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Middle colic artery

The middle colic artery is a key branch of the superior mesenteric artery (SMA). It typically arises just below the pancreas, near the anterior border of the SMA, and runs within the transverse mesocolon toward the transverse colon. It divides into right and left branches, which anastomose with the right colic artery (from SMA) and the left colic artery (from the inferior mesenteric artery, IMA), respectively, forming part of the marginal artery of Drummond.

The middle colic artery is the primary blood supply to the transverse colon and contributes collateral flow between the SMA and IMA territories. This is clinically critical in ischemic colitis, bowel resections, anastomoses, and mesenteric ischemia evaluation. Variations include accessory middle colic arteries or absence of a defined trunk.

Synonyms

  • Artery of the transverse colon

  • Arteria colica media

  • Middle branch of SMA

Function

  • Supplies the transverse colon via right and left branches

  • Forms an important collateral with SMA and IMA via the marginal artery of Drummond

  • Provides vascular redundancy critical during bowel surgery or ischemic compromise

  • Serves as a surgical landmark in right hemicolectomy and transverse colectomy

Branches

  • Right branch → anastomoses with right colic artery

  • Left branch → anastomoses with left colic artery (IMA)

  • Terminal arcades → contribute to marginal artery along the transverse colon

MRI Appearance

T1-weighted images:

  • Middle colic artery appears as a flow void (black lumen) within the transverse mesocolon

  • Surrounded by intermediate-signal mesenteric fat

T2-weighted images:

  • Vessel seen as a dark flow void; surrounding bowel wall edema or inflammation increases visibility

  • Helps in identifying mesenteric ischemia indirectly

STIR:

  • Suppresses fat, improving vessel conspicuity

  • Highlights perivascular edema or inflammation as hyperintense signal

T1 Fat-Saturated (Pre-contrast):

  • Lumen often shows intermediate signal, standing out against fat-suppressed mesocolon

  • Differentiates artery from surrounding mesenteric fat and lymph nodes

T1 Fat-Saturated Post-Contrast (Gadolinium):

  • Middle colic artery enhances brightly and homogeneously

  • Outlines its branching pattern and contribution to marginal artery

  • Detects occlusion, stenosis, or abnormal neovascularity

MRA (Magnetic Resonance Angiography):

  • Clearly shows origin from SMA, bifurcation into right and left branches, and marginal artery connections

  • Useful for diagnosing mesenteric ischemia, vascular stenosis, or surgical planning

CT Appearance

CT Pre-Contrast:

  • Appears as a linear soft-tissue density in transverse mesocolon

  • Calcifications may be seen in chronic atherosclerosis

CT Post-Contrast:

  • Enhances vividly, tracing its course from SMA to transverse colon

  • Helps assess patency, mural changes, and surrounding pathology

CT Angiography (CTA):

  • Gold standard for non-invasive assessment

  • High-resolution multiplanar and 3D reconstructions show origin, course, branching pattern, and anastomoses with right and left colic arteries

  • Critical for mesenteric ischemia detection, vascular mapping, and colectomy planning

CT images

Middle colic artery ct axial

MRI images

Middle colic artery MRI axial anatomy image -img-00000-00000

MRI images

Middle colic artery MRI coronal anatomy image -img-00000-00000