Left Colic Research Articles

Concurrent origin of right gastroepiploic and left colic arteries from inferior pancreaticoduodenal artery: rare variation of splanchnic anastomosis

In the present case, inferior pancreaticoduodenal artery, the first branch of superior mesenteric artery, was exceptionally giving rise to right gastroepiploic artery and left colic artery simultaneously. Right gastroepiploic artery is a branch of foregut artery, while left colic artery is a branch of hindgut artery. Concurrent origin of branches of foregut as well as hindgut arteries from a midgut artery i.e. superior mesenteric artery is very rare. Usual left colic artery from inferior mesenteric artery was also present but was supplying smaller area than usual. It can be explained as persistence of unusual channels and obliteration of usual ones along the dorsal splanchnic anastomosis during the embryonic development. The field of vascularization of superior mesenteric artery was extended beyond its usual boundaries both proximally as well as distally, which is clinically important as unawareness of the variations may lead to significant morbidity and mortality.

Resection of Infected Aneurysm at the Left Colic Artery after Mitral Valve Replacement for Infective Endocarditis

Resection of Infected Aneurysm at the Left Colic Artery after Mitral Valve Replacement for Infective Endocarditis

New ports placement in laparoscopic central lymph nodes dissection with left colic artery preservation for sigmoid colon and rectal cancer.

Lymph nodes (LNs) dissection around inferior mesenteric artery (IMA) with left colic artery (LCA) preservation is difficult due to the anatomical feature of IMA. The aim of this study is to evaluate the usefulness of new ports placement inserted from a suprapubic region in laparoscopic LNs dissection around IMA with LCA preservation for sigmoid colon and ractal cancer. Twenty-two patients who underwent laparoscopic colectomy for sigmoid colon and recal cancer were included. The new ports placement group (n=15, new group) was compared with the basic ports placement group (n=7, basic group). Average number of harvested LNs, total operation time, central LNs dissection time, intraoperative blood loss were compared. There was no significant difference in the average number of harvested LNs. The mean of intraoperative blood loss of new group was significantly lower than that of the basic group (40.0±39.8 ml vs 95.7±81.0 ml, p<0.05). In addition, the mean of operation time of the new group was significantly shorter than that of the basic group (250.0±55.7 min vs 353.4±80.2 min, p<0.05). The new ports placement is useful in laparoscopic LNs dissection around IMA with LCA preservation for sigmoid colon and rectal cancer.

The cobra head sign

A 39-year-old man presented with complaints of long standing lower abdominal pain and episodic left renal colic, associated with urgency, frequency and dysuria. His physical exam, urinalysis and blood tests were unremarkable. Images from the contrast enhanced computed tomographic (CECT) scan of abdomen demonstrated the “cobra-head sign”(A,B), consistent with diagnosis of intravesical ureterocoele. Endoscopic incision of the ureterocoele was successfully performed and complete resolution of symptoms achieved. Ureterocoeles result from incomplete dissolution of the primitive membrane separating the ureteric bud from the developing urogenital sinus. Intravesical ureterocoele is defined as a cystic out-pouching of the distal ureter within the bladder, arising from a ureter with a normal insertion into the trigone-“orthotopic ureterocoele”. This type of ureterocoele is usually diagnosed in adults; hence, it is also called adult-type ureterocoele. Most intravesical ureterocoeles are incidental findings in asymptomatic adult patients, but may cause infections or calculi. Larger ones may cause bladder neck obstruction, along with obstruction of the ipsilateral ureter, which seems to have happened in our patient (B, C). However, he had neither hydronephrosis nor delay in the function of the left kidney (D). On contrast studies, they appear as a bulbous dilatation within the bladder, surrounded by a radiolucent halo-the 'cobra-head sign'. The lucent rim represents the combined thickness of the ureteral wall and prolapsed bladder mucosa, outlined by contrast material within bladder lumen. Also known as the “spring onion sign”, this cobra-head deformity is seen in only 50% of cases. It is important to distinguish ureterocoele (with thin and well defined lucent rim) from a pseudo-ureterocoele (with thick, irregular, or less well-defined lucent rim), as the latter can be caused by distal ureteric obstruction from a tumor or impacted calculus.

