Moskowitz's Arterial and Venous Variants (Mo Type 2) in Sigmoid Resection for Diverticular Disease: A Case Report and Literature Review.

Diverticular disease of the sigmoid colon is common in Western countries, and acute diverticulitis may lead to complications requiring surgical intervention. Vascular anatomical variants, such as Moskowitz's artery and inferior mesenteric vein variations, can significantly influence surgical planning and outcomes. We report the case of a 57-year-old male with acute sigmoid diverticulitis complicated by a pericolic abscess. CT imaging revealed the presence of Moskowitz's artery and a venous variant of the inferior mesenteric vein draining directly into the portal vein. Due to clinical deterioration, a laparoscopic sigmoidectomy with protective ileostomy was performed. Intraoperatively, the arterial and venous variants were confirmed. The inferior mesenteric artery was ligated distal to the origin of the left colic artery, and the inferior mesenteric vein was ligated below the ligament of Treitz. The postoperative course was uneventful, and follow-up demonstrated good bowel function and quality of life. This case highlights the importance of recognizing vascular variants during sigmoid resection. Moskowitz's arterial and venous anomalies may complicate dissection and increase the risk of ischemia or bleeding. Preoperative imaging and intraoperative vigilance are essential to minimize complications. Current evidence favors low ligation of the inferior mesenteric artery in diverticular disease to preserve perfusion, although the optimal strategy must be tailored to individual anatomy. Awareness of vascular variants is critical in the surgical management of diverticular disease. Integrating modern imaging techniques and individualized vascular ligation strategies enhances safety and improves outcomes in sigmoid resection.