ANATOMICAL VARIATIONS OF THE SUPERIOR MESENTERIC ARTERY AND ITS CLINICAL AND SURGICAL IMPLICATIONS IN HUMANS

Natasha Gabriela Oliveira da SILVA Ana Beatriz Marques BARBOSA Nathalie de Almeida SILVA Diego Neves ARAÚJO Thiago de Oliveira ASSIS About the authors


Different morphological patterns of SMA

HEADINGS:
Mesenteric artery, superior; Anatomy; Intestinal atresia; Intestinal obstruction; Anatomic variation


ABSTRACT

Introduction:

Superior mesenteric artery (SMA) usually arises from the abdominal aorta, just below the celiac trunk and it supplies the midgut-derived embryonic structures. Anatomical variations in this vessel contribute to problems in the formation and/or absorption of this part of the intestine and its absence has been recognized as the cause of congenital duodenojejunal atresia.

Objective:

To analyze SMA anatomical variations in humans and the possible associated clinical and surgical implications.

Methods:

This is a systematic review of papers indexed in PubMed, SciELO, Springerlink, Science Direct, Lilacs, and Latindex databases. The search was performed by two independent reviewers between September and December 2018. Original studies involving SMA variations in humans were included. SMA presence/absence, level, place of origin and its terminal branches were considered.

Results:

At the end of the search, 18 studies were selected, characterized as for the sample, method to evaluate the anatomical structure and main results. The most common type of variation was when SMA originated from the right hepatic artery (6.13%). Two studies (11.11%) evidenced the inferior mesenteric artery originating from the SMA, whereas other two (11.11%) found the SMA sharing the same origin of the celiac trunk.

Conclusion:

SMA variations are not uncommon findings and their reports evidenced through the scientific literature demonstrate a great role for the development of important clinical conditions, making knowledge about this subject relevant to surgeons and professionals working in this area.

HEADINGS:
Mesenteric artery, superior; Anatomy; Intestinal atresia; Intestinal obstruction; Anatomic variation


Diferentes padrões morfológicos da AMS.

DESCRITORES:
Artéria mesentérica superior; Anatomia; Atresia intestinal; Obstrução intestinal; Variação anatômica


RESUMO

Introdução:

A artéria mesentérica superior (AMS), normalmente, tem sua origem a partir da aorta abdominal, um pouco abaixo do tronco celíaco e é responsável pela irrigação das estruturas derivadas, embrionariamente, do intestino médio. Variações anatômicas nesse vaso contribui para defeitos na formação e/ou absorção dessa parte do intestino e a sua ausência tem sido reconhecida como a causa da atresia duodenojejunal congênita.

Objetivo:

Analisar as variações anatômicas dela em humanos e as possíveis implicações clínicas e cirúrgicas associadas.

Métodos:

Trata-se de uma revisão sistemática de artigos indexados nas bases de dados PubMed, SciELO, Springerlink, Scienc Direct, Lilacs e Latindex. A busca ocorreu por dois revisores independentes entre setembro e dezembro de 2018. Foram incluídos artigos originais envolvendo as variações da AMS em humanos. Considerou-se para este estudo a presença/ausência da AMS, o nível, local de origem e seus ramos terminais.

Resultados:

Ao final da busca foram selecionados 18 artigos, caracterizados quanto à amostra, método para avaliar a estrutura anatômica e principais resultados. O tipo de variação mais comum foi aquele cuja AMS se originou da artéria hepática direita (6,13%). Dois estudos (11,11%) evidenciaram a artéria mesentérica inferior originando-se a partir da AMS, enquanto outros dois (11,11%) constataram ser ela compartilhada na mesma origem do tronco celíaco.

Conclusão:

Variações na AMS não são achados incomuns e seus relatos evidenciados através da literatura científica demonstram grande importância para o desenvolvimento de condições clínicas importantes, tornando o conhecimento sobre esse assunto relevante para os cirurgiões e profissionais atuantes nesta área.

