Question

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. At the origin from the inferior mesenteric artery
• B. At the level of the pelvic brim
• C. At the level of S3
• D. At the level of the promontory of sacrum

Hint:

The superior rectal artery crosses a major vascular landmark as it enters the pelvis.

Answer 1

The Correct Option is B

Step 1: Anatomy of the superior rectal artery.
The superior rectal artery (SRA) is the direct continuation of the inferior mesenteric artery (IMA). After the IMA gives off the left colic and sigmoid branches, it continues as the SRA and descends into the pelvis, crossing the left common iliac vessels at the pelvic brim before dividing into branches that supply the rectum.

Step 2: Surgical ligation level in rectal cancer.
During resection for carcinoma of the rectum, the SRA is ligated at the pelvic brim, where it crosses the left common iliac artery and vein. This level allows adequate oncological clearance of lymph nodes along the SRA and provides sufficient bowel length for anastomosis. A "high tie" at the IMA origin is used specifically for colon cancers to obtain additional lymph node clearance but is not the standard described ligation point for the SRA itself.

Step 3: Conclusion.
The correct level of ligation of the superior rectal artery in carcinoma rectum surgery is at the level of the pelvic brim, as the vessel crosses the left common iliac vessels at this point.