Rare variations in the Origin, Branching Pattern and Course of the Celiac Trunk: Report of Two Cases

Abstract

Multiple anomalies in the celiac arterial system presents as rare vascular malformations, depicting deviations of the normal vascular developmental pattern. We found a common left gastro-phrenic trunk and a hepato-spleno-mesenteric trunk arising separately from the abdominal aorta in one cadaver. We also found a common hepatic artery and a gastro-splenic trunk arising individually from the abdominal aorta in another cadaver. Even though many variations in the celiac trunk have been described earlier, the complex variations described here are not mentioned and classified by earlier literature. Knowledge of such variations has significance in the surgical and invasive arterial radiological procedures in the upper abdomen.

Keywords: celiac artery; common hepatic artery; superior mesenteric artery; variations.

Figure 1

Case 1– Abdominal arota (AA) gave two branches – common hepatic artery (CHA) and Gastrosplenic trunk (GST). CHA, within the right free margin of the lesser omentum gave rise to gastrodeuodenal artery (GDA) and then right gastric artery (RGA) and continued as hepatic artery proper (HPA). Just before the porta hepatis, the HPA then divided into right and left hepatic arteries (RHA & LHA). The GST further gave rise to left gastric artery (LGA) and splenic arteries (SA). Abbreviations: EA= esophageal artery; PA = pancreas.

Figure 2

Case 2–Immediately after entering to abdomen through the aortic opening, the abdominal aorta (AA) gave rise to small gastrophrenic trunk (GPT) which further divided into left phrenic artery (LPA) and left gastric artery (LGA). Just below the this small trunk, another large mesentrico-hepato-splenic trunk (MHST) was arising from the AA which then divided into Hepato-splenic trunk (HPT) and Superior mesenteric artery (SMA). HPT then divided into Splenic (SA) and common hepatic arteries (CHA). After the short course, CHA was further divided into Hepatic artery proper (HAP) and gastroduodenal artery (GDA). Abbreviations: RPA= right phrenic artery, LRA = left renal artery, JA = first jejunal artery, IVC = inferior vena cava.

Figure 3

Schematic representation (Lateral view) showing the normal developmental pattern of celiac trunk (CT) arteries and superior mesenteric artery (SMA) and probable developmental reasons for the variations observed in our cases. Abbreviations: AA = abdominal aorta; VSA = ventral splanchnic arteries; LGA = left gastric artery; SA = splenic artery; CHA = common hepatic artery; SMA = superior mesenteric artery; LPA = Left phrenic artery.