DESCRITORES:
Artéria mesentérica superior; Anatomia; Atresia intestinal; Obstrução intestinal; Variação anatômica

INTRODUCTION

The superior mesenteric artery (SMA) arises, classically, in the anterior part of the aorta and it is located 1 cm below the celiac trunk, posteriorly to the pancreas body and the splenic vein, at the level of intervertebral discs between L1 and L2, then going into the mesentery2020 Santos PVD, Barbosa ABM, Targino VA, Silva NA, Silva YCM, Barbosa F, Oliveira ASB, Assis TO. Anatomical variations of the celiac trunk: a systematic review. Arq Bras Cir Dig2018; 31: 1403..

This vessel arises from the aorta through the left renal vein and it supplies part of the small intestine, cecum, ascending colon and 2/3 of proximal transverse colon. Together with the inferior mesenteric artery and celiac trunk, SMA contributes to the vascularization of the gastrointestinal tract77 Gonçalves WM, Kruel NF, Araújo PA, Franzon O. Isquemia Mesentérica. ArqCatMed 1997; 26: 86-90..

SMA originates the middle colic, right colic, ileocolic, jejunal, ileal and appendicular arteries. Although this is commonly the classical anatomical pattern, some changes have been observed regarding the SMA branches, level and its origin. Such variations and their relationship with the surrounding structures are, therefore, important from a clinical and surgical perspective1717 Nayak SB. Hepatomesenteric trunk and gastro-splenico-phrenic trunk. International JournalofAnatomicalVariations2008; 1: 2-3.,2020 Santos PVD, Barbosa ABM, Targino VA, Silva NA, Silva YCM, Barbosa F, Oliveira ASB, Assis TO. Anatomical variations of the celiac trunk: a systematic review. Arq Bras Cir Dig2018; 31: 1403..

In a study with 607 kidney donors and trauma patients, it was observed that 388 (63.9%) had a classic arterial pattern, whereas 219 (36.1%) presented some type of variation. Among the observed changes, one variation was more common than others, in which the SMA originated the right hepatic artery in 58 (9.6%) of the cases22 Farghadani M, Momeni M, Hekmatnia A, Momeni F, Mahdavi MM. Anatomical variation of celiac axis, superior mesenteric artery, and hepatic artery: Evaluation with multidetector computed tomography angiography. J Res Med Sci2016; 21: 129..

Variations in the anatomy of this vessel may be related to the development of important clinical conditions, such as congenital duodenojejunal atresia, since SMA absence has been recognized as one of its causes in newborns. SMA absence contributes to problems in midgut formation or absorption. Patients with this type of variation are subject to death with no chance of surgical intervention2323 Taha KM, KarrarAlsharif MH, Elamin AY. Variation in morphology and branching pattern of superior mesenteric artery. Folia Morphol (Warsz) 2017; 76: 532-535.,2424 Torres A, Andrade EO, Christoph CL, Weinberger M. Congenital absence of the superior mesenteric artery. J Pediatr Surg 1999; 34: 1858-1860.,2525 Weber DM, Freeman NV. Duodenojejunal atresia with apple peel configuration of the ileum and absent superior mesenteric artery: Observations on pathogenesis. J Pediatr Surg 1999; 34: 1427-1429..

In this context, knowledge about these variations are relevant, considering that their study and investigation are important and valid, mainly for surgeons and professionals who work in this area, thus avoiding complications and iatrogenic situations.

This study aims to analyze the anatomical variations of SMA in humans and its possible clinical and surgical implications.

