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Gastrointestinal and genitourinary systems
Published in Helen Butler, Neel Sharma, Tiago Villanueva, Student Success in Anatomy - SBAs and EMQs, 2022
13 The superior rectal artery is a branch of which vessel? Inferior mesenteric arteryCoeliac arteryInternal pudendal arteryInternal iliac arteryExternal iliac artery
Laparoscopic Hemicolectomy for Left Colon Cancer
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Ashwin deSouza, Shankar Malpangudi
The extent of any radical colectomy is defined on the basis of the location of the primary tumor. However, it would scarcely be considered appropriate to resect the entire left colon, that is from the middle of the transverse colon to the rectosigmoid junction at the sacral promontory, for lesions at all locations within this colonic segment. Lesions at the apex of the sigmoid colon may be resected with a sigmoid colectomy, dividing only the sigmoid vessels and preserving both the superior rectal and left colic arteries. Lesions in the descending limb of the sigmoid colon may require a high anterior resection where the IMA is divided either at the root or after the origin of the left colic artery. For lesions in the distal descending or proximal sigmoid colon, it may be more appropriate to include the left colic pedicle (along with the sigmoid vessels) in the resection template due to the more proximal location of the tumor. The superior rectal artery may be preserved for tumors at this location as the entire rectum is retained. The problem arises for splenic flexure lesions where there is a lack of consensus on the extent of resection.
Anatomy
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Reza Mirnezami, Alex H. Mirnezami
The principal artery supplying the rectum is the superior rectal artery (the name given to the inferior mesenteric artery at the point where the latter crosses the pelvic brim to enter the pelvic cavity). The superior rectal artery runs with the pelvic attachment of the sigmoid mesocolon to enter the perirectal fat behind the rectum. Here it breaks into two, sometimes three longitudinal vessels that travel on either side of the rectum before sinking into the rectal wall. Supplementary arteries that make a contribution to the blood supply of the rectum are the middle rectal arteries and the inferior rectal artery.
A fatal and unusual iatrogenic fourth right lumbar artery injury complicating wrong-level hemilaminectomy: a case report and literature review
Published in British Journal of Neurosurgery, 2019
Francesco Ventura, Rosario Barranco, Carlo Bernabei, Lara Castelletti, Lucio Castellan
Vascular damage is most commonly related to L4-L5 and L5-S1 level laminectomy.12–14 Within these levels, the inferior vena cava is interposed between the disc and the right or common iliac arteries.12 The left common iliac artery is susceptible to injury due to its medial course and intimate relationship with the L4-L5 intervertebral disc. The aorta and inferior vena cava are subject to surgical injury at the level comprised within the second and fourth lumbar vertebrae, whereas the distal segments of the iliac vessels are exposed to any injury at the level of the fourth lumbar vertebra.15 Finally, the internal iliac veins, lumbar arteries, inferior mesenteric artery, median sacral artery and the superior rectal artery are other vessels that may also be injured during lumbar disc surgery.5,16
The rectal remnant after total colectomy for colitis – intra-operative,post-operative and longer-term considerations
Published in Scandinavian Journal of Gastroenterology, 2018
Kalle Landerholm, Christopher Wood, Alexander Bloemendaal, Nicolas Buchs, Bruce George, Richard Guy
The superior rectal artery should normally be preserved in order not to compromise the blood supply of the rectal remnant with the risk of ischaemia of the stump and suboptimal conditions for a later IRA. Keeping the dissection closer to the sigmoid also avoids disturbing the anatomical planes for later proctectomy. Few studies have addressed the impact of rectal stump length or position on the chance of reconstructive surgery. Ozuner et al. retrospectively examined 25 and 35 cm stumps and found no difference in the outcome after subsequent restorative proctocolectomy [24]. A low intrapelvic division of the rectum increases the risk of pelvic sepsis [18] and causes scarring in the pelvis. An excessively long stump instead risks leaving symptomatic colitis in situ/behind which may not give optimal conditions for subsequent reconstruction [23]. We have also not been able to identify any studies about the placement/location of the rectal stump (intraperitoneally, subcutaneously or as a mucus fistula) and the frequency and outcome of reconstructive surgery.
Transcatheter embolization effectively controls acute lower gastrointestinal bleeding without localizing bleeding site prior to angiography
Published in Scandinavian Journal of Gastroenterology, 2018
Han Hee Lee, Jung Suk Oh, Jae Myung Park, Ho Jong Chun, Tae Ho Kim, Dae Young Cheung, Bo-In Lee, Young-Seok Cho, Myung-Gyu Choi
Diagnostic angiography has been indicated by suspicion of LGIB based on clinical symptoms, contrast-enhanced CT or endoscopic findings. The common femoral artery was accessed via Seldinger technique and a 6-F arterial sheath was placed. To detect the bleeding sites, all patients underwent diagnostic angiography of the celiac axis, superior and inferior mesenteric artery via a 5-F angiographic catheter (Yashiro, Terumo, Japan or RH, Cook, Bloomington, IN, USA). For patients in whom diagnostic angiography failed to localize the bleeding source, selective angiography was performed using 2.0-2.1 Fr microcatheters (Parkway; Asahi, Japan or Progreat; Terumo, Japan) at the suspected bleeding area. When vascular abnormalities were demonstrated by angiography, embolic therapy was performed as selectively as possible. The embolic agents used were metallic coils ranging from 3 to 5 mm in diameter (Cook Medical, Bloomington, IN, USA), gelatin sponge particle (Spongostan, Ethicon Inc., Somerville, NJ, USA), polyvinyl alcohol particles measuring 355–500 μm or 500–710 μm (Contour, Boston Scientific, Watertown, MA, USA) and N-butyl-2-cyanoacrylate (Histoacryl®; B. Braun Dexon, Spangenberg, Germany) mixed with ultrafluid lipiodol (Therapex; E-Z-EM, Montreal, Canada) in a 1:3 ratio. These agents were used alone or in combination. Figure 1 shows an example of the patient without active bleeding focus on endoscopic or radiologic examination who were treated by embolization of superior rectal artery.