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.     

The third time is the charm--anastomosis between the celiac trunk and the left colic artery

An atypical case of abdominal vasculature, found in a 58-year-old woman is presented. The multidetector computed tomography angiogram revealed a large tortuous anastomotic vessel between the stem of the celiac trunk and the left colic artery, supplying branches for the left colon and pancreatic body and tail. We propose a simple embryological explanation for the development of this aberrant artery--the longitudinal ventral anastomosis, which connects the precursors of principal visceral arteries in a loop-like manner, loses its direct communication with the superior mesenteric artery but maintains its continuity above and below this level. This variation could pose a problem for radiological interpretation and affect surgical approaches to the aorta, left colon, and the pancreas.     

Clinical interest of digestive arterial trunk anastomoses

Arterial vascularization of the gastrointestinal tract is a three-level system composed of the coeliac trunk, and both superior and inferior mesenteric arteries. The three levels are joined together via arterial trunk anastomoses such as the so-called and well-known Riolan arcade or supramarginal arcade. The aim of this study was to review the embryology of the digestive arteries in order to understand the anatomic variations, the development of the arterial trunk anastomoses and the potential collateral circulation in the case of obstruction of one or several arterial trunks. The arch theory by Mac Kay and Tandler longitudinal arterial anastomosis account for the genesis of the arterial trunk anastomoses and the main anatomic variations. The coeliac trunk and the superior mesenteric artery are joined together via the pancreaticoduodenal arcades and the Bühler arcade. These anastomoses are divided during pancreatic resections but developed in the case of coeliac trunk stenosis. The mesenteric arteries are joined together by the Riolan, Villemin arcades and by the marginal artery of Drummond. This collateral circulation and the Riolan arcade in particular, is utilized during left colonic resection. In the case of this collateral circulation insufficiency, inferior mesenteric artery reimplantation is necessary during abdominal aortic aneurysmectomy. Arteriopathy, more and more frequent due to population ageing is responsible for frequent obliteration of one or several digestive arterial trunks with subsequent development of collateral circulation. For such reasons, a sound knowledge of digestive arterial anatomy is an absolute prerequisite for surgical practice.     

A rare case of inferior mesenteric artery arising from the superior mesenteric artery,with a review of the review of the literature

Anatomical variations of the inferior mesenteric artery (IMA) are uncommon. Generally, the IMA is very stable, arises directly from the abdominal aorta at the level of the third lumbar vertebra. We describe here an extremely rare case in which the IMA arose from the superior mesenteric artery. The findings were made during routine dissection of the cadaver of a 79-year-old Japanese man. This present case is the ninth report of this variation and was associated with gastrophrenic trunk, hepatosplenic trunk, hypoplastic spleen and accessory spleen. Clinically, cases like this highlight the importance of knowing the IMA anatomy and the possibility of its numerous variations in surgical procedures such as right hemicolectomy, resection of the transverse colon, left hemicolectomy, sigmoidectomy, and en bloc resection of the head of the pancreas and the superior mesenteric vessels. The developmental significance of this variation is also discussed with a detailed review of the literature.     

Atypical coeliomesenteric anastomosis: The presence of an anomalous fourth coeliac trunk branch

