The middle (anorectal) rectal artery is a branch of the anterior division of the internal iliac artery (Read more!). It is also known as the middle hemorrhoidal artery. This artery is often absent or very small. It forms anastomoses with both the superior rectal artery and the inferior rectal artery.

After the middle rectal artery arises, it descends within the lesser pelvis and then enters the mesorectum anterolaterally in the lateral rectal ligament. At first, the middle rectal artery takes a relatively vertical path, but then it makes a 90-degree turn to approach the rectum transversely.

This is typically the only vessel that penetrates through the rectal visceral fascia. Within the mesorectum, the middle anorectal artery is ensheathed by the rectal visceral fascia along with the branches of the inferior hypogastric plexus. When reaching the rectum, it splits into smaller branches that supply the middle and inferior aspects of the rectum.

The middle rectal artery also gives off several side branches, including prostatic branches to the prostate and seminal gland. In addition, it may also give branches to the ureter.

The middle rectal artery is highly inconsistent, and it is more commonly present in males than females. Also, it is common for only one side of the pelvis to have this artery. Additionally, some duplications (or even three or more arteries) can be present on either side of the pelvis.

The middle rectal artery has a variable point of origin. It may also arise from a common trunk shared with the inferior vesical artery. It can also arise from the internal pudendal artery, inferior gluteal artery, obturator artery, posterior trunk of the internal iliac artery, or directly from the internal iliac artery.

Unlock with Premium

Middle (anorectal) rectal artery