Presence of a Splenicocolic Ligament and an Unusual Vascular Peritoneal Fold Close To Spleen and Splenic Flexure of Colon- A Case Report

Spleen is the largest lymphatic organ and variation in its shape, location, number, and size are frequently seen in humans. However, peritoneal anomalies of spleen are very rare. We report a splenicocolic ligament which extended from the visceral surface of the spleen to the left colic flexure and the proximal part of the descending colon. Another unusual fold extended from the right end of the transverse mesocolon to the proximal part of the descending colon. The fold was vascular and was raised by a branch of the left colic artery. The vascular fold was in continuity with the splenicocolic ligament. Knowledge of these peritoneal anomalies is important for gastroenterologists, surgeons and radiologists.

Robotic Low Ligation of the Inferior Mesenteric Artery for Rectal Cancer Using the Firefly Technique.

PurposeBy integrating intraoperative near infrared fluorescence imaging into a robotic system, surgeons can identify the vascular anatomy in real-time with the technical advantages of robotics that is useful for meticulous lymphovascular dissection. Herein, we report our initial experience of robotic low ligation of the inferior mesenteric artery (IMA) with real-time identification of the vascular system for rectal cancer using the Firefly technique.Materials and MethodsThe study group included 11 patients who underwent a robotic total mesorectal excision with preservation of the left colic artery for rectal cancer using the Firefly technique between July 2013 and December 2013.ResultsThe procedures included five low anterior resections and six ultra-low anterior resections with loop ileostomy. The median total operation time was 327 min (226-490). The low ligation time was 10 min (6-20), and the time interval between indocyanine green injection and division of the sigmoid artery was 5 min (2-8). The estimated blood loss was 200 mL (100-500). The median time to soft diet was 4 days (4-5), and the median length of stay was 7 days (5-9). Three patients developed postoperative complications; one patients developed anal stricture, one developed ileus, and one developed non-complicated intraabdominal fluid collection. The median total number of lymph nodes harvested was 17 (9-29).ConclusionRobotic low ligation of the IMA with real-time identification of the vascular system for rectal cancer using the Firefly technique is safe and feasible. This technique can allow for precise lymph node dissection along the IMA and facilitate the identification of the left colic branch of the IMA.

Balloon-Occluded Transarterial Chemoembolization for Peritoneal Metastasis of Hepatocellular Carcinoma

We report unusual 2 cases treated with Balloon-occluded transarterial chemoembolization (B-TACE) for peritoneal hepatocellular carcinoma (HCC) metastasis. An 87-year-old female with hepatitis-C related cirrhosis underwent radiofrequency ablation (RFA) repeatedly. Computed tomography showed a 30 mm diameter tumor seeding adjacent to the ascending colon. Digital subtraction angiography (DSA) of the gastroduodenal artery showed a tumor stain fed by an omental arterial branch distributing from the greater curvature of the stomach. Since ultraselective cannulation was difficult, a micro-balloon catheter was selected and advanced to the right gastroepiploic artery on the central side of the omental artery, and B-TACE was performed at this point. A 78-yearold male with hepatitis-C related cirrhosis underwent RFA and TACE repeatedly, but multiple HCC developed and a 45 mm diameter metastatic tumor adjacent to the descending colon was observed. DSA of the inferior mesenteric artery showed a tumor stain fed by the several peripheral branches of the left colic artery. Since one of this several branches was noted the normal mesenteric blood vessel by selective angiography, the position of the tip of the micro-balloon catheter was finely adjusted by balloon inflation to prevent inflow of the contrast medium into the normal blood vessel, and then B-TACE was performed.

High Ligation of Inferior Mesenteric Artery in Left Colonic and Rectal Cancers: Lymph Node Yield and Survival Benefit.

During surgery for colorectal cancer, the inferior mesenteric artery (IMA) may be ligated either directly at the origin of the IMA from the aorta (high ligation) or at a point just below the origin of the left colic artery (low ligation). Sixty patients of left colonic and rectal cancer undergoing elective curative surgery in 2007 and 2008 were selected for this observational study. The resected lymph nodes were grouped into three levels: along the bowel wall (D1), along IMA below left colic (D2), and along the IMA and its root (D3). Statistical analysis was performed with SPSS version 20.0. D2 level was involved pathologically in 20 (33.3%) and D3 in six out of 44 (13.6%) patients. The median nodal yield with high and low ligation were 33 and 25, respectively (p = 0.048). Median overall survival for high ligation was 62months versus 42months for low ligation (p = 0.190). High ligation of the IMA for rectal and left colonic cancers can improve lymph node yield, thus facilitating accurate tumor staging and thus better disease prognostication, but the survival benefit is not significant.

