Exceptional vascular variants during oncological right colectomy: Case reports

• Published in: International journal of surgery case reports 2023-10, Vol.111, p.108853, Article 108853
• Main Authors: Landolsi, Sana, Youssfi, Rahma, Trabelsi, Mehdi, Touati, Dhaker, Saidi, Aymen, Chebbi, Faouzi
• Format: Article
• Language: English
• Subjects: Case Report; Oncological right colectomy; Surgery; Vascular variant
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2023.108853

Carcinological right colectomy with complete D3 mesocolon excision has to be guided by vascular variants in order to avoid complications especially in exceptional cases as illustrated by our two cases. Two women had right colectomies with compete D3 mesocolon excision via laparotomy for right colon tumors with a non-modal anatomy: an X-shaped relationship between the superior mesenteric artery and the superior mesenteric vein and a Y-shaped superior mesenteric vein, an ileocolic artery behind the two trunks, a right colic artery behind the left trunk, and the middle colic artery anterior to the main trunk of the superior mesenteric vein respectively. Our cases illustrated extremely rare vascular variants during right colectomy with complete mesocolic excision. These variants should be identified based on the computed tomography with coronal reconstructions allowing to guide surgical procedure before the operating room in order to anticipate per-operative difficulties and reduce morbidity. Vascular anatomical study based on computed tomography with coronal reconstructions was mandatory before right colectomy with complete mesocolic excision and D3 lymphadenectomy. •Vascular variants during right colectomy with complete mesocolic excision should be identified based on the computed tomography allowing to guide surgical procedure.•X-shaped relationship between the superior mesenteric artery and the superior mesenteric vein non recognition could lead to per-operative bleeding as well as small intestine ischemic necrosis.•A first description of Y-shaped superior mesenteric vein.