Hemorrhoidal branch

The IMA supplies colon distal to the splenic flexure including the descending colon, sigmoid colon, and rectum. When embolizing rectal branches off of the superior hemorrhoidal branch of the IMA, one must remember the rich collateral network around the rectum with middle hemorrhoidal branches arising from the internal iliac arteries. The internal iliac arteries should be studied after embolizing a rectal branch to exclude the possibility of collateral flow to the bleeding site. 

Differences in segmental arterial supply probably also impact on the risk of infarction. The rectum is likely to tolerate embolization better than other regions since it has a dual blood supply with the superior hemorrhoidal artery off of the inferior mesenteric artery and middle hemorrhoidal arteries arising from the internal iliac circulation. This translates into increased potential for collateral blood flow and thus decreased risk of ischemia. The cecum may be more prone to ischemia since there is not a well developed arcade along the mesenteric border of the cecum and instead there are separate anterior and posterior cecal branches. The tissue supplied by these individual branches may be more susceptible to ischemia and in fact infarction of the cecum (even after microcatheter embolization) has been reported [13]. 

Traditional use Thin branches, bark and fruits are used in folk medicine. Fruits are used as a laxative to treat chronic constipation, and the treatment starts to take effect 8-10 h after ingestion. A decoction of the fruits, with the addition of dairy whey, oil, and baking soda is used as a laxative for atonic and spastic constipation, and is used as a stool softener for cases of hemorrhoids and wounds to the colon. An infusion of the fruits in vodka is used externally to treat rheumatism. A decoction of the branches is used internally to treat ulcers and externally, as a compress to heal wounds. A decoction of the bark is used to treat stomach catarrh, low acidity of the stomach, and Polish plait (Maznev 2004). 

Regulatory Status. Used in OTC preparations in the United States. The leaves and branches are the subject of a positive German therapeutic monograph, indicated for minor skin injuries, local skin and mucous membrane irritation, hemorrhoids, and varicose... 

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