The middle colic artery is a branch of the superior mesenteric artery that emerges from its right side and passes anterosuperiorly in the transverse mesocolon to supply the transverse colon. It divides into right and left branches that anastomose with the right colic artery (from SMA) and left colic artery (from IMA) respectively through the marginal artery of Drummond.
The middle colic artery forms critical anastomoses at both Griffith point (junction with left colic at the splenic flexure) and Sudeck point (IMA territory junction). In extended right hemicolectomy and transverse colectomy, the middle colic vessels are ligated centrally. The arc of Riolan is an inconstant meandering collateral artery connecting the SMA and IMA through the left colic and middle colic circulations, sometimes enlarged in chronic mesenteric occlusive disease. Knowledge of middle colic anatomy is critical in laparoscopic colorectal surgery to avoid mesenteric haematoma.
Central ligation of the middle colic artery during transverse colectomy or extended right hemicolectomy must include assessment of remaining colonic blood supply, particularly the anastomotic adequacy of left colic and right colic marginal artery arcades, before creating the colorectal anastomosis.
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