An isolated right colic artery originating directly from the abdominal aorta was incidentally observed during diagnostic spinal angiography. Variations in origin of the right colic artery are reviewed, and their embryology and potential clinical implications discussed

Gailloud, Philippe

Ponti, Alexandre

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ITALIAN JOURNAL OF ANATOMY AND EMBRYOLOGY
DOI: 10.13128/IJAE-18350
Research article – Human anatomy case report
Direct origin of the right colic artery from the 
abdominal aorta
Alexandre Ponti, Philippe Gailloud*
Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, MD
Abstract
An isolated right colic artery originating directly from the abdominal aorta was incidentally 
observed during diagnostic spinal angiography. Variations in origin of the right colic artery are 
reviewed, and their embryology and potential clinical implications discussed.
Key words
Vascular anatomy, angiography, mesenteric arteries, colic arteries
Introduction
The subdiaphragmatic portion of the gastrointestinal tract is vascularized by three 
main arterial trunks corresponding to its embryological division in foregut, midgut, 
and hindgut. These vessels are the coeliac trunk, the superior mesenteric artery, and 
the inferior mesenteric artery. The right colic artery is a branch of the superior mes-
enteric artery supplying the ascending colon, which typically divides into ascending 
and descending branches respectively anastomosed with the middle colic and ile-
ocolic arteries. The right colic artery is usually found deep to the parietal peritoneum 
on its way to the ascending colon, which has a retroperitoneal position due to the 
embryological fusion of its mesentery with the peritoneal lining of the dorsal body 
wall. We report here the observation of a right colic artery originating directly from 
the abdominal aorta as an isolated vessel.
Case report
The patient was a 71-year-old man presenting with progressive myelopathy. Spi-
nal angiography, prompted by the suspicion of a spinal vascular malformation by 
magnetic resonance imaging, was unremarkable. Incidentally, a right colic artery 
(RCA) was seen originating as an isolated branch from the right anterolateral aspect 
of the abdominal aorta at the L2 vertebral level (Figure 1A). The RCA established an 
anastomotic connection with the right inferior phrenic artery, which branched off a 
right superior adrenal artery, while smaller adrenal contributions were coming from 
the RCA itself (Figure 1B,C). Normal L1 and L2 intersegmental arteries were docu-
mented on both sides. The vascularization of the gastrointestinal tract, being irrele-
vant to the patient’s condition, was not investigated further. 
* Corresponding author. E-mail: phg@jhmi.edu
101Direct aortic origin of the right colic artery
Figure 1 – Isolated origin of the right colic artery (RCA) from the aorta in a 71-year-old man. A: selective injec-
tion, posteroanterior view. The RCA typically divides into ascending and descending branches. An anasto-
motic connection with the right inferior phrenic artery is noted. B: selective injection, posteroanterior view. 
This magnified view offers a more detailed appreciation of the connection between the RCA and the right 
inferior phrenic artery. The latter provides a superior adrenal artery, while a middle adrenal artery stems from 
the anastomotic channel. Smaller adrenal branches are seen coming from the ascending branch of the RCA. 1 
- ascending branch of the RCA, 2 - inferior phrenic artery, 3 - anastomotic channel, 4 - superior adrenal artery, 
5 - middle adrenal artery, 6 - small adrenal branches. C: same injection and same view as B, delayed phase, 
showing the adrenal blush (arrowheads), located medially to the ascending branch of the RCA.
102 Alexandre Ponti, Philippe Gailloud
Discussion
Right colic artery variations
In a decreasing order of frequency, the RCA originates from the superior mes-
enteric artery (SMA) as a common trunk with the middle colic artery, as a separate 
branch from the SMA, or as a branch of the ileocolic artery. The RCA may be absent 
in up to 50% of cases (Garcia-Ruiz et al., 1996; Yada et al., 1997; Standring, 2008; 
Spasojevic et al., 2011). In spite of an extensive literature review that included clas-
sic anatomical textbooks as well as relevant anatomical and radiological journals, no 
prior description of an isolated RCA emerging directly from the aorta could be found. 
This variant does not appear in works specifically dealing with angiographic anat-
omy (Reuter et al., 1986; Kadir, et al., 1991; Boijsen, 1997) or with arterial variations 
(Adachi, 1928; Lippert and Pabst, 1985).
Embryology
The primitive vessels arising from the paired dorsal aortas are divided into three 
categories: (i) dorsal somatic intersegmental branches supplying the neural tube 
and body wall, (ii) lateral splanchnic segmental branches vascularizing the mesone-
phros, and (iii) ventral splanchnic segmental branches for the digestive tube. The lat-
ter group supplies the capillary plexus located in the roof of the yolk sac, itself com-
posed of the endoderm from which the gastrointestinal tract will derive. Following 
