PICTORIAL INTERLUDE 

41         SA JOURNAL OF RADIOLOGY • September 2006

	

A	 54-year-old	 man	 presented	 with	 a	 longstanding	 history	 of	
peripheral	 artery	 disease	 and	 right	 leg	 pain	 for	 2	 weeks.	 An	
angiogram	demonstrated	no	filling	of	the	celiac	axis	or	superior	
mesenteric	 artery	 implying	 stenosis/cut-off	 of	 these	 vessels.	 A	
meandering	mesenteric	artery	was	visible.	The	direction	of	flow	
in	this	vessel	was	shown	by	retrograde	filling	of	the	middle	colic	
branch	of	the	proximal	superior	mesenteric	artery,	which	in	turn	
provided	 collateral	 flow	 to	 the	 superior	 mesenteric	 artery,	 and	
then	subsequently,	collateral	flow	to	the	celiac	artery	through	an	
enlarged	pancreaticoduodenal	artery.	(Figs	1	a	and	b).

The	 digital	 subtraction	 arteriogram	 (DSA)	 imaging	 findings	
were	incidental	and	the	patient	had	no	symptoms	of	mesenteric	
ischaemia	or	abdominal	discomfort.

Discussion
The	meandering	artery	is	an	existing	vessel,	which	only	enlarges	
with	abdominal	arterial	occlusion.	The	combination	of	superior	
mesenteric	 artery	 and	 celiac	 axis	 occlusion	 in	 an	 asymptomatic	
patient	is	rare	and	these	vessels	usually	have	retrograde	filling	via	
the	meandering	mesenteric	artery.1,2

The	meandering	mesenteric	has	great	surgical	significance.	It	
should	therefore	be	noted	on	arteriogram	and	surgically	preserved	
when	performing	aortic	procedures,	left	colon	resections	(where	
the	inferior	mesenteric	artery	fills	the	superior	mesenteric	artery	
and/	or	celiac	truncus)	and	right	and	transverse	colon	resections	
(where	the	inferior	mesenteric	artery	has	previously	been	ligated	
during	 aortic	 surgery	 and	 is	 filled	 by	 the	 superior	 mesenteric	
artery).3

Conclusion
The	 meandering	 mesenteric	 artery	 is	 a	 rare	 finding	 with	 the	
combination	 of	 superior	 mesenteric	 artery	 and	 celiac	 axis	
occlusion.	Its	main	function	is	to	preserve	mesenteric	perfusion	in	
patients	with	severe	arterial	disease.	Therefore,	it	should	be	noted	
on	arteriograms	and	surgically	preserved	when	planning	bypass	
surgery	for	peripheral	arterial	disease	or	colon	resections.	
	
1.			Reiner	L,	Rodriques	FL,	Jimenez	FA,	Platt	R.	Injection	studies	on	mesenteric	artery	 	

	circulation.	III.	Occlusion	without	intestinal	infarction.	AMA Arch Pathol	1962; 73: 461-472.
2.			Kahn	 P,	 Abrahams	 HL.	 Inferior	 mesenteric	 arterial	 patterns:	 angiographic	 study.	 Radiology	 1964; 82: 

429-442.
3.			Gourley	EJ,	Gering	SA.	The	meandering	mesenteric	artery:	a	historic	review	and	surgical	implications.	Dis 

Colon Rectum	2005;	48: 996-1000.

The meandering inferior mesenteric artery

Melanie Strachan, MB ChB, LMCC II (Can)
Yousuf Vadachia, MB ChB

Stefan Przybojewski, MB ChB, MMed  
(Rad Diag), FCRad Diag (SA), Dip Pec (SA)

Department of Radiology, Stellenbosch University and  

Tygerberg Hospital

Fig. 1a. Digital subtraction arteriogram shows prograde filling of the abdomi-
nal aorta, bilateral renal arteries and inferior mesenteric artery. There is no 
filling of the celiac axis or superior mesenteric artery, implying stenosis or 
cut-off of these vessels. A meandering artery is visible.

Fig. 1b. The direction of flow in the meandering mesenteric artery is shown 
with retrograde filling of the middle colic branch of the superior mesenteric 
artery. There is subsequent filling of the superior mesenteric artery by the 
middle colic branch.

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