Robotic Right Hemicolectomy for Cecal Cancer with a Rare Ileocolic Artery-Middle Colic Artery Common Trunk: A Case...

While venous anomalies of the right colon are relatively common, arterial variations are rare. We report a case of cecal cancer with a unique vascular anomaly. A 65-year-old man presented with fatigue and melena. Colonoscopy revealed a cecal tumor, and biopsy confirmed moderately differentiated adenocarcinoma. Contrast-enhanced CT and three-dimensional CT angiography (3D-CTA) demonstrated a rare arterial anomaly in which the ileocolic artery (ICA) and middle colic artery (MCA) arose from a common trunk branching ventral to the superior mesenteric vein (SMV). The ICA coursed parallel to the ileocolic vein (ICV), while the MCA ran cranially along the ventral aspect of the SMV. Robot-assisted right hemicolectomy with D3 lymphadenectomy was performed. The ICA was divided distal to its bifurcation from the common trunk. The MCA was meticulously isolated during lymphadenectomy and traced cranially to its bifurcation, where the right branch was divided while preserving the left branch. Final pathology revealed T3 N1b (2/51) M0, Stage IIIB, with negative margins. This case highlights the value of preoperative 3D-CTA in detecting rare vascular anomalies and tailoring surgical strategies, and underscores how robot-assisted surgery, combined with precise preoperative imaging, facilitates optimal management in anatomically complex colorectal cases.