Vol.:(0123456789) 1 3 Surgical and Radiologic Anatomy https://doi.org/10.1007/s00276-019-02359-9 REVIEW Arterial vascularization of the right colon with implications for surgery Matthieu Bruzzi 1,2,3,5  · Leila M’harzi 1,2,3  · Tigran Poghosyan 1,2,3  · Iannis Ben Abdallah 2  · Argyri Papadimitriou 1  · Emilia Ragot 1  · Salma El Batti 2  · Vincent Balaya 2  · Julien Taieb 2,4  · Jean‑Marc Chevallier 1,2  · Richard Douard 1,2 Received: 30 May 2019 / Accepted: 4 October 2019 © Springer-Verlag France SAS, part of Springer Nature 2019 Abstract Purpose During right-sided colectomies, surgeons encounter major anatomical variations at the level of the right colon, leading to morbidity. Due to the confusion surrounding the colonic arterial vessels emerging from the superior mesenteric artery (SMA) to vascularize the right part of the colon, this review aimed to describe the arterial vessels found in the meso- colic structures of the ascending colon, the hepatic flexure and the right transverse colon. Methods A review of the literature was performed using the MEDLINE database. Only human studies were included. All dissection, angiographic, arterial cast and corrosion studies were analyzed. Results This review demonstrates that the right colon, the hepatic flexure and the right transverse colon are vascularized by three significant arteries emerging from the SMA and forming one peripheral paracolic arc: (1) the ileocolic artery (ICA), the most constant vessel (99.8%) with low variability; (2) the right colic artery (RCA), the most inconstant vessel (2/3 of cases) with high variability in its origin; and (3) the middle colic artery (MCA), a constant vessel (95%) with variation in its origin and its number. The marginal artery is almost constant (100%) and represents the only peripheral arterial arc at the level of the right side of the colon. Conclusions Three arteries emerging from the superior mesenteric artery exist: the ICA, the RCA and the MCA. The ICA and the MCA are the most constant. Knowledge of this vascular anatomy is essential for performing right-sided colectomies. Keywords Right-sided colectomy · Ileocolic artery · Right colic artery · Middle colic artery · Cancer colon Introduction Knowledge of the arterial vascular anatomy of the colon is essential in oncological colon surgeries [3, 9, 30]. Sur- gical resection of colon tumors is based upon the arterial blood supply of the colon as well as its lymphatic drain- age. The tumor localization, extent of surgical resection and associated lymphadenectomy are therefore directly related to the arterial anatomy of the colon [6]. In right or right transverse colon cancers, mesenteric root dissection must be performed close to the superior mesenteric artery (SMA) to ligate all arteries supplying the tumor at their origin on the SMA and to perform a complete mesocolic excision [5, 11, 15, 28, 34, 35]. In cases of right colon cancer (CC), the ileocolic artery (ICA) and the right colic artery (RCA) must be ligated, whereas in cases of right transverse CC, surgeons must ligate the ICA and the RCA but also the middle colic artery (MCA) [9]. Standard textbooks of surgery or anatomy are simply schematic, but in clinical practice, surgeons are exposed to major anatomical variations at the level of the ascending colon and the right colic angle, which can lead to periop- erative confusion during laparoscopic resection due to lack of understanding of the tridimensional surgical anatomy, increasing the postoperative morbidity because of insuffi- cient vascular supply [1, 2, 8, 17, 19, 23, 26]. In fact, a good vascularization of both colonic ends is required for good sutures and no fistula. * Matthieu Bruzzi matthieu.bruzzi@aphp.fr 1 General and Digestive Surgery Unit, Georges Pompidou AP-HP University Hospital, 20, Rue Leblanc, 75908 Paris Cedex 15, France 2 Paris Descartes Faculty of Medicine, Paris, France 3 INSERM 970, Équipe 2, PARCC, HEGP, Paris, France 4 Digestive Oncology Unit, Georges Pompidou AP-HP University Hospital, Paris, France 5 Service de Chirurgie générale et digestive, Hôpital européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France