The middle colic artery usually arises from the superior mesenteric artery, but in rare cases it may arise from the coeliac trunk or its branches. The aim of this study was to investigate variant origins of the middle colic artery on computed tomography and anatomical dissection. Variant middle colic arteries were identified on computed tomography as part of an ongoing study investigating anatomical variations of vessels of the upper abdomen. Three-dimensional reconstructions were made to demonstrate the variant findings. Cadaveric dissections were performed as part of a routine dissection course. We report five cases of rare variant origins of the middle colic artery arising from the coeliac axis. Among these sites of origin were the coeliac trunk, the gastrosplenic trunk, the splenic artery, and the common hepatic artery. Four cases were identified on multi-detector computed tomography and one in a cadaver. In all cases, the vessels passed posterior to the body of the pancreas before entering the transverse mesocolon. Knowledge of middle colic artery variations is important to prevent inadvertent injury in digestive surgery, especially in the hepatopancreatic area. Variant origins of the middle colic artery are rare, and their knowledge is crucial to prevent unnecessary iatrogenic injury during abdominal surgery.

CESKA Center for Endoscopic Surgical and Clinical Anatomy 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Anatomy 2nd Faculty of Medicine Charles University 5 Uvalu 84 Prague 5 Motol 150 06 Prague Czech Republic

Department of Health Care Studies College of Polytechnics Jihlava Czech Republic

Department of Radiology 3rd Faculty of Medicine University Hospital Kralovske Vinohrady Charles University Prague Czech Republic

Department of Surgery 3rd Faculty of Medicine University Hospital Kralovske Vinohrady Charles University Prague Czech Republic

Zobrazit více v PubMed

Amonoo-Kuofi HS, El-Badawi MG, El-Naggar ME (1995) Anomalous origins of colic arteries. Clin Anat 8:288–293 PubMed DOI

Bertelli L, Lorenzini L, Bertelli E (1996) The arterial vascularization of the large intestine. anatomical and radiological study. Surg Radiol Anat 18:S1–S59 DOI

Chitra R (2010) Clinically relevant variations of the coeliac trunk. Singapore Med J 51:216–219 PubMed

Douard R, Chevallier JM, Delmas V, Cugnenc PH (2006) Clinical interest of digestive arterial trunk anastomoses. Surg Radiol Anat 28:219–227 PubMed DOI

Ito K, Takemura N, Inagaki F, Mihara F, Kurokawa T, Kokudo N (2019) Arterial blood supply to the pancreas from accessary middle colic artery. Pancreatology 19:781–785 PubMed DOI

Kachlik D, Laco J, Turyna R, Baca V (2009) A very rare variant in the colon supply–arteria mesenterica media. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 153:79–82 PubMed DOI

Kachlik D, Hoch J (2008) The blood supply of the large intestine. Karolinum, Prague

Koizumi M (1990) Accessory arteries supplying the human transverse colon. Acta Anat (Basel) 137:246–251 PubMed DOI

Kwong MLM, Pelton J (2019) Middle colic artery originating from the gastroduodenal artery discovered during a Whipple. Case Rep Surg 2019:1986084 PubMed PMC

Michels NA (1955) Blood supply and anatomy of the upper abdominal organs with a descriptive atlas. J B Lippincott, Philadelphia

Murakami T, Mabuchi M, Giuvarasteanu I, Kikuta A, Ohtsuka A (1998) Coexistence of rare arteries in the human celiac-mesenteric system. Acta Med Okayama 52:239–244 PubMed

Sanjay P, Takaori K, Govil S, Shrikhande SV, Windsor JA (2012) “Artery-first” approaches to pancreatoduodenectomy. Br J Surg 99:1027–1035 PubMed DOI

Tandler J (1904) Über die Varietäten der Arteria coeliaca und deren Entwicklung. Anat Hft 25:472–500

Tubbs RS, Shoja MM, Loukas M (2016) Bergman’s comprehensive encyclopedia of human anatomic variation. John Wiley & Sons, Hoboken DOI

Vandamme JP, Bonte J (1985) The branches of the celiac trunk. Acta Anat (Basel) 122:110–114 PubMed DOI

Wadhwa S, Barua MP (2008) Anomalous middle colic artery originating from common hepatic artery: a case report. Clin Anat 21:798–799 PubMed DOI

Whitley A, Oliverius M, Kocian P, Havluj L, Gurlich R, Kachlik D (2020) Variations of the celiac trunk investigated by multidetector computed tomography: systematic review and meta-analysis with clinical correlations. Clin Anat 33:1249–1262 PubMed DOI

Woodfield CA, Torigian DA (2006) MDCT angiography of middle mesenteric artery with associated bowel nonrotation complicating management of abdominal aortic aneurysm. AJR Am J Roentgenol 187:W524-527 PubMed DOI

Yamada M, Nojiri I, Kosugi M (1963) Two anomalies: 1) middle colic artery from the splenic artery, 2) anomalous hepatic duct combined with arterial anomalies. Acta Anat Nippon 38:7 ((in Japanese))