A case of celiacomesenteric trunk with some other arterial anomalies in a Japanese woman

We found a case of multiple arterial anomalies in a Japanese female cadaver during a routine dissection course. In the present case, a combination of three arterial anomalies was recognized in the abdominal digestive organs: (i) a celiacomesenteric trunk; (ii) a right accessory hepatic artery; and (iii) a left colic artery arising from a portion corresponding to the superior mesenteric artery. The typical celiacomesenteric trunk can be regarded as a variation of the arterial convergence at its origins progressing further between the celiac trunk and the superior mesenteric artery. The celiacomesenteric trunk in the present case included the left colic artery, which is usually one branch of the inferior mesenteric artery. Previously, a case had been reported in which all three arteries supplying the abdominal digestive organs had converged into one trunk, the celiac-bimesenteric trunk. Therefore, the celiacomesenteric trunk in the present case showed an intermediate degree of arterial convergence between that of the typical celiacomesenteric trunk and the celiac-bimesenteric trunk.     

An anomalous case of the hepatic artery arising from the superior mesenteric artery

In a stdudenet course of gross anatomy dissection at Kanagawa Dental College in 2006, we found an extremely rare case of the hepatic artery arising from the superior mesenteric artery of a 78-year-old Japanese male cadaver. This case belonged to type V in Adachi's classification of the celiac trunk and the superior mesenteric artery (1928). The gastro-splenic trunk and hepato-mesenteric trunk both arose from the abdominal aorta and the left gastric artery arose from the gastro-splenic trunk. The hepatic artery arose from the hepato-mesenteric trunk and crossed the portal vein anteriorly.     

Coexistence of multiple anomalies in the celiac-mesenteric arterial system

The origins and distribution of arteries of the celiac-mesenteric system were examined by dissection of 52 formalin-fixed human cadavers. Seventy-five percent of the cadavers exhibited the classic Michels' Type I hepatolienogastric pattern; 25% had different branching patterns. Multiple anomalies of the celiac-mesenteric arterial system were observed in one Caucasian female cadaver: a short lienogastric trunk; a common hepatic artery arising directly from the abdominal aorta; an anomalous course of the hepatic arteries; an accessory left hepatic artery arising from the left and right gastric arterial anastomosis along the lesser curvature of the stomach; a double cystic artery; a common inferior phrenic trunk arising from the celiac trunk; and an aberrant arterial channel connecting the proximal segments of the splenic and gastroduodenal arteries. A patent ductus venosus and an anomalous formation of the portal vein by the confluence of the splenic and superior and inferior mesenteric veins was also observed. Although single anomalies of the celiac-mesenteric arterial system are common, complex combinations, such as were observed in the present case, represent a significant deviation from the normal developmental pattern. There seems to be no report in the literature of such a combination of anomalies coexisting in one individual. The developmental and clinical significance of these anomalous vessels is discussed.     

Multiple variations of the hepatobiliary vasculature including double cystic arteries, accessory left hepatic artery and hepatosplenic trunk: a case report

Anatomical variations in the origins and branching patterns of the hepatobiliary arterial system may be encountered during both conventional surgical and laparoscopic cholecystectomy. We report a rare case of double cystic arteries arising from both the right hepatic artery and the proximal part of the posterior superior pancreaticoduodenal artery. Additional variations consisting of an accessory left hepatic artery arising from a left gastric which in turn arose from the descending aorta superior to the origin of the celiac trunk and a small left hepatic artery arising from the hepatic proper artery were also noted. The celiac trunk bifurcated into the splenic artery and the common hepatic artery forming a hepatosplenic or lienohepatic trunk. The possible clinical implications are discussed.     

Aortic origin of right hepatic artery and superior mesenteric origin of splenic artery two rare variations demonstrated angiographically

Abstract Anatomical variations of the celiac trunk and superior mesenteric artery are not infrequent. Knowledge of the existing aberrations is important in planning and conducting surgical or radiological procedures. A case of right hepatic artery arising independently from the aorta supplying an hepatocellular carcinoma was identified, through which transarterial chemoembolization was successfully performed. A second case is presented with a common splenomesenteric trunk branching into the splenic and superior mesenteric arteries. These two cases represent exceptional arterial variations in the upper abdomen.     