METHOD

This is a systematic review. In order to conduct this study, the following databases were consulted: SciELO (Scientific Electronic Library Online); Springerlink; Science Direct; Pubmed (National Library of Medicine); Lilacs (Latin American and Caribbean Literature in Health Sciences) and Latindex. The research strategy involved such databases and their respective search terms: in SciELO and Springerlink: “Superior mesenteric artery” AND “Anatomy” AND “Anatomical variation.” In Lilacs, Latindex and Science Direct databases: “Superior Mesenteric Artery” AND “Absence of Superior Mesenteric Artery” AND “Anatomical Variation.” Whereas in Pubmed the following keywords were used: “Superior mesenteric artery” AND “Anatomical variation” AND “Absence of superior mesenteric artery”. The electronic search was performed by two independent reviewers between September and December 2018.

Were included original studies involving SMA in humans or studies on human cadavers. Reviews were excluded as well as those studies involving animals.

Studies found in more than one of the databases were counted only once. The selected papers were published between 2002 and 2016. In SCIELO, 18 studies were found, 1,182 in Springerlink, 831 in Science Direct, 56 in Lilacs, 275 in Pubmed and 0 in Latindex, totaling 2,362 papers. After abstract screening, the inclusion and exclusion criteria were applied, and 18 papers were selected for analysis.

The selected studies were critically analyzed by an interpretation guide, used to evaluate their individual quality, based on the studies of Greehalgh88 Greenhalgh T. Assessing the methodological quality of published papers. BMJ 1997 315: 305-308. and adapted by Mcdermid et al.1515 Macdermid JC, Walton DM, Avery S, Blanchard A, Etruw E, Mcalpine C, Goldsmith CH. Measurement properties of the neck disability index: A systematic review. J OrthopSports Phys Ther2009; 39: 400-417.. The studies quality evaluation items are expressed by scores in Table 1, in which 0=absent; 1=incomplete; and 2=complete.

Statistical analysis

The search was performed by two independent reviewers, and the interobserver agreement analysis was performed using the Kappa test, using Prism V 5.0 software, according to Landis and Koch1414 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics1977; 33: 159-174. method. The value found was K=0.77 (substantial agreement).

RESULTS

Table 1 shows the quality analysis of the selected studies for this study.

TABLE 1
Quality analysis of studies on SMA variations in humans

A summary of the electronic search in the selected databases is presented in Figure 1. Initially, 2,362 studies were identified, and 2,277 were removed because they did not have relevant data, changed the topic or because they were in duplicates, with 85 remaining, which were submitted to content analysis and verification of inclusion and exclusion criteria. Of these, 20 were read in full, and only 18 studies2,3,5,6,9,11,12,16,18,13,21,22,23,24,25,26,27,28 adequately fulfilled all inclusion criteria and were selected for this review.

FIGURE 1
Studies included and excluded in the review on anatomical variations of the superior mesenteric artery

Table 2 summarizes the selected studies for the analysis of the findings related to SMA.

TABLE 2
Characteristics of the studies that evaluated the anatomical variations in SMA

The most common form of the emergence of SMA and its variants, direct or indirect, found in the analysis of the selected works totaled 16 forms and were represented in Figure 2 for a better understanding. The central vascular axis represents the abdominal segment of the aortic artery, except in the variant form VIII whose trunk represents the thoracic aorta artery.

FIGURE 2
SMA in its most common origin to the left. In right, SMA variant forms.

DISCUSSION

This study proposes a review on the anatomical variations involving the SMA, from its origin variant aspects, as to its variant aspects about which vessel it may originate. It also relates these variant aspects and verifies the anatomical variations of SMA as well as its clinical and surgical implications, performed through different methods.

During the embryonic development, there is the formation of four ventral splenic vessels, where after its maturation two central roots disappear, thus, remaining the first and fourth roots that originate the anastomoses of the celiac trunk and SMA. If there is a bifurcation between these arteries at a level different than normal, there may be displacement of some vessel from the celiac trunk to SMA2020 Santos PVD, Barbosa ABM, Targino VA, Silva NA, Silva YCM, Barbosa F, Oliveira ASB, Assis TO. Anatomical variations of the celiac trunk: a systematic review. Arq Bras Cir Dig2018; 31: 1403., generating the possibility of variations involving vessels of origin or destination of the celiac trunk and the SMA66 Gomes GV, Encina CAC, Guerra FB, Lira GN, Fonseca JLI, Pardins JP. Atypical origin of the common hepatic artery. Arq Bras Cir Dig 2014; 27: 308-309..