Laparoscopic D3 lymph node dissection with preservation of left colic vessels for the treatment of rectal cancer

D3 lymph node dissection could reduce the recurrent and metastatic rates of rectal cancer.How to completely dissect No.3 lymph node and protect the left colic vessels deserve further investigation.From January 2012 to March 2013,133 patients with rectal cancer received laparoscopic D3 lymph node dissection with preservation of left colic vessels in the First Affiliated Hospital of Jilin University.The recovery and postoperative complications were observed.The operation was successfully carried out with no conversion to open surgery and no intraoperative complications.The incidence of postoperative complications was 6.77％ (9/133).A total of 118 patients were followed up for 2-16 months,and the median time of follow-up was 7 months.Two patients were complicated with liver metastasis,6 with elevation of tumor markers,while no signs of tumor recurrence or metastasis were detected.The condition of other patients was normal.Laparoscopic D3 lymph node dissection with preservation of left colic vessels for the treatment of rectal cancer is feasible and safe. Key words: Rectal neoplasms; D3 lymph node dissection; Laparoscopy

Os ramos colaterais da aorta abdominal em jaguatirica (Leopardus pardalis)

A jaguatirica (Leopardus pardalis) é uma das espécies de felino silvestre que pouco foi investigada quanto a sua morfologia. Assim, o estudo objetivou detalhar a origem e distribuição dos ramos colaterais da aorta abdominal deste animal. Avaliou-se dois exemplares, sendo um macho e uma fêmea, jovens, provenientes de Paragominas-PA, doados ao Laboratório de Pesquisa Morfológica Animal (LaPMA) da Universidade Federal Rural da Amazônia (UFRA). O sistema arterial foi preenchido com látex pigmentado de vermelho e os cadáveres foram preservados com solução de formaldeído tamponado a 10%. A aorta abdominal do L. pardalis teve origem entre T12 e L1, sendo a artéria celíaca o primeiro ramo visceral no sentido crânio-caudal, resultando nas artérias hepática, gástrica esquerda e esplênica. A artéria mesentérica cranial surgiu como segundo ramo da aorta abdominal, originando as artérias jejunais. Na sequência localizamos artéria pancreáticoduodenal caudal, artérias ileais, artérias ileocólicas, artérias renais direita e esquerda, artérias adrenais direita e esquerda e artérias ováricas ou testiculares direita e esquerda. Parietalmente, a aorta abdominal originou em média seis ramos lombares, bem como a artéria frenicoabdominal, as artérias circunflexas ilíacas profundas e artérias ilíacas externa e interna. A aorta abdominal gerou ainda a artéria mesentérica caudal, a qual dividiu-se em artérias cólica esquerda e retal cranial. A artéria cólica esquerda seguiu cranialmente paralela ao cólon descendente irrigando-o, originando em média 18 ramos, e anastomosando-se com a artéria cólica média. A artéria retal cranial seguiu em direção caudal distribuindo oito ramos à porção final do cólon descendente e ao reto, e uniu-se com a artéria retal média. Por fim, a aorta abdominal emitiu como ramo terminal a artéria sacral mediana. A vascularização arterial abdominal desta espécie é bastante semelhante ao descrito em felinos domésticos e demais mamíferos, com diferenças quanto ao número de artérias jejunais e origem das artérias renais.

Is low tie ligation truly reproducible in colorectal cancer surgery? Anatomical study of the inferior mesenteric artery division branches

Curative surgery is the standard treatment for colorectal cancer. The ligation level of the inferior mesenteric artery (IMA) is still debated, as neither low tie (LT) nor high tie ligation (HT) has shown any benefit on the patients' overall survival. We examined whether LT is standardizable and easily reproducible from an anatomical point of view. One hundred CT angiographies of healthy patients were analysed for the anatomy of the IMA and its division branches: left colic artery (LCA), sigmoid arteries trunk and superior rectal artery. Data analysed comprised angles between the IMA and the aorta, diameters of the IMA and its branches, repartition of the branches and distances between the origin of the branches and the origin of the IMA. IMA anatomy showed no variation. In contrast, its division branches showed important variability in terms of distance to the origin and repartition: in 19.9% of the patients, the IMA directly splits into three branches, and in 17.6% of the patients, the LCA originated at more than 5 cm from the origin of the IMA. These frequent variations led us to assume that the standardization of LT is very difficult in a context of neoplasm, where the quality of the lymphadenectomy is fundamental. The division branches of the IMA are extremely subject to interindividual variations, making it difficult if not impossible to reproduce identically a surgical procedure based on their anatomy. HT appears to us as the only relevant procedure for colorectal cancer.

