Unraveling Variations in Celiac Trunk and Hepatic Artery by CT Angiography to Aid in Surgeries of Upper Abdominal Region

Abstract

Understanding of variations in the course and source of abdominal arteries is crucial for any surgical intervention in the peritoneal space. Intricate surgeries of the upper abdominal region, such as hepato-biliary, pancreatic, gastric and splenic surgeries, require precise knowledge of regular anatomy and different variations related to celiac trunk and hepatic artery. In addition, information about the origin of inferior phrenic artery is important in conditions such as hepatocellular carcinoma and gastroesophageal bleeding management. The present study gives an account of anatomical variations in origin and branching pattern of celiac trunk and hepatic artery by the use of CT (computed tomographic) angiography. The study was performed on 110 (66 females and 44 males) patients in a north Indian population. Results unraveled the most common celiac trunk variation as hepatosplenic trunk with left gastric artery, which was observed in 60% of cases, more common in females than in males. Gastrosplenic and hepato-gastric trunk could be seen in 4.55% and 1.82% cases respectively. Gastrosplenic trunk was more commonly found in females, whereas hepato-gastric trunk was more common in males. A gastrosplenic trunk, along with the hepato-mesenteric trunk, was observed in 1.82% cases and was more common in males. A celiacomesenteric trunk, in which the celiac trunk and superior mesenteric artery originated as a common trunk from the aorta, was seen only in 0.91% of cases, and exhibited an origin of right and left inferior phrenic artery from the left gastric artery. The most common variation of hepatic artery, in which the right hepatic artery was replaced and originated from the superior mesenteric artery, was observed in 3.64%, cases with a more common occurrence in males. In 1.82% cases, the left hepatic artery was replaced and originated from the left gastric artery, which was observed only in females. Common hepatic artery originated from the superior mesenteric artery, as observed in 1.82% cases, with slightly higher occurrence in males. These findings not only add to the existing knowledge apart from giving an overview of variations in north Indian population, but also give an account of their correlation with gender. The present study will prove to be important for various surgeries of the upper abdominal region.

Keywords: 64-row scanner computed tomography; anatomical variations; celiac trunk; hepatic artery.

Figure 1

3D-Volume render (3D-VR) image of (64 row scanner CT angiography) abdominal region showing superior mesenteric artery (red arrow) and division of regular celiac trunk (blue arrow) into left gastric artery (pink arrow), splenic artery (yellow arrow) and common hepatic artery (purple arrow).

Figure 2

3D-VR image of (64 row scanner CT angiography) abdominal region showing superior mesenteric artery (red arrow) and division of Celiac trunk (blue arrow) into left gastric artery (pink arrow) and hepatosplenic trunk (green arrow). Hepatosplenic trunk further divides into common hepatic artery (purple arrow) and splenic artery (yellow arrow).

Figure 3

3D-VR image of (64 row scanner CT angiography) abdominal region showing superior mesenteric artery (red arrow) and division of celiac trunk (blue arrow) into gastrosplenic trunk (black arrow) and common hepatic artery (purple arrow).

Figure 4

Coronal maximum intensity projection (MIP) image of (64 row scanner CT angiography) abdominal region showing superior mesenteric artery (red arrow) and division of celiac trunk (blue arrow) into gastro-hepatic trunk (dark green arrow) and splenic artery (yellow arrow), gastro-hepatic trunk further divides into common hepatic artery (purple arrow) and left gastric artery (pink arrow). Slice thickness: 1.2 mm.

Figure 5

3D-VR image of (64 row scanner CT angiography) abdominal region showing gastrosplenic (black arrow) and hepato-mesenteric trunk (orange arrow), gastrosplenic trunk divides into left gastric artery (pink arrow) and splenic artery (yellow arrow), hepato-mesenteric divides into common hepatic artery (purple arrow) and superior mesenteric artery (red arrow).

Figure 6

3D-VR image of (64 row scanner CT angiography) abdominal region showing the Celio-mesenteric trunk (grey arrow), which divided into celiac trunk (blue arrow) and superior mesenteric artery (red arrow). Left gastric artery gives rise to right inferior phrenic artery (brown arrow) and left inferior phrenic artery (white arrow).

Figure 7

Coronal MIP image of (64 row scanner CT angiography) abdominal region showing the celiac trunk (blue arrow) and superior mesenteric artery (red arrow), the celiac trunk gives rise the left gastric artery (pink arrow), common hepatic artery (purple arrow) and splenic artery (yellow arrow), in which left gastric artery gives rise to left hepatic artery (light green arrow). Slice thickness: 1.2 mm.

Figure 8

3D-VR image of (64 row scanner CT angiography) abdominal region showing celiac trunk (blue arrow) and superior mesenteric artery (red arrow), common hepatic artery divides into gastroduodenal artery (dark green arrow), left hepatic artery (light green arrow). Replaced right hepatic artery (light pink arrow) originated from superior mesenteric artery. Splenic artery (yellow arrow), left gastric artery (pink arrow), common hepatic artery (purple arrow).

Figure 9

3D-VR image of (64 row scanner CT angiography) abdominal region showing the hepato-mesenteric (orange arrow) and gastrosplenic trunk (black arrow), hepato-mesenteric trunk divides into common hepatic artery (purple arrow) and superior mesenteric artery (red arrow).