In a study with 45 cadavers, seven cases were identified with anatomical variations related to SMA. In two, it was originated the common hepatic artery; in one case the left hepatic artery; and in three, the right hepatic artery originated, the latter being the most significant variation presented in this study2222 Sebben GA, Rocha SL, Sebben MA, Parussolo Filho PR, Gonçalves BHH. Variations of hepatic artery: anatomical study on cadavers. Rev Col Bras Cir. 2013; 40:221-6.. This finding is consistent with the ones of Farghadani et al.22 Farghadani M, Momeni M, Hekmatnia A, Momeni F, Mahdavi MM. Anatomical variation of celiac axis, superior mesenteric artery, and hepatic artery: Evaluation with multidetector computed tomography angiography. J Res Med Sci2016; 21: 129., that evaluated 607 patients by computed tomography, observing 219 (36.1%) individuals with some type of variation, the most common being the SMA originated from the right hepatic artery, present in 9.6% of cases. This type of variation is highly relevant both for its higher prevalence and for its potential risk during procedures in the area, since this condition exposes these vessels to suffer damages during surgical approaches involving this region.

It was also verified in the studies of Fonseca Neto et al.33 Fonseca-neto OCL, Lima HCS, Rabelo P, Melo PSV, Amorim AG, Lacerda CM. Anatomic variation of hepatic artery: a study in 479 liver transplantions. ArqBrasCirDig 2017; 30: 35-37., that SMA originated the right hepatic artery. Of the 479 patients who underwent liver transplantations, 63 (13.15%) had some type of SMA variation. Of those, 27 presented SMA originating the right hepatic artery, while the other four presented right hepatic artery from SMA, as well as the left hepatic artery originating from the left gastric artery. In this context, the detailed knowledge of these variations in SMA involving hepatic arterial anatomy is of great interest to surgeons who develop procedures in this area, especially liver transplants, since besides representing an ideal opportunity for their anatomical surgical study, their identification and correct handling are fundamental for the good outcome of the procedure11 Andraus W, Haddad LBP, Ducatti L, Martino RB, Santos VR, D`albuquerque LAC. Artery reconstruction in liver transplantation: the best reconstruction of right hepatic artery variation. Arq Bras Cir Dig2013; 26: 62-65.,44 Freitas ACT, Coelho JCU, Matias JEF, Zeni Neto C, Martins EL, Druszcz CC. Anatomia arterial hepática: estudo em 150 transplantes hepáticos. RevColBrasCir2001;28: 13-16.,2222 Sebben GA, Rocha SL, Sebben MA, Parussolo Filho PR, Gonçalves BHH. Variations of hepatic artery: anatomical study on cadavers. Rev Col Bras Cir. 2013; 40:221-6.,2929 Zagyapan R, Kurkcuoglu A, Bayraktar A, Pelin C, Aytekin C. Anatomic variations of the celiac trunk and hepatic arterial system with digital subtraction angiography. Turkish J Gastroenterol2015; 25: 104-109..

Another relevant finding in the included studies in this review was the origin of SMA and celiac trunk from the thoracic aorta, 9 mm and 21 mm above the aortic hiatus, respectively. The SMA trajectory descends at the thoracoabdominal level, inducing the formation of a 17º angle, having a 9 mm aortomesenteric distance at the level of the lower duodenum. For this reason, the patient would be likely to simultaneously develop a triple syndrome: the celiac axis compression syndrome, that is, compression of the celiac trunk by the median arcuate ligament, SMA compression syndrome (SMA compression by median arcuate ligament), and SMA syndrome (duodenum compression by SMA)1616 Matusz P, Iacob N, Miclaus GD, Pureca A, Ples H, Loukas M, Tubbs RS. An unusual origin of the celiac trunk and the superior mesenteric artery in the thorax. Clin Anat,2013;26: 975-979..

