizuka, Ryoji; Miyata, Keigo; Matsumura, Hiromi

doi:10.5833/jjgs.34.1442

Cited by 8 publications

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“…Variations or anomalies in the IMA anatomy are rare. In the report by Kakihara et al, abdominal angiography in 3182 patients revealed occasional IMA bifurcation anomalies, consisting of a defect in one patient (0.03%), running anomaly due to visceral retroversion in two patients (0.06%), and bifurcation from the root of the SMA in two patients (0.06%) [ 5 ]. Similarly, studies by Kondo et al and Minamizawa et al reported presence of abnormality, in which IMA branched from SMA, in 0.07% (one among 1516 cases) and 0.05% of the primary resection cases of colorectal cancer, respectively [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Using a Japanese literature search in “Igaku Chuo Zasshi” (Central Journal of Medicine), we found five cases, including our case (Fig. 6 ) [ 5 , 7 , 8 , 14 , 15 ]. In most cases, the superior margin of lymphadenectomy was set at the inferior border of the duodenum at the position where the IMA normally originates from the abdominal aorta or at the plexus of the colic branch of the lumbar splanchnic nerve.…”

Section: Discussionmentioning

confidence: 99%

“…Both are achieved by ligating the root of the inferior mesenteric artery (IMA), for example left-sided advanced colorectal cancer [ 1 , 2 ]. There have been few reports of colorectal cancer with IMA branching abnormalities, and to the best of our knowledge, no report exists describing the lymphatic flow in such cases [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…cancer [1,2]. There have been few reports of colorectal cancer with IMA branching abnormalities, and to the best of our knowledge, no report exists describing the lymphatic flow in such cases [3][4][5].…”

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Laparoscopic low anterior resection for rectal cancer wherein the inferior mesenteric artery arose from the superior mesenteric artery: a case report

et al. 2021

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Background Few cases have been reported of colorectal cancer with inferior mesenteric artery (IMA) branching abnormalities; therefore, the lymphatic flow in such cases remains unknown. We report the first case of locally advanced rectal cancer in which the IMA arose from the superior mesenteric artery (SMA) in which we achieved to visualize the lymphatic flow. Case presentation A 65-year-old woman complaining of bloody stools was investigated in our hospital and suspected with rectal cancer. Colonoscopy and abdominal enhanced computed tomography (CT) revealed a circumscribed, localized ulcerative tumor in the rectum. 3-Dimensional contrast-enhanced computed tomography (3D-CT) showed that the IMA arose from the SMA. The patient was diagnosed with rectal cancer (cT3N0M0, cStage IIa) and laparoscopic low anterior resection was performed. The sigmoid colon was resected using the medial approach. Only the plexus of the colic branch of the lumbar splanchnic nerve was observed at the site where the root of the IMA usually exists and showed interruption of the indocyanine green (ICG) fluorescence-illuminated lymphatics. The root of the IMA was ligated, and Japanese D3 lymphadenectomy was performed, preserving the accessory middle colic artery. All fluorescent lymph nodes were resected. The pathological diagnosis was pT4aN1aM0 stage IIIb. The patient’s postoperative course was uneventful. Adjuvant chemotherapy was administered, and the patient was recurrence-free at 1.5 years after surgery. Conclusions We were able to perform safe and appropriate surgery oncologically, despite abnormal vascular anatomy, due to preoperative identification using 3D-CT and intraoperative navigation using ICG administration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Laparoscopic low anterior resection for rectal cancer wherein the inferior mesenteric artery arose from the superior mesenteric artery: a case report

et al. 2021

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“…Kakihara et al 2) previously analyzed 3,182 abdominal angiographs, and reported that in all cases the IMA arised slightly to the left of the center of the Ao at the L3, and as a result the L3 is currently used as a landmark when performing angiographs of the IMA. However, Kahn et al 3) reported that the branching point of the IMA was at the L3 only in approximately 66% of all cases, and that among these 27% occurred in the lower third of the L3.…”

Section: Discussionmentioning

confidence: 99%

Positional relationships of abdominal aortic branches for contrast radiography of the inferior mesenteric artery using the coeliac trunk and superior mesenteric artery as landmarks

Nakayama

Hayashi

Takeuchi

et al. 2017

Okajimas Folia Anat. Jpn.

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Summary: Purpose: To establish a method by which angiography of the inferior mesenteric artery (IMA) can be performed smoothly, we investigated the relative locations of the coeliac trunk (CT), superior mesenteric artery (SMA), IMA, and left renal artery (LtRA). Methods: From a total of 60 cadavers, 32 cadavers with few arteriosclerotic lesions and little vascular tortuosity were selected for the study. The abdominal aorta (Ao) were removed and incised on both lateral side, along the vertical axis and transected into the ventral and dorsal sides. The intravascular lumen on the ventral side of the Ao was photographed using a digital camera, and the horizontal and vertical diameters of the sites of confluence of the CT, SMA, and IMA, were measured on the computer screen. We also calculated the distances between the branches, including the CT, SMA, IMA, LtRA, and the common iliac artery (CoI). Results: Although the SMA-IMA distance did not correlate with the CT-SMA distance, the ratio of the SMA-IMA to CT-CoI distance was four times greater than the ratio of the CT-SMA to CT-CoI distance. Conclusions: The site of branching of the IMA can be inferred to some extent from the CT and SMA distance.

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A case report of sigmoid colon cancer with the inferior mesenteric artery directly originating from the superior mesenteric artery

Mizoguchi,

Nagayoshi,

Mizuuchi

et al. 2023

surg case rep

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Background There are few reports describing the unusual origin of the inferior mesenteric artery (IMA). We report a rare case of advanced sigmoid colon cancer with the IMA arising from the superior mesenteric artery. Case presentation A 59-year-old man with diarrhea and abdominal distention was diagnosed with advanced sigmoid colon cancer. Colonoscopy revealed a semi-circumferential cancer lesion in the sigmoid colon. Enhanced CT scan and CT angiography showed that the IMA directly originated from the superior mesenteric artery at the level of the second lumbar vertebra. PET-CT suggested metastases in the para-intestinal lymph nodes and the liver, but not in the central lymph nodes along the IMA. Preoperative diagnosis was sigmoid colon cancer cT4aN2aM1a cStage IVA(UICC, 8th edition). We performed laparoscopic complete resection as the radical treatment of the primary region prior to resection of the liver metastases. Intraoperative findings showed that the IMA was running parallel to the abdominal aorta; meanwhile, the colonic autonomic nerve was supplied from the lumbar splanchnic nerve at the caudal side of the duodenum. Central lymph nodes around the colonic autonomic nerve were dissected en bloc with the regional lymph nodes. Pathological radical resection including the regional lymph nodes metastasis was achieved. Two months later, complete resection of the liver metastasis was performed. After the adjuvant chemotherapy, no recurrence was observed 1.5 years after the liver resection was performed. Conclusions Preoperative confirmation of the anatomy helped us to safely complete radical surgery in a patient with unusual bifurcation of the IMA.

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A Rare Case of Abnormal Inferior Mesenteric Artery.

Cited by 8 publications

References 0 publications

Laparoscopic low anterior resection for rectal cancer wherein the inferior mesenteric artery arose from the superior mesenteric artery: a case report

Laparoscopic low anterior resection for rectal cancer wherein the inferior mesenteric artery arose from the superior mesenteric artery: a case report

Positional relationships of abdominal aortic branches for contrast radiography of the inferior mesenteric artery using the coeliac trunk and superior mesenteric artery as landmarks

A case report of sigmoid colon cancer with the inferior mesenteric artery directly originating from the superior mesenteric artery

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