Anomalous origins of colic arteries

The topography of the celiac trunk and superior and inferior mesenteric arteries was studied by dissection in 27 embalmed cadavers. Variant vascular patterns were noted in four subjects. These consisted of: (1) an accessory right hepatic artery from the superior mesenteric artery, (2) an anomalous middle colic artery from the proximal segment of the splenic artery, and (3) two instances of an accessory left colic artery originating from the superior mesenteric artery. The precarious course of the middle colic artery (coming from the splenic artery) and its dominance in the formation of the marginal artery were thought to predispose the ascending and transverse colon to an increased risk of vascular damage. These cases also illustrate two variant patterns of formation of the marginal artery. In the case of the anomalous middle colic artery, the only contribution of the superior mesenteric artery to the marginal artery was through the anastomosis of its ileocolic branch with the right branch of the aberrant middle colic artery. In subjects with accessory left colic arteries, the superior mesenteric artery played a dominant role in the formation of the marginal artery by contributing the accessory left colic artery, which supplied the splenic flexure and the proximal part of the descending colon. These arterial variations underscore the importance of doing vascular studies prior to major abdominal surgery. © 1995 WiIey-Liss, Inc.     

Right hepatic artery from splenic artery: the four-leaf clover of hepatic surgery

The anatomy of hepatic arteries is one of the most variable. Accurate awareness of all the possible anatomic variations is crucial in the upper GI surgery and especially in liver and pancreas transplantation. The most frequent anatomical variants are: a replaced or accessory right hepatic artery (RHA) from the superior mesenteric artery (6.3–21 %), a replaced or accessory left hepatic artery (LHA) from the left gastric artery (LGA) (3–18 %) or a combination of these two variants (up to 7.4 %). Herein, we describe the case of a 67-year-old cadaveric organ donor who presented a RHA originating from the splenic artery (SA) associated with both a CHA originating from the celiac trunk (CT) and a LHA originating from the LGA.     

The arterial blood supply of the pancreas: a review. V. The dorsal pancreatic artery. An anatomic review and a radiologic study

The present article is the fifth part of a comprehensive review on the arterial blood supply of the pancreas and deals with the dorsal pancreatic artery. The aim of this review is to summarise the anatomic studies, starting from Haller’s reports, and to supply, as far as possible with original material, angiographic evidence for the classic anatomic notions. For this purpose, the overall research was carried out by studying 1015 selective angiographies (celiac trunk and its branches, superior mesenteric artery) taken from the angiographic archives of the Institutes of Radiology of Siena, Rome (Catholic University), and Perugia. Angiographically, the authors could demonstrate the dorsal pancreatic artery, present in most instances, as arising from the splenic artery, common hepatic artery, superior mesenteric artery or celiac trunk and accessory right hepatic artery as coming from the superior mesenteric artery. Variations in the course and length of the dorsal pancreatic artery were demonstrated as well as some collateral branches. The authors underline the discordant opinions still existing regarding the incidence of the different ways the dorsal pancreatic artery arises, and discuss its uncertain embryologic development and surgical relevance.     

Variations of the celiac trunk branches in the fetus

The study was performed on 60 human foetuses, aged between 4 to 9 months, using as methods dissection and plastic and contrast substances injection. We studied the celiac trunk in what concerns the division into its terminal branches, insisting on the possible morphological variations, some rare collateral branches starting from the common arterial trunk, the dimensional relations between the branches at their origin and the level of the celiac trunk origin from the aorta, in relation with the vertebral column, the diaphragmatic passage of the aorta and with the superior mesenteric artery. We also assessed the dimensional relations (calibers at origin) between the branches of the celiac trunk. Ass possible variations of the division of the celiac trunk, we assessed: gastro-hepatic trunk, with the splenic artery directly from the aorta or from the hepatic artery; gastro-splenic trunk, with the hepatic artery originating from the aorta; hepato-splenic trunk, with origin of the left gastric artery either directly from the aorta or from the hepatic artery. Rare variations: celiaco-mesenteric trunk; two arterial trunks, hepato-splenic and hepato-gastric; separate aortic origin for all three "classic" branches of the celiac trunk; two hepatic arteries, one from the celiac trunk and the other from the aorta or superior mesenteric artery; celiac trunk that divides into several terminal branches; one or two suprarenal arteries originating from the celiac trunk.     

