Aberrant Left Colic Artery and Its Surgical Implications

Abstract

Arterial anomalies of the viscera are not unusual. Of the arterial anomalies, the celiac and the superior mesenteric anomalies are well studied and reviewed in the literature. These variations are due to changes occurring during the development of vessels. Also, the variations in the colonic blood supply have been detailed in the context of conduit surgery in esophageal replacement and oncological resections. Of these, the rarer anomaly is the aberrant left colic artery (ab LCA). Previously described in various anatomic descriptions; it has never been reported in a clinical situation. A middle-aged female presented with abdominal pain and lower gastrointestinal (GI) bleed. On further evaluation, she was diagnosed to have transverse colon malignancy. She underwent extended right hemicolectomy with complete mesocolic excision and D3 lymphadenectomy as classically described. During the dissection, she was found to have an LCA arising from the superior mesenteric artery (SMA) just below the inferior border of the pancreas two centimeters higher to the origin of the middle colic artery. This artery was carefully dissected and preserved. Injury of the ab LCA is possible given the unusual course of the artery. Implications of iatrogenic injury in colonic and pancreatic surgeries may result in additional morbidity which is discussed in detail.

Unique Constellation of Vascular Anomalies in a Female Cadaver: IVC, Renal Vein, and Left Colic Artery Variation

“…The incidence of this anomaly alone has been cited at a very low frequency of just 1% [7]. In addition to this study, only a few other cadaveric case reports [14,15] and one clinical case report [8] are known to have identified aberrancies in the LCA.…”

“…As is the case for DIVC, arterial anomalies of the gut are believed to be the result of changes occurring during the development of these vessels. The most noteworthy variation pertains to aberrancies specific to the origin of the left colic artery (LCA), as these tend to occur less frequently [8].…”

A Unique Arc of Bühler Variant Connecting the Arteries of the Foregut, Midgut, and Hindgut and Its Surgical Significance

“…In this case, we discovered a unique anastomotic channel that not only connects the CT and SMA, as typically seen with the AOB [ 1 ], but also bridges the arterial supply of the foregut, midgut, and hindgut by extending to the MCA, LCA, and gastric arteries. Although vascular variations are common, to our knowledge, this AOB variant has not previously been reported [ 5 , 6 ]. Douard et al categorized variations of vascular anastomotic arcades according to Tandler's theory [ 2 ].…”

Aberrant Left Colic Artery and Accessory Right Colic Artery: A Case Report and Surgical Implications

“…Lack of consideration for the aberrant LCA poses potential complications. Hence, the colon may no longer be used as a safe substitutive graft due to the risk of jeopardizing the blood supply of the remaining segment of the colon [ 6 ]. In addition, aberrant LCAs have been observed to branch directly from the SMA in cadavers [ 7 , 8 ] and from the SMA in a live patient [ 6 ].…”

“…Hence, the colon may no longer be used as a safe substitutive graft due to the risk of jeopardizing the blood supply of the remaining segment of the colon [ 6 ]. In addition, aberrant LCAs have been observed to branch directly from the SMA in cadavers [ 7 , 8 ] and from the SMA in a live patient [ 6 ]. The retroperitoneal location of the aberrant LCA is near other various major vessels such as the inferior vena cava and the abdominal aorta.…”