Retroperitoneal Major Pelvic Arteries' Anatomic Variation: Pictorial Essay and Significance in Obstetrical and Gynecological Surgery.

INTRODUCTION: Congenital anomalies of the iliac arteries are rare, and are usually discovered incidentally or infrequently intraoperatively. AIM: To show the retroperitoneal major pelvic blood vessels anatomical variation during gynecologic and obstetrics surgeries in cases of retroperitoneal dissection. PATIENTS: We report three cases with incidental finding of anatomical variation in retroperitoneal major pelvic blood vessels. One patient underwent staging laparotomy for endometrial cancer with intraoperative finding of bilateral long internal iliac artery with short common iliac artery. The second patient underwent staging laparotomy for suspicious ovarian mass and mesh sacrocolpopexy for uterine prolapse with accidental finding of kinked long external iliac artery with short common iliac artery. The third patient underwent total hysterectomy with pelvic lymphadenectomy for endometrial cancer with incidental finding of bilateral absent internal iliac artery with common iliac artery continuing as external iliac artery.
CONCLUSIONS: Anatomical variations in the major retroperitoneal pelvic vasculature should be familiar with during surgeries to avoid inadequate management. Internal iliac artery ligation should be done as low as possible close to the bifurcation in case of long internal iliac artery as in case of bleeding, slipped uterine or injured vesical vessels. Kinked external iliac artery should not be considered as anomaly or swollen node with trial of excision in dissection of lymph nodes in gynecological cancer or a thrombosed vessel but continue as usual in dissection and preserve any branches arising from it which is a normal variation. Also, the absent internal iliac artery is no problem as its branches may arise from the aorta or the external iliac artery. The uterine artery can be traced in this condition from the uterine side and any branches from external iliac artery in pelvis can be a normal variation. © Indian Association of Surgical Oncology 2020.