Superior mesenteric origin of the proper hepatic artery: embryological and clinical implications

The hepatic arteries are subject to a great deal of anatomical variation, potentially complicating hepatobiliary surgical procedures as well as general gastrointestinal procedures that involve foregut and midgut structures. We report a case of a rare variant of the proper hepatic artery discovered during dissection of an 84-year-old male cadaver. In this individual, the common hepatic artery was absent and the proper hepatic artery was replaced directly to the superior mesenteric artery. The gastroduodenal artery and the right inferior phrenic artery took origin from the celiac trunk. In addition, there was no identifiable right gastric artery. The celiac trunk gave off three branches: the splenic, left gastric, and gastroduodenal arteries. The entire arterial blood supply to the liver, therefore, was derived from the superior mesenteric artery. Patterns of regression of the ventral branches and the partial disappearance of the ventral anastomotic arteries during embryonic development play a major role in the variations of the gut arteries. An intraoperative encounter with this particular variant carries a significant risk of iatrogenic injury with potentially devastating ischemia and necrotic results. Accurate depiction and definition of the hepatic arterial anatomy are crucial. Variations like the one described here underscore the importance of pre-operative imaging and knowledge of the embryological origins of variation.     

Anatomic variation of the celiac trunk with special reference to hepatic artery patterns

Based on a large homogeneous sample from a Japanese population, anatomic variations in the celiac trunk (CT) and the hepatic artery were studied. Previously we analyzed the branching mode of the CT in 450 Japanese cadavers. In order to maximize the database on the CT and hepatic artery, we examined the anatomy of these arteries in 524 cadavers, a total of 974 cases. A total of 89.8% of cases showed the classical trifurcation of the CT. The typical normal pattern of the CT and the hepatic artery was confirmed in 66.6% and 72.4% of the cadavers, respectively. Variant left and right hepatic arteries were observed in 11.0% and 4.9%, respectively. A variant anatomy involving both the left and right hepatic arteries was found in 1.5%. A common hepatosplenic trunk and a gastrohepatic trunk were seen in 4.4% and 0.3%, respectively. A common hepatic artery (CHA) arising from the superior mesenteric artery (SMA) or directly from the aorta was present in 3.5% or 0.5%, respectively. A hepatosplenomesenteric trunk and a celiomesenteric trunk were encountered in 0.7%, respectively. This anatomical update of the CT and the hepatic artery can be useful for transplantation and general surgeons, as well as vascular radiologists in this area.     

Congenital absence of the portal vein in a middle-aged man

Congenital absence of the portal vein with systemic diversion of mesenteric blood is extremely rare. We report a case of a congenital absence of the portal vein, accidentally discovered in a 59-year-old man, completely asymptomatic and not associated with other malformations or biochemical disorders. Ultrasonography imaging showed the absence of the portal vein and the distal tract of superior mesenteric and splenic veins draining together into a dilated left renal vein. Computed tomography and magnetic resonance confirmed the presence of a congenital portosystemic venous shunt and also revealed two hepatic arteries: one arising from the celiac trunk and the other from the superior mesenteric artery.     

Variations in the source of origin of inferior phrenic artery: a cadaveric study

Introduction: The right and left inferior phrenic arteries perfuse the diaphragm. They may originate either from the aorta, celiac trunk, or from the renal artery. Most textbooks of human anatomy give little information regarding the functional anatomy of the inferior phrenic artery. In the past few years, however, more articles have been published regarding the arterial supply in cases of hepatocellular carcinoma. The inferior phrenic artery is seen as an important source of collateral arterial supply to hepatocellular carcinoma, the hepatic artery being the main source. Materials and methods: A cadaveric study was conducted in the Anatomy Department of Bangalore Medical College during the years 2009–2011. Manual dissection was done to identify the inferior phrenic arteries, and their origins were traced. Results: The inferior phrenic artery arose from the aorta in 53.125%, celiac trunk in 28.125%, renal artery in 15.625%, and the superior mesenteric artery in 3.125% of the 32 cadavers studied. The right inferior phrenic artery arose from aorta in 56.25%, celiac trunk in 18.75%, renal artery in 18.75%, and superior mesenteric artery in 6.25% cases. The left inferior phrenic artery arose from aorta in 50%, from celiac trunk in 37.5%, and the rest arose (12.5%) from the renal artery. Discussion: The results were compared with those of earlier studies so that such findings could be applied in the treatment of hepatocellular carcinoma. The significance of this information is due to the fact that an unresectable hepatocellular carcinoma can be treated by transcatheter embolization of the right inferior phrenic artery, in case it is involved.     