The presence of more than three coeliac trunk branches is a commonly encountered variant. Literature occasionally describes cases of middle or left colic arteries originating from the celiac trunks or its branches; however, the presence of an anomalous arterial connection between the celiac trunk and both the superior and inferior mesenteric arteries (SMA and IMA, respectively) has yet to be reported. Routine abdominal dissection of a male Caucasian cadaver, revealed the presence of an anomalous fourth arterial branch on the 4‐cm long coeliac trunk. The course of this artery was traced, and it terminated by anastomosing with the marginal artery of the mesenteric circulation. The distal termination point of this anomalous fourth coeliac branch was the marginal artery, 5 cm medial of the splenic flexure, anastomosing almost perpendicularly. The diameter of this anomalous artery was comparable with the left gastric artery at their origins. The artery coursed inferiorlaterally toward the splenic flexure, passing immediately posterior to both the pancreas and the splenic vein. The anastomosis point of this artery, near Griffith's Point, is normally considered a watershed region with dual arterial supply from both the SMA and IMA, allowing collateral circulation. This region has a relatively higher susceptibility to irreversible damage in ischemic diseases because of lower perfusion, thus, the anastomosis of atypical coeliac branches represents a rare case for consideration. Awareness of the possibility of embryological variants will minimize the risk of complications in surgical or clinical procedures, and exploration of rare variants will benefit the understanding of vascular embryology. Clin. Anat., 2010. © 2010 Wiley‐Liss, Inc.     

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.     

Rare case of the inferior mesenteric artery and the common hepatic artery arising from the superior mesenteric artery

We found a case in which inferior mesenteric artery and the common hepatic artery arose from the superior mesenteric artery, forming the common hepatomesenteric trunk, during a routine dissection carried out at Iwate Medical University in 2002. This variation is rare, but can be embryonically explained. A change in the positions of the disappearance of the ventral splanchnic arteries and the longitudinal anastomotic channel results in variations in the system of arteries distributed to the digestive organs. In the present case, the longitudinal anastomotic channel between the superior and the inferior mesenteric arteries survived to form the common mesenteric artery, which was joined by the common hepatic artery, forming the common hepatomesenteric trunk.     

肠系膜下动脉根部自主神经保护的解剖学基础

目的　观察肠系膜下动脉（IMA）根部与其周围自主神经的解剖学关系,为肠系膜下动脉根部自主神经保护提供解剖学证据。 方法　7例10%福尔马林固定标本进行大体解剖及显微解剖;2例新鲜标本模拟腹腔镜下直肠癌D3根治术中肠系膜下动脉根部自主神经的显露和保护。 结果　上腹下丛(SHP)的左、右侧束及束间交通支与肠系膜下动脉根部关系密切。右侧束距离肠系膜下动脉根部较远,位于肾前筋膜下。以左侧束降支为界,其近端,上腹下丛左侧束、肠系膜下丛、腹主动脉丛紧贴肠系膜下动脉根部左侧壁并相互延续,其远端左侧束走行于肾前筋膜下。左侧束降支距离IMA起点的距离不恒定。 结论　在肾前筋膜前平面分离可有效保护上腹下丛右侧束及侧束间交通支;以SHP左侧束降支作为肠系膜下动脉根部离断的解剖学标志可以有效保护左侧束。     

The relationship of the inferior mesenteric vein with arteries

The investigation was based on the results of roentgen-anatomical study of 155 digestive tract complexes obtained from 155 cadavers of humans of both genders aged 17-90 years. It was established that in 91% (in 141 of 155) of the cases the trunk of the inferior mesenteric vein (IMV) was accompanied by the arteries only in the lower part (by inferior mesenteric artery) and in the middle part (by the left colic artery). The terminal part of IMV was separated from the artery. In 9% of (in 14 of 155) cases the trunk of the IMV is accompanied along the whole extent by different arteries (from down upwards): by inferior mesenteric artery and left colic artery from inferior mesenteric artery, and in its terminal part either by an additional anastomosis between the superior and inferior mesenteric arteries (in 5 of 14 cases), or by an additional anastomosis between superior and inferior mesenteric arteries and the branch or trunk of the proximal colic artery from the superior mesenteric artery (in 9 of 14 cases).     

