Watershed area is the medical term referring to regions of the body, that receive dual blood supply from the most distal branches of two large arteries, such as the

splenic flexure In the anatomy of the human digestive tract, there are two colic flexures, or curvatures in the transverse colon. The right colic flexure is also known as the hepatic flexure, and the left colic flexure is also known as the splenic flexure. Note ...

of the

large intestine The large intestine, also known as the large bowel, is the last part of the gastrointestinal tract and of the digestive system in tetrapods. Water is absorbed here and the remaining waste material is stored in the rectum as feces before being r ...

. The term refers metaphorically to a geological watershed, or drainage divide, which separates adjacent drainage basins. During times of blockage of one of the arteries that supply the watershed area, such as in

atherosclerosis Atherosclerosis is a pattern of the disease arteriosclerosis in which the wall of the artery develops abnormalities, called lesions. These lesions may lead to narrowing due to the buildup of atheroma, atheromatous plaque. At onset there are usu ...

, these regions are spared from

ischemia Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems wi ...

by virtue of their dual supply. However, during times of systemic hypoperfusion, such as in disseminated intravascular coagulation or

heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, a ...

, these regions are particularly vulnerable to ischemia because they are supplied by the most distal branches of their arteries, and thus the least likely to receive sufficient blood. Watershed areas are found in the brain, where areas are perfused by both the anterior and middle cerebral arteries, and in the intestines, where areas are perfused by both the superior and inferior mesenteric arteries (i.e., splenic flexure). Additionally, the sigmoid colon and rectum form a watershed zone with blood supply from inferior mesenteric, pudendal and iliac circulations. Hypoperfusion in watershed areas can lead to mural and mucosal infarction in the case of ischemic bowel disease. When

watershed stroke A watershed stroke is defined as a brain ischemia that is localized to the vulnerable border zones between the tissues supplied by the anterior, posterior and middle cerebral arteries. The actual blood stream blockage/restriction site can be lo ...

occurs in the brain, it produces unique focal neurologic symptoms that aid clinicians in diagnosis and localization. For example, a cerebral watershed area is situated in the dorsal prefrontal cortex; when it is affected on the left side, this can lead to

transcortical motor aphasia Transcortical motor aphasia (TMoA), also known as commissural dysphasia or white matter dysphasia, results from damage in the anterior superior frontal lobe of the language-dominant hemisphere. This damage is typically due to cerebrovascular accide ...

References

Circulatory system {{anatomy-stub