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[Arterial supply in the left colonic flexure].

L Lorenzini1, L Bertelli, M Lorenzi

  • 1Istituto di Chirurgia Generale, Università degli Studi di Siena.

Annali Italiani Di Chirurgia
|February 29, 2000
PubMed
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The left colic flexure is well-vascularized, but the descending colon has poor blood supply due to interrupted arterial arcades. Surgeons must consider these vascular variations in left colon surgery.

Area of Science:

  • Vascular anatomy
  • Surgical anatomy
  • Colorectal surgery

Background:

  • The vascular supply of the left colon, particularly the left colic flexure and descending colon, is crucial for surgical interventions.
  • Existing literature often assumes consistent arterial supply, which may not reflect anatomical variations.

Purpose of the Study:

  • To investigate the detailed vascular anatomy of the terminal transverse colon, left colic flexure, and descending colon.
  • To identify variations in arterial arcades, including Riolan's arcade and the intermesenteric arcade.
  • To assess the vascularity of the descending colon and its implications for surgical practice.

Main Methods:

  • Analysis of 1200 angiographies of the superior and inferior mesenteric arteries.
  • Examination of 150 anatomical specimens from left hemicolectomy surgeries.

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Main Results:

  • The left colic flexure is well-supplied with blood.
  • The descending colon exhibits poor vascularization, often relying on a single, small left superior colic artery with inconsistent branches.
  • Arterial arcade continuity in the descending colon is frequently interrupted.
  • Riolan's arcade is a constant vascular structure, though its variations and connections were noted.
  • The intermesenteric arcade was observed in 20% of cases.

Conclusions:

  • The vascular supply to the left colon, especially the descending colon, is not consistently robust.
  • Surgical planning for left colon procedures must account for potential interruptions in arterial continuity and variations in vascular supply.
  • The findings challenge previous assumptions about the consistent vascularity of the left colon.