The SMA was present in 100% of the sample in the studies of Olave et al.1818 Olave E, Puelma F, Henríquez J, Cruzat C, Soto A. Niveles de origen de las arterias renales y mesentérica superior respecto a la columna vertebral en individuos chilenos. Estudio por tomografíacomputarizada helicoidal. Int J Morphol 2009; 27: 447-452., in which more than 50% of the sample observed the SMA at the L1 level, these findings may serve as a morphological support for the surgical procedures that involve the management of abdominal organs, especially the posterior ones.

SMA is known to supply the middle intestinal loop of the primitive intestine that originates the distal half of the duodenum, 3rd and 4th duodenal parts, jejunum, ileum, cecum and vermiform appendix, ascending colon and 2/3 of the transverse colon. It is possible that the SMA is absent and in these cases other vessels may supply some of these structures, on the other hand, it is also possible that areas of this primitive intestine are without vascularization which may lead to atresia or a delay in intestinal development preventing its normal function.

Saša et al.2121 Saša RV, Ranko L, Snezana C, Lidija B, Djordje S. Duodenal atresia with configuration of ileum of the ileum and absence of superior mesenteric artery. BMC Pediatr2016; 16: 150. revealed a case of a 29-week-old premature infant who did not have SMA, and consequently did not develop the distal part of the duodenum as well as the jejunum, undergoing surgery to remove the atresic portion ligating the functional ends. Another study also observed, in a 34-week-old child, SMA absence, and consequently absence of the jejunum, ileum, cecum and appendix as well as the ascending colon and the proximal part of the transverse colon2424 Torres A, Andrade EO, Christoph CL, Weinberger M. Congenital absence of the superior mesenteric artery. J Pediatr Surg 1999; 34: 1858-1860.. The compensatory hypertrophy of the celiac trunk kept part of the duodenum extension. Weber and Freeman2525 Weber DM, Freeman NV. Duodenojejunal atresia with apple peel configuration of the ileum and absent superior mesenteric artery: Observations on pathogenesis. J Pediatr Surg 1999; 34: 1427-1429. found atresia of the distal duodenum in a 36-week-old child due to absence of the inferior duodenal pancreatic branch (SMA branch).

Variations were also observed regarding the SMA absence in adults, accompanied by compensatory dilation of the inferior mesenteric artery. Acknowledging this issue is essential for health professionals, especially for medical surgeons who perform rectal and sigmoid colon surgeries, because in these cases, ligation of the inferior mesenteric artery during these procedures would bring harmful consequences to the subject, since in such situations, the inferior mesenteric would be the only artery responsible to supply the structures derived from the middle and posterior intestine2626 Wu Y, Peng W, Wu H, Chen G, Zhu J, Xing C. Absence of the superior mesenteric artery in an adult and a new classification method for superior-inferior mesenteric arterial variations. Surg RadiolAnat2014; 36: 511-515.. In addition, the SMA absence in adults is rare, but in newborns it is reported as the cause of congenital duodenojejunal atresia, which contributes to defects in the formation and absorption of the entire median intestine, since irrigation of this area is dependent on this vessel. Congenital atresia and duodenal stenosis are often responsible for intestinal obstructions, occurring in 1:5,000-10,000 live births and affect males more than females1010 Kimura K, Loening-baucke V. Bilious vomiting in the newborn: rapid diagnosis of intestinal obstruction. Am Fam Physician2000; 61: 2791-2798..

Classical SMA arises as a collateral branch, anterior to the abdominal aorta artery. As to its variant forms, there was a greater predominance of SMA originating the right hepatic artery.

