Question:hard
A patient with carcinoma of rectum has been taken up for surgery. The superior rectal artery is to be ligated. Which of the following is the correct level of ligation of the superior rectal artery?
A patient with carcinoma of rectum has been taken up for surgery. The superior rectal artery is to be ligated. Which of the following is the correct level of ligation of the superior rectal artery?
Show Hint
The superior rectal artery crosses a major vascular landmark as it enters the pelvis.
Updated On: Jun 23, 2026
- At the origin from the inferior mesenteric artery
- At the level of the pelvic brim
- At the level of S3
- At the level of the promontory of sacrum
Show Solution
The Correct Option is B
Solution and Explanation
Approach: Vascular anatomy applied to colorectal surgery.
The inferior mesenteric artery (IMA) terminates as the superior rectal artery (SRA). As the SRA descends toward the pelvis, it crosses the left common iliac vessels at the pelvic brim. This anatomical crossing point is the landmark surgeons use to identify and divide the SRA during resection for rectal carcinoma.
Why not at the IMA origin? Ligation at the IMA origin (high tie) is reserved for sigmoid and descending colon cancers to maximally harvest the apical lymph nodes along the IMA trunk. For rectal cancer, the SRA is specifically ligated at the pelvic brim to achieve clearance of lymph nodes along the SRA while preserving the IMA trunk if required.
Key landmark: The SRA crosses the left common iliac artery and vein as it transitions from the retroperitoneum into the pelvis -- this is the pelvic brim level.
\[\boxed{\text{Superior rectal artery is ligated at the level of the pelvic brim}}\]
The inferior mesenteric artery (IMA) terminates as the superior rectal artery (SRA). As the SRA descends toward the pelvis, it crosses the left common iliac vessels at the pelvic brim. This anatomical crossing point is the landmark surgeons use to identify and divide the SRA during resection for rectal carcinoma.
Why not at the IMA origin? Ligation at the IMA origin (high tie) is reserved for sigmoid and descending colon cancers to maximally harvest the apical lymph nodes along the IMA trunk. For rectal cancer, the SRA is specifically ligated at the pelvic brim to achieve clearance of lymph nodes along the SRA while preserving the IMA trunk if required.
Key landmark: The SRA crosses the left common iliac artery and vein as it transitions from the retroperitoneum into the pelvis -- this is the pelvic brim level.
\[\boxed{\text{Superior rectal artery is ligated at the level of the pelvic brim}}\]
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