Anat Cell Biol.  2022 Jun;55(2):118-123. 10.5115/acb.22.010.

Anatomical classification of middle rectal arteries regarding detailed vasculature patterns

• Kim H
• Youn KH
• Kim YS

• KMID: 2531196
• DOI: http://doi.org/10.5115/acb.22.010

Abstract

This study aimed to clarify the anatomy of middle rectal artery and pelvic vasculature patterns, and to provide schematic information in a manner applicable to the total mesorectal excision. Forty sides of pelvis from 20 formalinembalmed cadavers (10 male, 10 female) were dissected, and all the pelvic vasculatures from the internal iliac artery were investigated, focusing on the middle rectal artery. Middle rectal arteries were classified into major types depending on their vascular origins. Each type was subdivided into minor types according to variability of the pelvic vasculature. A middle rectal artery was identified in 18 out of 20 cadavers, and in 25 out of 40 pelvic sides. In most cases, the middle rectal artery originated from the internal pudendal artery or inferior gluteal artery. These two arteries arose directly from the anterior trunk of the internal iliac artery or were bifurcated from the gluteal-pudendal trunk. In rare cases, these arteries arose from the posterior trunk of the internal iliac artery. The other origins of the middle rectal artery included the gluteal pudendal trunk, inferior vesical artery, internal iliac artery, obturator artery, and the prostatic artery, and the pelvic vasculatures in these cases also presented variability. The detailed anatomical findings related to the middle rectal artery and pelvic vasculatures are noteworthy for their improved clinical applicability.

Keyword

Middle rectal artery; Pelvic vasculature; Rectal surgery; Total mesorectal excision; Vascular origin

Figure

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  Fig. 1 Middle rectal artery arising from internal pudendal artery (type I). (A) Internal pudendal artery arises directly from anterior trunk of internal iliac artery and gives off middle rectal artery (type Ia). (B) Internal pudendal artery arises from gluteal-pudendal trunk and gives off middle rectal artery (type Ib). (C) Internal pudendal artery arises from posterior trunk of internal iliac artery and gives off middle rectal artery (type Ic). IIA, internal iliac artery; AT, anterior trunk of internal iliac artery; PT, posterior trunk of internal iliac artery; IPA, internal pudendal artery; IGA, inferior gluteal artery; MRA, middle rectal artery; GPT, gluteal-pudendal trunk.

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  Fig. 2 Middle rectal artery arising from inferior gluteal artery (type II). (A) Inferior gluteal artery arises directly from anterior trunk of internal iliac artery and gives off middle rectal artery (type IIa). (B) Inferior gluteal artery arises from gluteal-pudendal trunk and gives off middle rectal artery (type IIb). (C) Inferior gluteal artery arises from posterior trunk of internal iliac artery and gives off middle rectal artery (type IIc). IIA, internal iliac artery; AT, anterior trunk of internal iliac artery; PT, posterior trunk of internal iliac artery; IPA, internal pudendal artery; IGA, inferior gluteal artery; MRA, middle rectal artery; GPT, gluteal-pudendal trunk.

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  Fig. 3 Middle rectal artery arising directly from gluteal-pudendal trunk (type III). IIA, internal iliac artery; AT, anterior trunk of internal iliac artery; PT, posterior trunk of internal iliac artery; GPT, gluteal-pudendal trunk; IPA, internal pudendal artery; IGA, inferior gluteal artery; MRA, middle rectal artery.

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  Fig. 4 Middle rectal artery arising from inferior vesical artery (type IV). (A) Inferior vesical artery arises from gluteal-pudendal trunk and gives off middle rectal artery (type IVa). (B) Inferior vesical artery arises from obturator artery and gives off middle rectal artery (type IVb). IIA, internal iliac artery; AT, anterior trunk of internal iliac artery; PT, posterior trunk of internal iliac artery; GPT, gluteal-pudendal trunk; IPA, internal pudendal artery; IGA, inferior gluteal artery; IVA, inferior vesical artery; MRA, middle rectal artery; OA, obturator artery.

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  Fig. 5 Middle rectal artery arising from internal iliac artery (type V). (A) Middle rectal artery arises from the anterior trunk of internal iliac artery, and presents independent course from internal pudendal artery and inferior gluteal artery (type Va). (B) Internal iliac artery gives off middle rectal artery before it is separated into anterior and posterior trunk (type Vb). IIA, internal iliac artery; AT, anterior trunk of internal iliac artery; PT, posterior trunk of internal iliac artery; IGA, inferior gluteal artery; IPA, internal pudendal artery; MRA, middle rectal artery; GPT, gluteal-pudendal trunk.

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  Fig. 6 Additional origins of middle rectal arteries. (A) Middle rectal artery arises from obturator artery (type VI). (B) Middle rectal artery arises from prostatic artery (type VII). IIA, internal iliac artery; AT, anterior trunk of internal iliac artery; PT, posterior trunk of internal iliac artery; GPT, gluteal-pudendal trunk; OA, obturator artery; IPA, internal pudendal artery; IGA, inferior gluteal artery; MRA, middle rectal artery; PA, prostatic artery.

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