Current surgical procedures, including transplants, vascular reconstructions as well as abdominal surgeries, require detailed technical knowledge about the regional vascular anatomy, being of fundamental importance for the success of the procedure. Knowledge about the possibility of non-existence of SMA has an influence on the development of important clinical and surgical conditions, such as duodenojejunal atresia in newborns, and surgeons who perform liver transplantation, allowing professionals to plan and conduct better their treatment interventions appropriately.

CONCLUSIONS

SMA variations are not uncommon findings and their reports evidenced through the scientific literature demonstrate a great role for the development of important clinical conditions, making knowledge about this subject relevant to surgeons and professionals working in this area.

REFERENCES

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    Andraus W, Haddad LBP, Ducatti L, Martino RB, Santos VR, D`albuquerque LAC. Artery reconstruction in liver transplantation: the best reconstruction of right hepatic artery variation. Arq Bras Cir Dig2013; 26: 62-65.
  • 2
    Farghadani M, Momeni M, Hekmatnia A, Momeni F, Mahdavi MM. Anatomical variation of celiac axis, superior mesenteric artery, and hepatic artery: Evaluation with multidetector computed tomography angiography. J Res Med Sci2016; 21: 129.
  • 3
    Fonseca-neto OCL, Lima HCS, Rabelo P, Melo PSV, Amorim AG, Lacerda CM. Anatomic variation of hepatic artery: a study in 479 liver transplantions. ArqBrasCirDig 2017; 30: 35-37.
  • 4
    Freitas ACT, Coelho JCU, Matias JEF, Zeni Neto C, Martins EL, Druszcz CC. Anatomia arterial hepática: estudo em 150 transplantes hepáticos. RevColBrasCir2001;28: 13-16.
  • 5
    Gamo E, Jiménez C, Pallares E, Simón C, Valderrama F, Sañudo JR, Arrazola J. The superior mesenteric artery and the variations of the colic patterns. A new anatomical and radiological classification of the colic arteries. Surg RadiolAnat2016; 38: 519-527.
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    Gomes GV, Encina CAC, Guerra FB, Lira GN, Fonseca JLI, Pardins JP. Atypical origin of the common hepatic artery. Arq Bras Cir Dig 2014; 27: 308-309.
  • 7
    Gonçalves WM, Kruel NF, Araújo PA, Franzon O. Isquemia Mesentérica. ArqCatMed 1997; 26: 86-90.
  • 8
    Greenhalgh T. Assessing the methodological quality of published papers. BMJ 1997 315: 305-308.
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    Jain P, Motwani R. Morphological variations of superior mesenteric artery: a cadaveric study. International Journal of Anatomy and Research 2013; 1: 83-87.
  • 10
    Kimura K, Loening-baucke V. Bilious vomiting in the newborn: rapid diagnosis of intestinal obstruction. Am Fam Physician2000; 61: 2791-2798.
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    Kitamura S, Nishiguchi T, Sakai A, Kumamoto K. Rare case of the inferior mesenteric artery arising from the superior mesenteric artery. Anat Rec 1987; 217: 99-102.
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    Koops A, Wojciechowski B, Broering DC, Adam G, Krupski-berdien G. Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surg RadiolAnat 2004; 26: 239-244.
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    Kornafel O, Baran B, Pawlikowska I, Laszczyński P, Guziński M, Sąsiadek M. Analysis of anatomical variations of the main arteries branching from the abdominal aorta, with 64-detector computed tomography. Pol J Radiol 2010; 75: 38-45.
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    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics1977; 33: 159-174.
  • 15
    Macdermid JC, Walton DM, Avery S, Blanchard A, Etruw E, Mcalpine C, Goldsmith CH. Measurement properties of the neck disability index: A systematic review. J OrthopSports Phys Ther2009; 39: 400-417.
