Aberrant Left Colic Artery and Its Surgical Implications

Area of Science:

• Vascular anatomy
• Surgical anatomy
• Gastrointestinal surgery

Background:

• Arterial anomalies, particularly those of the celiac and superior mesenteric arteries, are documented variations in visceral vasculature.
• Variations in colonic blood supply are relevant for esophageal replacement conduit surgery and oncological resections.
• The aberrant left colic artery (ab LCA) is a rare arterial anomaly, previously described anatomically but not in a clinical context.

Observation:

• A middle-aged female presented with abdominal pain and lower gastrointestinal bleeding, diagnosed with transverse colon malignancy.
• During an extended right hemicolectomy with complete mesocolic excision and D3 lymphadenectomy, an ab LCA was identified.
• The ab LCA originated from the superior mesenteric artery (SMA) below the pancreatic border, unusually high and near the middle colic artery origin.

Findings:

• The aberrant left colic artery (ab LCA) was successfully dissected and preserved during the oncological resection.
• This case represents the first clinical report of an ab LCA encountered during surgical intervention.
• The unusual anatomical course of the ab LCA poses a risk of iatrogenic injury.

Implications:

• Iatrogenic injury to the ab LCA during colonic or pancreatic surgery can lead to increased patient morbidity.
• Awareness of this rare arterial variation is crucial for surgeons to prevent inadvertent damage.
• Detailed anatomical knowledge and careful surgical technique are essential when managing patients with potential vascular anomalies.