A direct anastomosis between the stems of celiac trunk and left colic artery by an anomalous fourth celiac trunk branch: First cadaveric study

Coeliac trunk (CT) is a ventral branch of abdominal aorta (AA) supplying the foregut through its three main branches, left gastric (LGA), common hepatic (CHA) and splenic artery (Standring et al., 2009). Branching pattern of CT may vary from above mentioned classical three to four, five or six. Additional branches include inferior phrenic artery, dorsal pancreatic artery, middle colic or accessory middle colic artery (Hamilton and Mossman, 1972; Amonoo‐Kuofi et al., 1995). Anastmosis between CT and Superior mesenteric artery (SMA) which supplies the midgut derivatives in the form of Bühler's arcade (1‐2%) is present posterior to the body of pancreas (Douard et al., 2006; McNulty et al., 2001). Anastomoses between SMA and Inferior mesenteric artery (IMA) which supplies hindgut derivatives are also documented (Lange et al, 2007; Van Damme and Bonte, 1990). Until recently no communications between arteries of foregut and hindgut were reported (Manoharan et al., 2010; Patel et al., 2010; Stimec et al., 2011). We report the first cadaveric finding demonstrating a direct communication between the stems of CT and left colic artery (LCA) via a fourth anomalous CT branch in the absence of any co‐existing stenosis or aneurysm in the main vessels. Clin. Anat. 26:984–986, 2013. © 2012 Wiley Periodicals, Inc.     

Rare case of right accessory renal artery originating as a common trunk with the inferior mesenteric artery: a case report

Dissection of a male cadaver revealed several vascular abnormalities in the abdominal cavity, notably of the renal circulation. In particular, three renal arteries were observed on the right side and two on the left. On the right side, one accessory renal artery originated as a common trunk with the inferior mesenteric artery. Additional variations included a left inferior phrenic artery originating from the celiac trunk, bilateral testicular veins emptying into renal veins, and the left testicular artery arising from the left renal artery. The possible embryonic development of these branching patterns and their clinical significance are discussed briefly.     

Anatomical study on the branches of the celiac trunk (IV). Comparison of the findings with Adachi's classification]

The authors studied the mode of branching of the celiac trunk in 184 Japanese cadavers during dissecting practice at Gifu University from 1985 to 1988. The findings were as follows; 1) One hundred and sixty-six of the 184 cases belonged to Type I of Adachi's classification of variation in the arrangement of the branches of the celiac trunk. One hundred and twenty-nine cases belonged to Group 1, one case to Group 2, 10 cases to Group 3, 9 cases to Group 4, one case to Group 6, 2 cases to Group 7, 8 cases to Group 8 and 4 cases to Group 11. Two cases did not belong to any group. One of them had an anastomosis between the hepatic artery and the superior mesenteric artery. The other one had the middle colic artery arising from the hepatic artery. 2) Seven cases belonged to Type II, Group 12. 3) Two cases belonged to Type III. One belonged to Group 18. The other one had an accessory right hepatic artery arising from the superior mesenteric artery. 4) One case belonged to Type IV, Group 20. 5) Three cases belonged to Type V, Group 23. 6) Two cases belonged to Type VI. One case had a gastrolienal trunk and an accessory right hepatic artery arising from the superior mesenteric artery. The other one had a gastrolienal trunk and an accessory right hepatic artery arising from the gastrolienal trunk. 7) Of the 184 cases, three could not be classified according to Adachi. Two cases had a gastrolienal trunk and the hepatic artery arising from the abdominal aorta. One case had a lienomesenteric trunk and a gastrohepatic trunk.     