Huge Trombus including Left Renal Vein, Ovarian Vein, and Inferior Vena Cava Mimicking Renal Colic.

A 31-year-old female presented with acute left flank pain; she had a C/S at the postpartum day 24. Ureteral stone was suspected but ultrasound examination was normal. Then Doppler ultrasound revealed a trombus in left renal vein and inferior vena cava. Contrast enhanced MDCT scan showed swelled and nonfunctional left kidney, a trombus including distal part of left ovarian vein, left renal vein, and inferior vena cava. We started anticoagulation treatment. Further examination revealed diagnosis of chronic myeloproliferative disease. The trombus was completely recanalized at 3-month followup.

Surgical technique of robotic D3 lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery and autonomic nerves for the treatment of distal rectal cancer

Our objective was to evaluate the quality of surgery regarding application of the robotic approach to perform D3 lymph node dissection over the inferior mesenteric artery (IMA) with preservation of the left colic artery (LCA) and autonomic nerves for the treatment of distal rectal cancer, which has not been reported before, although it has been successfully performed by some surgeons laparoscopically. Patients with distal rectal cancer posing risk factors for anastomotic leakage were recruited and underwent the present robotic procedure, which was standardized and presented in the attached video file. Patients' surgical outcomes were prospectively evaluated. A total of 26 patients with distal rectal cancer were operated on via the present robotic approach. The number of cleared lymph nodes was 26.1 ± 7.2 (range 10-44). The operation time was 307.3 ± 74.1 min (including docking time). The blood loss was 190.5 ± 225.8 ml. Anastomotic leakage occurred in one (1/16, 6 %) patient without preoperative chemoradiation therapy, and wound infection of port sites was detected in two (2/26, 7.6 %) patients. The patients had quick convalescence, as evaluated by the recovery of flatus passage (48.0 ± 12.0 h), hospitalization (14.6 ± 4.8 days), and degree of postoperative pain (2.5 ± 0.5, visual analog scale). The median duration for indwelling urine Foley catheter was 6.0 days (range 3.0-28). The voiding function after removal of the urine Foley catheter was good (International Prostate Score Symptom [IPSS] 0-7) in 22 (84.6 %) patients, fair (IPSS 8-14) in three (11.5 %), and poor (IPSS 15-35) in one (3.8 %). The median time of return to partial activity, full activity, and work was 2.0, 4.0, and 6.0 weeks, respectively. By using the three-armed Da Vinci(®) robotic system in our clinical setting, quality surgery of the D3 lymph node dissection around the IMA with preservation of the LCA and autonomic nerves, in which the adequacy of lymph node harvest and the security of blood supply over distal colon were juggled, can be achieved for patients with distal rectal cancer posing risk factors of anastomotic failure.

Lost and Found Unusual Location of a Urinary Tract Calculus = فقد ثم تم العثور عليه موقع غير عادي لحصوة في المجرى البولي

