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. 2021 Apr;34(3):342-347.
doi: 10.1002/ca.23611. Epub 2020 May 6.

The median sacral artery in rectal blood supply: A cadaveric study

Ivan Dimov  1 , Stéphane Sobczak  1   2 , Detlev Grabs  1   2 , Anna Nayouf  1   2
Affiliations

The median sacral artery in rectal blood supply: A cadaveric study

Ivan Dimov et al. Clin Anat. 2021 Apr.

Abstract

Introduction: Insufficient blood supply to the posterior rectal remnant after proctectomy is a possible mechanism for anastomotic leakage. The median sacral artery (MSA) is not generally considered to participate in the rectal blood supply, although some case studies have reported the rectum being supplied by it. The aim of this study is to elucidate the anatomy of the MSA in relation to the posterior rectal wall.

Methods: Nineteen embalmed cadavers (12 males, seven females; mean age: 76 ± 9 years) were injected with a colored radio-opaque mixture in the aortic bifurcation, radiographed and subsequently dissected along the sacrum. The relationship between the MSA and the rectum was observed and the diameter of the MSA was measured 2 cm below the aortic bifurcation.

Results: MSAs were identified in 16 (84.2%) of the 19 cadavers. Nine MSAs (47.4%) reached the rectal wall and penetrated it. MSAs that reached the posterior rectum took two different routes in the presacral space. Dissection and radiography showed four penetrating MSAs (21.1%) ending in a branching pattern and five (26.3%) as a tapering vessel. Seven MSAs (36.8%) did not reach the rectal wall. The mean MSA diameter was 1.98 ± 0.12 mm.

Conclusions: Almost half the MSAs reached and penetrated the posterior rectal wall, suggesting possible participation in the rectal blood supply. A large portion of the MSAs that penetrate the rectal wall run outside surgical margins and could continue to provide blood supply to the rectal remnant, potentially preventing anastomotic leakage.

Keywords: anastomotic leakage; median sacral artery; proctectomy; rectum.

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