Navigating the mesentery: Part III. Unusual anatomy of ileocolic vessels

Abstract

Aim The ileocolic vessels are important landmarks in advanced surgery of the midgut. The aim of the present study is to present variations of ileocolic vessels relevant to complete mesocolic excision with D3 lymphadenectomy of the right colon, within their detailed and precise morphometric framework and deriving from a large and consistent series of operated patients. Methods An ongoing prospective trial 'Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multidetector Computed Tomography Angiography' was reviewed. The imaging datasets underwent manual segmentation and 3D reconstruction, and the results were validated at surgery. A total of 356 patients were included in the study. Results A cross-section of the series revealed five cases (1.4%) with variation of ileocolic vessels relevant to complete mesocolic excision or D3 extended mesenterectomy. There were two cases with absence of a true classical ileocolic artery, two cases with absence of a true classical ileocolic vein, and one case of precocious bifurcation of the ileocolic artery, left to the superior mesenteric vein. The entire D3 area in all the cases was thoroughly documented and analysed from the morphometric point of view (calibres, lengths of vessels, crossing patterns). Conclusion The preoperative visualization of a patient's individual 3D anatomy is a powerful tool in identifying the variations whose negligence could have dire consequences in complete mesocolic excision of the right colon.

Preoperative segmentation of MultiDetector Computed Tomography Angiography (MDCTA)—solution to vascular variations

“…Our Right Colon Cancer (RCC) study group has accomplished 650 colectomies of the right colon for cancer to this date, with extended mesenterectomy and D3 lymphadenectomy. We regularly perform a minute manual segmentation with 3D reconstruction on preoperative MultiDetector Computed Tomography Angiography (MDCTA) ( 2 - 4 ), which serves as a powerful tool for road-mapping and surgical planning, particularly when the complex, rare and unexpected anatomical variations may occur ( 2 , 4 ). In one of our cases ( 2 ), we found a similar ( Figure 1 ), but not identical case as reported by Du et al We found that the ileocolic artery was very short and promptly divided to the left of the superior mesenteric vein.…”

“…We regularly perform a minute manual segmentation with 3D reconstruction on preoperative MultiDetector Computed Tomography Angiography (MDCTA) ( 2 - 4 ), which serves as a powerful tool for road-mapping and surgical planning, particularly when the complex, rare and unexpected anatomical variations may occur ( 2 , 4 ). In one of our cases ( 2 ), we found a similar ( Figure 1 ), but not identical case as reported by Du et al We found that the ileocolic artery was very short and promptly divided to the left of the superior mesenteric vein. Further, a preoperative MDCTA segmentation offers the possibility of 3D printing ( 3 ), which adds to the practical anatomical orientation before and even during operation.…”

“… A STL file, segmented from the MDCTA. Reused with permission from ( 2 ). GTH, gastrocolic trunk of Henle; MCV, middle colic vein; MCA, middle colic artery; ICA, ileocolic artery; ICV, ileocolic vein; JA, jejunal artery; MDCTA, MultiDetector Computed Tomography Angiography.…”