Anatomical considerations on Sudeck's critical point and its relevance to colorectal surgery

Abstract

Sudeck's critical point at the rectosigmoid junction is described as the point of origin of the last sigmoid arterial branch, originating from the inferior mesenteric artery (IMA). There is controversy on the importance of Sudeck's point, and the frequency in which the anastomosis is found. Furthermore, the diameter of the anastomosis, if present, may also impact on the viability of the caudal stump. This study aimed to determine the frequency in which a macroscopic anastomosis occurs, between the superior rectal artery and the last sigmoidal branch, in a cadaver population; the diameter of this anastomosis and the distance from the origin of the IMA to Sudeck's point. Sixty-four cadavers were included in the study, excluding those with previous surgery to the rectosigmoid junction. Sudeck's point was carefully identified and dissected to establish the presence of an anastomosis. Subsequent measurements were performed using a digital caliper (accuracy = 0.01 mm). A macroscopic anastomosis was absent in three cases (4.7%). The mean diameter of the anastomosis when present was 1.9 mm (SD: 0.5 mm), and the distance from the origin of the IMA to Sudeck's point was 55.5 mm (SD: 14.6 mm). Although an anastomosis is present in the majority of cases, the vessel is very small in diameter, and may not be sufficient to meet the demands of the caudal stump. The distance from the origin of the IMA to Sudeck's point is sufficient enough to allow for ligation of the IMA proximal to Sudeck's point.