Gastrointestinal surgery in gynecologic oncology
J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan in An Atlas of Gynecologic Oncology, 2018
The blood supply to the colon and rectum is derived from branches of the superior mesenteric, inferior mesenteric, and internal iliac arteries. The right colon is supplied by the SMA through the ileocolic artery, the right colic artery, and a branch of the middle colic artery. The transverse colon is chiefly supplied by the middle colic artery, but there is a communication with the inferior mesenteric arterial system via the marginal artery of Drummond. The inferior mesenteric artery supplies the colon from the splenic flexure to the proximal rectum. The inferior mesenteric artery branches into the left colic artery, the superior rectal artery, and the sigmoid arteries. The distal rectum receives its blood supply from the paired middle and inferior rectal arteries which originate from the internal iliac artery system (Figure 29.10).
Abdomen
Bobby Krishnachetty, Abdul Syed, Harriet Scott in Applied Anatomy for the FRCA, 2020
Blood supply to the bowel comes from three main branches of the aorta – coeliac axis, superior and inferior mesenteric arteries. Coeliac axis and branches – left gastric, common hepatic, splenic arteryThe coeliac axis comes off at the T12 level and supplies the foregut structures such as liver, stomach, spleen, pancreas and the duodenum.Superior mesenteric artery (SMA) and branches – ileocolic artery, right colic artery, middle colic arteryThe SMA originates at L1, and supplies the embryonic midgut structures such as the duodenum, pancreas, small bowel, caecum, ascending colon and two-thirds of the transverse colon until the splenic flexure.Inferior mesenteric artery (IMA) and branches – left colic artery, sigmoid artery, superior rectal arteryThe IMA comes off at L3 and supplies the hindgut structures, such as the remaining one third of the transverse colon, descending colon, sigmoid and rectum (Figures 3.3 and 3.4).
The gastrointestinal system
C. Simon Herrington in Muir's Textbook of Pathology, 2020
It is important to know the blood supply of the intestines, because this determines the site and pattern of ischaemic damage, and is also followed by lymphatics, thereby determining the routes of spread of carcinoma. The superior mesenteric artery supplies the entire small intestine apart from the first half of the duodenum. This artery also supplies the right side of the colon and most of the transverse colon. In the small intestine, the terminal branches of the superior mesenteric artery are end-arteries, with few anastomoses between them. In the large bowel there is a degree of distal and proximal anastomosis between all of the supplying vessels. The inferior mesenteric artery supplies the distal transverse, the descending and the sigmoid colon, and the upper part of the rectum. The middle and inferior rectal arteries, branches of the internal iliac, and internal pudendal arteries supply the remainder of the rectum. The venous drainage of the bowel, apart from the anal canal, is via the portal system to the liver. This is the reason why primary gastrointestinal malignancies frequently spread to the liver, producing hepatic metastases.
Total mesorectal excision – 40 years of standard of rectal cancer surgery
Published in Acta Chirurgica Belgica, 2020
J. Votava, D. Kachlik, J. Hoch
The TME can be defined as a sharp dissection and a complete removal of the mesorectum, containing pararectal lymph nodes, along with its intact enveloping fascia [15]. Operative steps of the TME as described by Heald [16] are: 1. ligation of the inferior mesenteric artery at its origin; 2. mobilization of the left colic flexure; 3. transection of the left-sided colon at the junction between the descending and sigmoid colon; 4. sharp dissection in the avascular plane into the pelvis ventrally to the presacral fascia (of Waldeyer) and outside the enveloping visceral fascia of the rectum; 5. division of the lymphatic vessels and middle rectal vessels ventrolaterally at the level of the pelvic floor, 6. inclusion of all pelvic fat tissue and lymphatic structures to the level of the pelvic floor.
Routine CT scan one year after surgery can be used to estimate the level of central ligation in colon cancer surgery
Published in Acta Oncologica, 2019
Ditte Louise E. Munkedal, Mona Rosenkilde, Nicholas P. West, Soren Laurberg
The available images included scans undertaken prior to surgery, 2 days after surgery and approximately 1 year after surgery. The study radiologist first assessed the images taken 1 year after surgery in order to identify the residual arterial stump and measure its length. If this was not possible, the preoperative CT-scan was used for identification. Afterwards, the CT-scan performed 2 days after surgery was used as a control. On the right side only, the ileocolic artery was measured from its origin at the superior mesenteric artery to the ligation. On the left side only, the inferior mesenteric artery was measured from its origin at the aorta to the ligation. The arterial stumps were classified as: a normal vessel (Figure 1(a)), thrombosed (visible thrombosis within the vessel, Figure 1(b)), a fibrotic line (mostly degenerated, Figure 1(c)) and not visible.
Identifying and addressing the limitations of EVAR technology
Published in Expert Review of Medical Devices, 2018
Viony M Belvroy, Ignas B Houben, Santi Trimarchi, Himanshu J Patel, Frans L Moll, Joost A. Van Herwaarden
Ischemic complications can occur not only due to a clot formation or clot embolization but also due to incorrect placement of the stent graft while covering side branches of the aortic or iliac arteries. Systematic overstenting of the inferior mesenteric artery can cause bowel ischemia. The incidence of bowel ischemia in open repair is similar to EVAR and lies between 1 and 3% of the cases [38]. It is a serious complication, with a 50% mortality rate within 1 month. Spinal cord ischemia is rare in infrarenal EVAR and has an incidence of 0.21% [39]. Unrecognized renal artery occlusion after EVAR is very rare, since total occlusion will always show on a check-up angiogram. If unrecognized and untreated, it often leads to permanent failure, mandating dialysis or renal replacement therapy [40]. Limb thrombosis after EVAR is a known complication and can occur in 2% of the cases in the early phase [10]. Most of these events are caused by stent graft kinking and extension of the small diameter stent graft into the external iliac artery [10]. See Table 1 for an overview of the comparison of complications between EVAR and open surgery [41–52].
Related Knowledge Centers
- Abdominal Aorta
- Aortic Bifurcation
- Lumbar Vertebrae
- Renal Artery
- Sigmoid Colon
- Descending Colon
- Body
- Large Intestine
- Navel
- Duodenum