  • 16
    Matusz P, Iacob N, Miclaus GD, Pureca A, Ples H, Loukas M, Tubbs RS. An unusual origin of the celiac trunk and the superior mesenteric artery in the thorax. Clin Anat,2013;26: 975-979.
  • 17
    Nayak SB. Hepatomesenteric trunk and gastro-splenico-phrenic trunk. International JournalofAnatomicalVariations2008; 1: 2-3.
  • 18
    Olave E, Puelma F, Henríquez J, Cruzat C, Soto A. Niveles de origen de las arterias renales y mesentérica superior respecto a la columna vertebral en individuos chilenos. Estudio por tomografíacomputarizada helicoidal. Int J Morphol 2009; 27: 447-452.
  • 19
    Rocha SL, Sebben MA, Parussolo Filho PR, Gonçalves BHH. Variations of hepatic artery: anatomical study on cadavers. Rev Col Bras Cir2013; 40: 221-226.
  • 20
    Santos PVD, Barbosa ABM, Targino VA, Silva NA, Silva YCM, Barbosa F, Oliveira ASB, Assis TO. Anatomical variations of the celiac trunk: a systematic review. Arq Bras Cir Dig2018; 31: 1403.
  • 21
    Saša RV, Ranko L, Snezana C, Lidija B, Djordje S. Duodenal atresia with configuration of ileum of the ileum and absence of superior mesenteric artery. BMC Pediatr2016; 16: 150.
  • 22
    Sebben GA, Rocha SL, Sebben MA, Parussolo Filho PR, Gonçalves BHH. Variations of hepatic artery: anatomical study on cadavers. Rev Col Bras Cir. 2013; 40:221-6.
  • 23
    Taha KM, KarrarAlsharif MH, Elamin AY. Variation in morphology and branching pattern of superior mesenteric artery. Folia Morphol (Warsz) 2017; 76: 532-535.
  • 24
    Torres A, Andrade EO, Christoph CL, Weinberger M. Congenital absence of the superior mesenteric artery. J Pediatr Surg 1999; 34: 1858-1860.
  • 25
    Weber DM, Freeman NV. Duodenojejunal atresia with apple peel configuration of the ileum and absent superior mesenteric artery: Observations on pathogenesis. J Pediatr Surg 1999; 34: 1427-1429.
  • 26
    Wu Y, Peng W, Wu H, Chen G, Zhu J, Xing C. Absence of the superior mesenteric artery in an adult and a new classification method for superior-inferior mesenteric arterial variations. Surg RadiolAnat2014; 36: 511-515.
  • 27
    Yakura T, Hayashi S, Terayama H, Miyaki T, Nakano T, Naito M. A case of a cystic artery arising from the superior mesenteric artery with abnormal branching of the celiac trunk. BMC Res Notes2017; 10: 526.
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    Yoo SJ, Ku MJ, Cho SS, Yoon SP. A case of the inferior mesenteric artery arising from the superior mesenteric artery in a korean woman. J Korean Med Sci2011; 10: 1382-1385.
  • 29
    Zagyapan R, Kurkcuoglu A, Bayraktar A, Pelin C, Aytekin C. Anatomic variations of the celiac trunk and hepatic arterial system with digital subtraction angiography. Turkish J Gastroenterol2015; 25: 104-109.

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  • Mensagem central

    The superior mesenteric artery (SMA) originates from the abdominal aorta and is responsible for irrigating the structures of the midgut. Anatomical variations contribute to defects in the formation and / or absorption of this part of the intestine and its absence is recognized as the cause of congenital duodenojejunal atresia
  • Perspective

    Variations in SMAare not uncommon and their reports demonstrate great importance for the development of important clinical conditions, making knowledge on this subject relevant for professionals working in this area, especially for surgeons who need a thorough understanding of blood irrigation. of the abdominal viscera. Knowledge about the variant forms of this vessel allows professionals to plan and better conduct their surgical interventions with as little iatrogenesis as possible.

Publication Dates

  • Publication in this collection
    24 Aug 2020
  • Date of issue
    2020

History

  • Received
    29 Nov 2019
  • Accepted
    02 Apr 2020
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