Celiacomesenteric trunk: a short report

The authors describe the case of a 44-year-old male with chronic liver disease in whom celiacomesenteric trunk (CMT) was incidentally detected on routine multidetector row computed tomography of abdomen. The CMT (measuring approximately in diameter 12.3 mm) divided into celiac trunk and superior mesenteric artery (SMA) (measuring approximately 7.5 and 7.2 mm, respectively). The celiac trunk further divided into common hepatic, left gastric, and right inferior phrenic and splenic arteries. The common hepatic artery gave off gastroduodenal arteries before continuing as hepatic artery proper. The SMA was seen running down, deep to the neck of the pancreas to supply the midgut. The incidence and clinical implications of this vascular variation are discussed with a review of the relevant literature.     

Anatomical variations of the hepatic portal vein associated with incomplete celiac trunk

An association of two anatomical variations was revealed in a 65-year-old male cadaver: the first variation concerns the forming of the trunk of the hepatic portal vein, while the second concerns the branches of the celiac trunk. In this case, the inferior and superior mesenteric veins form a common trunk that is further united with the splenic vein and gives rise to the hepatic portal vein. At the same time, the existence of an incomplete (branched) celiac trunk was revealed, the hepatosplenic trunk from which the common hepatic artery and the splenic artery arise; the left gastric artery arises separately at 0.5 cm superolaterally from the origin of the celiac trunk. Familiarity with this anatomical variation provides useful information for abdominal surgery procedures.     

Retroportal proper hepatic artery with malrotated gut

Variations in celiac and hepatic vasculature are common and reported in one in five individuals. We report a rare case of a retroportal proper hepatic artery arising from a celiac trunk with quadruple branching associated with an intraperitoneal duodenum, pancreas and ascending colon. In addition, accessory left hepatic artery arose from the left gastric and the cystic artery originated abnormally from the gastroduodenal artery. Awareness of such variable arterial patterns is relevant in radiological assessment and planning for successful liver transplants, hepatobiliary surgery, portal vein resections and particularly interventional transarterial regional/focal chemoablative procedures of liver.     

An anatomic study of the peripancreatic lymphatics

A detailed study of the lymphatics around the pancreas was carried out in order to provide a theoretic basis for ideal lymph-node resection in radical cancer operations. The following results were obtained as a result of minute macroscopic dissection of the lymphatics. Three major pathways are identified on the anterior surface of the head of the pancreas. The upper pathway belongs to the common hepatic group. The middle and lower routes are associated with the superior mesenteric nodal group. All these pathways terminate in the node situated to the right of the origins of the celiac trunk and the superior mesenteric artery. The lymphatics arising from the neck of the pancreas also converge at the same node. Behind this node, there is a terminal node for the lymphatics which arise from the posterior surface of the head. Both nodes are firmly adherent, with only the nerve plexus of the head of the pancreas intervening. In this study, we have named these lymph-nodes Lnn celiacomesenterici dextri superficialis et profundi. Two distinct pathways are identified in the left half of the pancreas. One follows the splenic blood vessels and the other accompanies the inferior pancreatic artery. By way of these routes, lymphatics from the left half of the pancreas terminate in the node situated to the left of the origins of the celiac trunk and superior mesenteric artery. We have applied the term Ln celiacomesentericus sinister to this node. From these lymphatic terminalis on both sides of the origins of the two arteries, efferent vessels are sent to the abdomino-aortic nodes: on the right side, efferents reach the inter-aorticovenous nodes lying in the upper and lower angles formed by the inferior vena cava and the left renal vein; and on the left side, they arrive at the left latero-aortic nodes lying above and below the left renal vein. The efferents of these nodes then extend to the retro-aortic space, where they compose an ascending lymphatic system. Our study revealed no lymphatic vessels communicating with the retro-aortic system at levels above the renal arteries.