title: Evaluating distribution of the left branch of the middle colic artery and the left colic artery by CT angiography and colonography to classify blood supply to the splenic flexure.
abstract: BACKGROUND
  CT angiography has gained widespread acceptance for preoperative evaluation of blood supply in patients with colorectal cancer. However, there have been few reports that pertain to the splenic flexure, for which surgery is technically difficult. We used preoperative CT angiography and CT colonography to evaluate blood supply to the splenic flexure.
  
  
  METHODS
  We defined the splenic flexure as the junction of the distal third of the transverse colon and the proximal third of the descending colon. We reviewed 191 cases and considered the descending colon as divided into the proximal third and the distal two-thirds; we then determined which part of the descending colon the left colic artery (LCA) entered. We also considered the transverse colon as divided into the proximal two-thirds and the distal third, and evaluated which part of the transverse colon the left branch of the middle colic artery entered.
  
  
  RESULTS
  We classified blood supply to the splenic flexure into six types, described by the feeder vessels: type 1, the LCA (39.7%); type 2, the left branch of the middle colic artery (17.8%); type 3, the LCA and the left branch of the middle colic artery (9.9%); type 4, the accessory left colic artery (4.1%); type 5, the LCA and the accessory left colic artery (2.6%); and type 6, the marginal artery (25.6%).
  
  
  CONCLUSIONS
  We classified blood supply to the splenic flexure into more complex types than previous reports had. Because we dissect the lymph nodes according to the type of blood supply, knowing the type before splenic flexure surgery is crucial.
authors.affiliation: Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.|Department of Gastroenterological Surgery, St. Marianna University Toyoko Hospital, Kawasaki, Japan.
authors.forename: Asako
authors.initials: A
authors.lastname: Fukuoka
authors.affiliation: Department of Gastroenterological Surgery, St. Marianna University Toyoko Hospital, Kawasaki, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sasaki
authors.affiliation: Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tsukikawa
authors.affiliation: Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Miyajima
authors.affiliation: Department of Gastroenterological Surgery, St. Marianna University Toyoko Hospital, Kawasaki, Japan.
authors.forename: Takehito
authors.initials: T
authors.lastname: Ostubo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044683:Colon, Descending / Q000098:blood supply / Q000000981:diagnostic imaging; D044684:Colon, Transverse / Q000098:blood supply* / Q000000981:diagnostic imaging*; D023881:Colonography, Computed Tomographic; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: CT angiography; CT colonography; splenic flexure