37 - Aberrant Middle Colic and Left Hepatic Arteries in a 76-year-old Female: A Case Report and Literature Review

Poster Board Number: 37
There are separate poster presentation times for odd and even posters.
Odd poster #s – first hour
Even poster #s – second hour

Abstract Body : Introduction: A high degree of anatomical variation exists in blood supply patterns of the gastrointestinal system. Anomalous middle colic artery (MCA) has rarely been reported. Reported variations include branching from the aorta between the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA), proximal splenic artery, celiac trunk, SMA via an accessory MCA, gastroduodenal artery, or ileocecal artery. The left colic artery from IMA may give rise to a large ascending branch to the transverse colon, with the absence of MCA. One case of the MCA arising from IMA, described as a left middle colic artery, has been reported by Granite et al. Hepatic artery anatomic variations are well documented. An aberrant left hepatic artery may be from left gastric artery, the splenic artery, arising from the aorta, and duplication of hepatic artery.
Methods: The embalmed cadaver of a 76-year-old female with known medical history of multiple myeloma was dissected during the anatomy class at A. T. Still University School of Osteopathic Medicine in Arizona.
Results: An aberrant middle colic and left hepatic artery are identified. There is no middle colic artery arising from SMA. Instead, the proximal part of the IMA gives rise to a relatively large aberrant left MCA and the first sigmoidal artery. The ascending aberrant artery arising from the IMA courses upward towards the transverse colon and merges with the marginal artery. Additionally, an aberrant left hepatic artery is identified arising from the aorta. The “normal” left hepatic artery is atrophic. Two left gastric arteries originate from the aberrant left hepatic artery.
Conclusion: The aberrant middle colic artery originating from IMA and aberrant left hepatic artery from the aorta are rare. To our knowledge, no report of aberrant arteries identical to this study exist nor has both variations been seen in one cadaver. Therefore, these findings can contribute to the arterial variation of the gastrointestinal system.
Significance: The gastrointestinal system identifiably has a multitude of arterial variation. In our cadaver, the “normal” left hepatic artery is atrophic and likely unable to sustain blood supply to the left lobe of the liver if the aberrant left hepatic artery is ligated during gastric surgery. If there is ligation of the aberrant MCA from IMA in a left colectomy procedures may cause ischemia of transverse or upper part of the descending colon. Awareness of the variations preoperatively by radiologists, gastroenterologists and surgeons are of upmost importance to prevent adverse outcomes.