Enlarged arc of Riolan and marginal artery of Drummond secondary to occluded celiac axis and superior mesenteric artery
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Gross loss of weight over the last 2 years following complicated abdominal surgery. Marked ischemic gastritis on endoscopy
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Occluded celiac axis and SMA at their origins (only tiny stumps are visible) with the IMA feeding enlarged arc of Riolan and wandering artery of Drummond (arrows) through to the SMA and its branches via the ileo-colic, and celiac axis branches via the inferior pancreatico-duodenal branches of the SMA into the pancreatico-duodenal branches of the common hepatic artery.
Vascular anastomoses in the bowel are such that chronic occlusion can be compensated by hypertrophy of these anastomoses including Drummond and Riolan, such that in this case the IMA is supplying the entire blood supply to the bowel and upper abdominal organs.