Clinical anatomy of celiac artery compression syndrome: a review

Anatomic variations are often responsible for a variety of clinical conditions. In this review we investigate compression of the celiac artery and the superior mesenteric artery by the median arcuate ligament (MAL), diaphragmatic crura, or the celiac nerve plexus. This clinical condition known as celiac artery compression syndrome (CACS) has proven controversial in definition and relevance. This condition was first described as chronic abdominal pain because of the mesenteric ischemia caused by extrinsic compression of the celiac artery. Dunbar and others presented surgical approaches to decompress the celiac artery by releasing the MAL. Definitive answers have been sought to classify and relieve the clinical symptoms patients experience postprandially. Persistent symptoms following surgical treatment for CACS have led investigators to question the existence of this disease. Advances in technology such as angiographic MRI and color duplex ultrasonography have refreshed the importance of considering compression of the celiac artery during differential diagnoses. Because of the varying anatomic etiologies of disease, it is not possible to pinpoint a single cause for CACS. Potential etiologies for compression of the celiac artery include a "high take off" origin of the celiac artery compressed by normal diaphragmatic crura and MAL, a normal origin of the celiac artery with long diaphragmatic crura and MAL, large bilaterally fused celiac ganglia (with or without the involvement of the superior mesenteric ganglia) compressing the celiac trunk, celiacomesenteric trunk compression by diaphragmatic crura and MAL, or combinations of the above mentioned entities. In this review we describe potential sources of compression of the celiac artery by regional structures and treatments of CACS in an effort to justify the relevance of CACS in modern medicine.     

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 inferior mesenteric artery supplying the ascending,transverse, descending,and sigmoid colons

We have encountered in our anatomical practice the first case and an extremely rare second case in which the ascending, transverse, descending, and sigmoid colons were supplied by the inferior mesenteric artery. The causes of colic artery anomalies are generally explained in conjunction with the development of the superior mesenteric artery, which is intimately related to embryonic elongation and midgut rotation. However, this embryological model was inapplicable to both cases. This difficulty motivated us to seek possible relationships with reported anomalous inferior mesenteric arteries in adults as well as their embryological causes. We consider that the aberrant right colic artery found in 2009 is an “intermesenteric artery” which anastomoses the superior (or its middle colic branch) and inferior mesenteric artery, but secondarily lost its origin from the superior mesenteric artery. The aberrant colic artery found in 2010 is a “middle–inferior mesenteric artery” in which the inferior mesenteric artery formed a common trunk with remnant middle mesenteric artery.     

Hepatomesenteric trunk

Abstract An hepatomesenteric trunk, formed by the common hepatic and superior mesenteric arteries, was found in a 50-year-old male cadaver. The left gastric and splenic arteries arose as a common trunk, the gastrosplenic trunk, from the abdominal aorta; no typical celiac trunk was present. In addition, the hepatomesenteric trunk passed posterior to the portal vein. A knowledge of variations of the common hepatic artery may be important in pancreaticoduodenectomy, as well as during hepatic artery infusion chemotherapy.     

Absence of the celiac trunk: case report and review of the literature

The authors report a rare variation of the absence of the celiac trunk in a Japanese cadaver, with the left gastric, splenic, common hepatic, and superior mesenteric arteries arising independently from the abdominal aorta in the routine dissection of a 95-year-old Japanese male cadaver. The incidence and developmental and clinical significance of this variation is discussed with a detailed review of the literature. Knowledge of such case has important clinical significance in an abdominal operation or invasive arterial procedure, that is, Appleby procedure and liver transplantation, laparoscopic surgery, and radiological procedures in the upper abdomen.     

A rare case of the inferior mesenteric artery and some colic arteries in man

The case in which the inferior mesenteric artery (MI) arose from superior one (MS), the common mesenteric artery (MC) of Kitamura et al. (1987), was observed in a 61-year-old female cadaver. This is the 6th report on this anomaly and the only one on the female. The MS arising normally from abdominal aorta sent the MI as the first colic artery, this condition being common in 4 among 5 cases of this anomaly. The MI, however, did not send left colic artery (CS) which arose from a common trunk with right (CD) and middle colic (CM) arteries, which pattern has not been reported. 3 cases of this anomaly may be led from either of 3 kinds of intermesenteric artery (IM) reported by Williams and Klop (1957); the actual IM, an anastomotic artery between CM and CS and the one between MS and CS. The present case is extremely rare, being a compound type led from the first 2 IMs and another case with the common trunk composed of CM and CD, the last of which is collected in Lippert and Pabst (1985). From these examination, formation of MC is discussed with special reference to the inferior pancreatico-duodenal artery.     

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.