the fusion of the dorsal aortas and the growth of the embryo, the longitudinal dis-
tance separating the origin of each pair of ventral splanchnic branches increases, par-
ticularly below the diaphragm. At the adult stage, only three subdiaphragmatic ven-
tral aortic branches persist, the coeliac trunk and the two mesenteric arteries.
After the early development of the primitive dorsal, lateral, and ventral aortic 
branches, the sprouting of additional arterial stems is prevented by the growth of a 
layer of mesenchyma around the aortic wall. A capillary network, described by Jei-
dell (1911), forms beyond this mesenchymal wall and interconnects all the primitive 
aortic branches. This network participates in the vascularization of the surrounding 
organs. As the periaortic mesenchyma develops further, only functionally important 
connections between the aorta and the visceral capillary network remain patent; these 
connections will form the principal aortic stems and their branches at the adult stage 
(Jeidell, 1911; Bremer, 1915). The persistence of a portion of the network of Jeidell can 
result in the formation of anastomoses between the main aortic trunks, for example 
between the coeliac trunk and SMA, so called arc of Bühler (Bühler, 1904).
A similar developmental mechanism is likely at the origin of the isolated RCA 
described in this report. The portion of the vascular plexus destined to form the RCA 
may become attached to the aorta rather than to the SMA through the persistence of 
an alternate periaortic pathway, which can potentially involve any of the primitive 
aortic branches (ventral, lateral, or dorsal). The connection seen between the RCA and 
the right inferior phrenic artery, which is similar in nature to an arc of Bühler, repre-
sents another example of anastomosis resulting from the persistence of a portion of 
the primitive periaortic network. The right inferior phrenic artery normally originates 
as an isolated vessel from the aorta or as a branch of the coeliac trunk, the right renal 
103Direct aortic origin of the right colic artery
artery, the left gastric artery, or the hepatic artery (Loukas et al., 2005). Right inferior 
phrenic artery origin from the T12 or L1 intersegmental arteries is also occasionally 
documented during spinal angiography. All these inferior phrenic artery variants can 
be viewed as the selection of alternative connection patterns within the primitive per-
iaortic network of Jeidell.
Clinical implications 
Most studies looking at the vascular anatomy of the right colon are related to col-
ic cancer and its surgical treatment. Standard therapy includes complete resection of 
the tumor, with ligation of its vessels and dissection of the lymphatic drainage area 
(Herfarth and Runkel, 1994). As locoregional metastatic spread tends to follow arte-
rial paths, the surgical planning will vary according to the anatomy of the supplying 
arteries. An accurate understanding of their origins and courses is therefore essential 
to optimal management (Yada et al., 1997; Shatari et al., 2003), and preoperative radi-
ological mapping of the vascular anatomy, CT (computed tomography) angiography 
in particular, plays a critical role in this evaluation (Smith et al., 2006; Tajima, et al., 
2011; Mari et al., 2013). Failing to recognize atypical arterial patterns such as the one 
presented here may lead to intraoperative surprises and suboptimal surgical treat-
ment. Aberrant vessels may also be injured during abdominal aortic aneurysm repair, 
either with open or endovascular techniques, potentially resulting in colic ischemia 
(Perry et al., 2008). Finally, the possibility of a branch with an aberrant origin should 
also be considered during angiography performed to locate the source of an elusive 
gastrointestinal bleed.
On the other hand, the presence of an anomalous RCA stemming directly from the 
aorta may represent an additional source of collateral supply in case of obstruction of 
the superior or inferior mesenteric arteries, and have a protecting effect against colic 
ischemic disease. It is also possible that an isolated RCA may become prominent while 
being recruited as a collateral pathway (Kim et al., 2011). While the other gastroin-
testinal arteries were not investigated in our patient, as they were not relevant to his 
medical condition, the absence of significant aortic atheromatous disease and digestive 
symptomatology renders this hypothesis unlikely in the reported case.
In summary, an isolated RCA emerging directly from the aorta appears to be an 
exceptional anatomical variation, which sheds some light on the development of the 
gastrointestinal vascular system, notably the role played by the capillary plexus of 
Jeidell. This variant can also represents a significant pitfall during abdominal surgical 
or endovascular procedures.
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Direct origin of the right colic artery from the abdominal aorta

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Direct origin of the right colic artery from the abdominal aorta

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