A 41-year-old male patient presented to the Emergency Department (ED) of Sultan Qaboos University Hospital (SQUH) complaining of left flank pain of one day’s duration which was colicky and increasing in intensity. There was no history of fever, nausea or vomiting or other significant medical history; however, a similar episode had occurred previously. The patient’s vital signs were stable and he was afebrile. Physical examination of the abdomen was non-contributory; routine microscopic urinalysis was normal. In view of the suspicion of left renal colic, he was referred for a non-contrast enhanced computed tomography (NCCT) scan, the gold standard at SQUH to assess urinary tract calculi in patients presenting with renal colic. The scan showed significant left perinephric fat stranding and mild left hydroureteronephrosis and evidence of periureteric fat stranding around the left ureter. No calculi could be identified in the left kidney or the left ureter. There was a direct inguinal hernia on the right side which contained part of the urinary bladder and a small radio-opaque calculus. These findings suggested the recent passage of a left ureteric stone into the bladder and the migration of this stone into the herniated part of the urinary bladder. It is also possible that the patient had passed out the ureteric stone via the urethra, and that the stone in the herniated bladder was an incidental finding. Clinically, the pain decreased over the period of observation in the ED, and the patient was discharged. At Urology Clinic follow-ups, there was no recurrence of pain, and the patient was managed conservatively. Inguinal hernias can be direct or indirect; the Hesselbach triangle is usually the site for direct inguinal hernias. On CT, the direct inguinal hernia lies medial to the inferior epigastric artery.1 A total of 1–3% of all inguinal hernias involve the bladder;2 in obese men aged 50–70 years, the incidence may reach 10%.3 Inguinal hernias generally occur on the right side.2 Urinary bladder hernias are mostly diagnosed incidentally during hernia surgeries,4 or during imaging.2 The herniated parts of the urinary bladder can contain tumors or calculi.2,5 These may migrate from upper tracts or form de novo in the hernia due to stasis. CT is the best modality for the diagnosis and evaluation of inguinoscrotal urinary bladder herniation after injection of intravenous contrast. The post-processing of the CT using 3D reconstructions can demonstrate the contents of the hernia and its relationships.6 Our patient’s calculus, could possibly have passed from the left ureter. However, it is possible that it may instead have travelled to the herniated component of the urinary bladder and been overlooked, especially as the herniated part of the bladder was small and did not significantly distort the urinary bladder in the pelvis. Therefore, we suggest that the protocol for the routine NCCT of the kidney, ureter and bladder for urolithiasis should extend below the pubic symphysis so as not to miss posterior urethral calculi or calculi in unusual areas.

Level of arterial ligation in sigmoid colon and rectal cancer surgery.

358 Background: Curative resection of sigmoid colon and rectal cancer includes "high tie" of the inferior mesenteric artery (IMA). However, IMA ligation compromises blood flow to the anastomosis, which may increase the leakage rate and it is unclear whether this confers a survival advantage. Accodingly, IMA may be ligated at a point just below the origin of the left colic artery (LCA) ("low tie"), with lymph node (LN) dissection around IMA. No study has investigated the detailed prognostic results between "high tie" and "low tie, with LN dissection around IMA". The aim of this study was to assess the utility of "low tie, with LN dissection around IMA" on survival in patients with sigmoid colon or rectal cancer. Methods: A total of 268 sigmoid colon or rectal cancer patients who underwent curative operation from 1998 to 2007 were enrolled in this study. The patient's medical records were reviewed to obtain information about operative method, the number of LN dissection, the number of metastatic LN, the site of metastatic LN, recurrence pattern, complication. Overall survival and relapse-free survival were calculated using the Kaplan-Meier method, with differences assessed using logrank test. Results: We divided all patients into three groups according to the ligation level of IMA. 41 patients were ligated at the level of IMA root (Group A: "high tie"). 164 patients were ligated just caudally to the origin of the LCA ("low tie"), with LN dissection around IMA. 63 patients were ligated at the level of superior rectal artery just caudally to the sigmoid artery. The significant difference was not observed in a complication rate in three groups. The significant difference was not observed in the survival rate and the relapse-free survival rate according to each stage in group A and group B either. Also, the significant difference was not observed in the survival rate and the relapse-free survival rate in node-positive cases in group A and group B. Conclusions: "Low tie,with lymph node dissection aroud IMA" is anatomically less invasive and is not inferior to the ligation in the IMA root ("hige tie") in prognostic point.

Curative resection of gastric tube cancer by hand-assisted thoracoscopic surgery

We report a 78-year-old male who underwent successful resection of a gastric tube cancer by hand-assisted thoracoscopic surgery. The patient was initially placed in the supine position, and the abdominal portion of the gastric tube was mobilized via upper midline laparotomy. A pedicled colonic graft supplied by the left colic artery was prepared. The patient was then moved to the left decubitus position, and five ports were placed in the right chest wall. The surgeon stood in front of the patient, and inserted his left hand into the right pleural cavity through the laparotomy incision. After the whole gastric tube was successfully mobilized, the patient was returned to the supine position. The gastric tube was reconstructed with the pedicled colonic graft via the subcutaneous route. The surgical resection margins were free of cancer. The patient currently survives more than 16 months after surgery.

