|Year : 2016 | Volume
| Issue : 1 | Page : 49-51
Absence of middle colic artery from the superior mesenteric artery
Reshma Betal1, Sibani Mazumdar1, Ardhendu Mazumdar2
1 Department of Anatomy, Calcutta National Medical College, Kolkata, West Bengal, India
2 Department of Physiology, IPGMER, Kolkata, West Bengal, India
|Date of Submission||29-Apr-2016|
|Date of Acceptance||16-May-2016|
|Date of Web Publication||2-Jun-2016|
Department of Anatomy, Calcutta National Medical College, 32 Gorachand Road, Kolkata - 700 014, West Bengal
Source of Support: None, Conflict of Interest: None
The knowledge of branches of superior mesenteric artery important for Surgeon and radiologists who deals abdominal diseases. Superior mesenteric artery is second ventral branch of abdominal aorta which arises from 1 cm below coelic trunk, opposite L1 vertebrae and supplies lower portion of duodenum, whole jejunum, ileum caecum, appendix, ascending colon and major portion transverse colon. Actually it is the artery for derivates of midgut.  Superior mesenteric artery gives inferior pancreatic duodenal artery, middle colic artery, right colic artery and ileo colic artery from its right concave side some ileo-jejunal artery from convex left side. Usually middle colic artery arises from superior mesenteric artery at the lower border of pancreas and immediately enters the root of transverse mesocolon and divides into right and left branch. The right branch anastomose with ascending branch of right colic artery near right colic flexure and left anastomose with ascending branch of left colic. Here we present a case of absence of mid colic artery from superior mesenteric artery and right colic artery shows some extra branches from its proximal part which supplies transverse colon.
Keywords: Absence, middle colic artery, superior mesenteric artery
|How to cite this article:|
Betal R, Mazumdar S, Mazumdar A. Absence of middle colic artery from the superior mesenteric artery. BLDE Univ J Health Sci 2016;1:49-51
The knowledge of branches of superior mesenteric artery is important for surgeons and radiologists who deal abdominal diseases. Superior mesenteric artery is the second ventral branch of abdominal aorta which arises from 1 cm below celiac trunk, opposite to L1 vertebrae and supplies lower portion of duodenum, whole jejunum, ileum, cecum, appendix, ascending colon, and major portion transverse colon. Actually, it is the artery for derivatives of midgut. 
Superior mesenteric artery gives inferior pancreaticoduodenal artery, middle colic artery, right colic artery, and ileocolic artery from its right concave side and ileo-jejunal artery from convex left side.
Usually, middle colic artery arises from superior mesenteric artery at the lower border of the pancreas and immediately enters the root of transverse mesocolon and divides into right and left branches. The right branch anastomose with ascending branch of right colic artery near right colic flexure and the left anastomose with ascending branch of left colic.
Here, we present a case of the absence of middle colic artery from superior mesenteric artery, and right colic artery shows some extra branches from its proximal part which supplies transverse colon.
| Case Report|| |
During routine dissection for undergraduate classes in the session of 2014-2015 at Calcutta National Medical College, a 72-year-old male cadaver of Kolkata origin shows some variations in the arterial system which we are going to present in steps of dissection.
Steps of dissection:
- Abdomen opened through subcostal incision extending up to iliac crest and abdominal wall reflected below
- Greater omentum reflected superiorly
- Transverse mesocolon reflected upward
- Loops of small intestine put downward and leftward so that the right surface of mesocolon is exposed
- Peritoneal layer and fat over the artery are removed
- Trunk of superior mesenteric artery identified
- All the branches of it stressed and studied properly.
In this case, the following has seen:
- Absence of middle colic artery from the superior mesenteric artery [Figure 1]
- Two extra branches arise from the right colic artery for supplying transverse colon [Figure 2]
- The artery arises from the right side divides into two branches: one branch [Figure 3] anastomose with ascending branch of right colic artery and another branch anastomose with one branch of left-sided artery
- The left-sided artery divides into two branches: one branch anastomose with branch coming from the right-sided artery and another branch supplies the left side of the transverse colon, but no anastomosis is seen with branch of the left colic artery.
- Anastomosis of successive branches of superior and inferior mesenteric arteries to form the marginal artery of Drummond is incomplete here as the branch from superior mesenteric artery does not anastomose with branch of inferior mesenteric artery. Hence, marginal artery of Drummond is incomplete
- Right colic artery supplies a large portion of large gut than usual.
| Discussion|| |
Abdominal aorta gives rise to three ventral branches named as celiac trunk, superior mesenteric artery, and inferior mesenteric artery with supplies the derivatives of foregut, midgut, and hindgut, respectively. The variation in number and branching pattern of arteries of gut may be correlated with their embryonic development. 
In the early fetal life, there are two dorsal aortae which give of ventral branches to supply the gut and its derivatives. Initially, the ventral branches are paired. After the fusion of two dorsal aortae, the paired ventral branches also fuse to form unpaired segmental arteries. These segmental arteries run into dorsal mesentery of gut and divides into ascending and descending branches to form a continuous longitudinal anastomotic channel. In course of time, several ventral branches disappear and only three persists as celiac trunk, superior mesenteric artery, and inferior mesenteric artery. If there is any deviation in fusion and disappearance of arteries from its normal pattern, then there is abnormality in branching of these major three arteries. 
Variation of the middle colic artery reported in literature present in a few:
A study done in 2005 shows its absence in 33% cases.  A case report in 2013 shows origin of middle colic artery from gastroduodenal artery instead of superior mesenteric artery. 
Superior mesenteric artery itself shows variations as reported in some cases. A study done in 1995 shows hepatic artery arising from superior mesenteric artery.  Another study done in 2011 shows superior mesenteric originates from celiac trunk.  Another case reported in 2013 shows common trunk for right colic and ileocolic artery in 25% cases. 
Knowledge of branching pattern of abdominal arteries is very important to surgeons and radiologist who deal with abdominal pathology. In this case, if occlusion of the right colic artery occurs, then it leads to devitalization of extensive portion of gut than usual. As the marginal artery of Drummond is not complete in this case, hence, the left side of the transverse colon near the left colic flexure is vulnerable for less blood supply. During hemicolectomy operation, such type of anomaly needs technical expertise.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]