Massive Rectal Hemorrhage from the Middle Hemorrhoidal Artery after Blunt Perineal Trauma Without Pelvic Fracture

The middle anorectal artery - a systematic review and meta-analysis of 880 patients / 1905 pelvic sides

INTRODUCTION

The middle anorectal artery (MAA) is considered to supply the middle and lower parts of the rectum however its prevalence and point of origin vary across the literature. Clinical importance of the MAA becomes evident in the total mesorectal excision during the colorectal surgery of rectal cancer in both sexes, as well as interventional radiology procedures utilizing the prostatic vasculature in males.

MATERIALS AND METHODS

Major electronic medical databases were investigated for terms pertaining to the MAA and its associated variations. Compatible data regarding the artery's prevalence, laterality, origin, and distribution in both sexes was acquired. The risk of bias within the studies was assessed utilizing the AQUA tool.

RESULTS

In total, 28 works (n=880 patients / 1905 pelvic sides) were included in this systematic review and meta-analysis, and their publication date ranged from 1897 until 2021. The overall pooled prevalence estimate for the MAA was 59.8% of the patients, and 55.2% of the pelvic sides studied. The vessel was identified more frequently in cadaveric pelvic sides evaluations (79.3%). The artery was found bilaterally more often (56.7%), and most commonly originated from the internal pudendal artery (50.3%). Anastomoses between the MAA and the other anorectal arteries were reported in 78.1%.

CONCLUSIONS

The MAA is predominantly a present vessel, with various point of origin. Its direct clinical significance is yet to be discovered in larger study samples, providing more detailed and unified reports of its anatomical features, especially regarding its branches.