Anomalous origin and vulnerable course of left colic artery in relation to the pancreas—A case report

We report here an anomalous origin and course of left colic artery in relation to pancreas during routine dissection of the abdominal region in a 70-year-old male cadaver in the department of anatomy. The anomalous left colic artery took its origin from the superior mesenteric artery and immediately divided into right and left branches. The right branch passed through the transverse mesocolon to supply the left one third of the transverse colon. The left branch traversed to the left along the inferior border of the body of the pancreas and crossed the left kidney before supplying the left colic flexure of colon and descending colon. This aberrant course of the left branch of the left colic artery can be considered as a “vulnerable” course as it is liable to injury during pancreatic and renal surgeries since the artery is not expected to run along the inferior border of the pancreas. The pancreas, a retroperitoneal organ, is related to major arteries such as abdominal aorta, inferior vena cava, coeliac trunk and its main branches, superior mesenteric vessels, splenic and portal veins. Surgery of the pancreas therefore, not only needs a thorough knowledge of the normal course of branches of these vessels but also demands a good knowledge of possible anomalous vessels arising in this region.

Right sided descending and sigmoid colon: its embryological basis and clinical implications

Anatomical variations of the colon are described by various authors, but the occurrence of right sided descending and sigmoid colon is rare and has not been reported. We found that the anomalous right-sided descending and sigmoid colon had four parts. The proximal segment of the first part consisted of the descending colon extending across the midline from the splenic flexure to the portion supplied by the left colic artery. The distal segment was supplied by the superior sigmoid artery. The second and third parts formed a loop in the right lumbar region anterior to the lumbar cecum. The fourth part was in the lesser pelvis, extending from right sacroiliac joint to the third sacral body. Parts two, three, and four were supplied by the inferior sigmoid artery, which arose from the right side of the inferior mesenteric artery. The ascending and transverse colon was normally placed. This is a rare anomaly that has not been reported so far in adults and is of immense importance to interventional radiologists and colorectal surgeons. The embryological basis of such an anomaly is defective fixation occurring as early as the 12th-17th week of intrauterine life.

Identifying Important Predictors for Anastomotic Leak After Colon and Rectal Resection

The purpose of this study was to identify patient, clinical, and surgical factors that may predispose patients to anastomotic leak (AL) after large bowel surgery. Anastomotic leak is still one of the most devastating complications following colorectal surgery. Knowledge about factors predisposing patients to AL is vital to its early detection, decision making for surgical time, managing preoperative risk factors, and postoperative complications. This was a prospective observational, quality improvement study in a cohort of 616 patients undergoing colorectal resection in a single institution with the main outcome being AL within 30 days postoperatively. Some of the predictor variables were age, sex, Charlson Comorbidity Index (CCI), radiation and chemotherapy, immunomodulator medications, albumin, preoperative diagnoses, surgical procedure(s), surgical technique (laparoscopic vs open), anastomotic technique (staple vs handsewn), number of major arteries ligated at surgery, surgeon's experience, presence of infectious condition at surgery, intraoperative adverse events, and functional status using 36-Item Short Form General Health Survey. Of the 616 patients, 53.4% were female. The median age of the patients was 63 years and the mean body mass index was 25.9 kg/m. Of them, 80.3% patients had laparoscopic surgery and 19.5% had open surgery. AL occurred in 5.7% (35) patients. In multivariate analysis, significant independent predictors for leak were anastomoses less than 10 cm from the anal verge, CCI of 3 or more, high inferior mesenteric artery ligation (above left colic artery), intraoperative complications, and being of the male sex. Multiple risk factors exist that predispose patients to ALs. These risk factors should be considered before and during the surgical care of colorectal patients.

Branching pattern of inferior mesenteric artery in a black african population: a dissection study.

Background. Branching pattern of inferior mesenteric artery (IMA) and pattern of vascular supply to the left colon and rectosigmoid areas, though important during colorectal surgery, display interethnic variations. Further, these regions have notable vascular “weak points” reported to be highly susceptible to ischemic colitis. This study aimed at evaluating the branching pattern of IMA in a black African population. Materials and Methods. Fifty-seven formalin-embalmed cadavers (28 Male, 27 Female) were studied. The length, branching pattern, and diameter of IMA at its origin were recorded. Results. IMA mean length and diameter at origin were 30.57 ± 10.0 mm and 4.10 ± 0.9 mm, respectively. IMA most frequently branched into left colic artery and a common sigmoid trunk in 23 cases while the classical branching pattern was observed in only 7 cases. Colic marginal artery was absent at the splenic flexure and sigmoid colon in 7 and 5 cases, respectively. Arc of Riolan was observed in 9 cases. Conclusion. Branching pattern of IMA shows variations from the previously reported cases which might help account for some of the untoward outcomes observed following colon surgery. An angiographic study to further delineate functionality of the arterial anastomoses in this region is recommended.