c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

The Anatomy of Colectomy: 10

A D V E R T I S E M E N T

   
 

The middle colic artery arises as the SMA emerges from beneath the neck of the pancreas. Finding the superior mesenteric vessels in the root of the small bowel mesentery for embolectomy, endarterectomy or bypass is facilitated by tracing the middle colic back from the transverse colon.      

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The Anatomy of Colectomy: 11

A D V E R T I S E M E N T

   
 

The superior mesenteric artery arises from the aorta at the level of the first lumbar vertebra behind the neck of the pancreas, is the principle blood supply to the small bowel and supplies middle colic, right colic, iliocolic and terminal appendiceal branches. The inferior mesenteric arises at the level of L3 inferior to the third portion of the duodenum and supplies left colic, sigmoidal and superior rectal branches.      

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The Anatomy of Colectomy: 12

A D V E R T I S E M E N T

   
 

Collateral colonic blood supply between superior and inferior mesenteric territories is weakest at the splenic flexure, where branches of the middle colic and left colic often do not communicate as a complete marginal artery (of Drummond). In some cases of gradual SMA stenosis, proximal mesenteric vascular channels hypertrophy into a robust meandering mesenteric artery (arc of Riolan). Back-bleeding from the divided IMA during abdominal aortic aneurysm repair is an indication of good collateral supply, decreasing the chance of left colon ischemia. If there is no back-bleeding, reimplantation may be indicated.     

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This page was last modified on 9/15/2009.