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.     

The topographic relationships of the unpaired visceral branches of the aorta

We examined the metric relationship among the origins of the unpaired visceral branches of the aorta, their relationship to the total descending aorta (TDA), and the relationship between the TDA and stature to see whether a graft for the TDA, e.g., from the left subclavian artery to the aortic bifurcation, which includes its visceral branches, could be pre-constructed. These proportions were compared between the genders and between adults and children to see whether any differences exist. Thirty-four adult aortae and eight juvenile aortae were examined. These segments—TDA, aortic bifurcation to celiac artery, aortic bifurcation to superior mesenteric artery, and aortic bifurcation to inferior mesenteric artery, were defined as the distances between the origins of the left subclavian, celiac, superior mesenteric, and inferior mesenteric arteries, respectively, to the aortic bifurcation. Stature was known only in 15 adult cadavers. The absolute lengths of the segments were correlated to each other and the ratios of these absolute lengths (proportional lengths) were calculated. The statistical significance was examined by Student's T-test and variability by the F test. The TDA correlated well with aortic bifurcation to celiac artery and aortic bifurcation to superior mesenteric artery, whereas a weaker correlation existed with aortic bifurcation to inferior mesenteric artery. The ratio aortic bifurcation to celiac artery and aortic bifurcation to superior mesenteric artery to TDA was less variable than the ratio aortic bifurcation to inferior mesenteric artery to TDA. The abdominal aorta measured approximately a one-third of TDA. No differences in correlation nor in ratio were found between genders and between adults and children. No correlation between stature and TDA was found. The two upper unpaired visceral branches originate from the aorta in a prefixed site, which correlates closely with the length of the descending aorta, whereas the lower one has a more variable point of origin. This is true for all ages and for both genders. Aortic length does not correlate with stature. It is not possible thus to predict the length of the descending aorta by stature. However, a model of the descending aorta can be constructed, but with less accuracy, for the inferior mesenteric artery. Clin. Anat. 11:304–309, 1998. © 1998 Wiley-Liss, Inc.     

Median arcuate ligament syndrome: Predictor of ischemic complications?

Median arcuate ligament syndrome (MALS) is a pathologic entity that can affect the celiac axis. Due to the extensive collateral network of mesenteric circulation, stenosis of one mesenteric artery does not lead to significant symptoms. The purpose of this study was to describe multidetector computed tomography (MDCT) angiography findings of celiac artery entrapment by the median arcuate ligament and determine those patients with high risks of ischemic complications. From January 2012 to March 2016, 103 patients with celiac artery (CA) compression by median arcuate ligament were detected. In 23 patients collateral circulation was developed. In order to investigate the problem, we managed to estimate the correlation between range of stenosis of CA and presence of collateral circulation between the celiac artery (CA) and superior mesenteric artery (SMA). A statistically significant correlation was found between range of CA stenosis and collateral circulation presence (Spearman's correlation coefficient 0.339, P < 0.0001). In conclusions, based on our observations, we hypothesize that ischemia as a result of mesenteric vessel narrowing by the median arcuate ligament may occur more often than indicated by clinical symptoms and described in literature. Clin. Anat. 29:1025–1030, 2016. © 2016 Wiley Periodicals, Inc.     

腹腔动脉与肠系膜上动脉侧支循环通路假性闭塞

目的：分析腹腔动脉与肠系膜上动脉侧支循环通路假性闭塞的原因和价值。方法：由两名有经验的介入放射学医生共同回顾性分析15例该类患者的肠系膜上动脉造影，腹腔动脉造影及介入治疗资料，并达成一致意见。结果：15例假性闭塞中，临床基础病变包括原发性肝癌12例，肝血管瘤3例。假性闭塞位于肝总动脉与腹腔动脉分叉处者8例，肝总动脉分出胃十二指肠动脉支处6例，1例右肝动脉直接起源于腹腔动脉，并在其分叉处发生假性闭塞。该假性闭塞于腹腔动脉造影时呈闭塞状态，而肠系膜上动脉造影却完全通畅，似静脉瓣样，并且导丝、导管能够顺利通过该闭塞处。结论：这一少见现象可能与其血液动力学改变和解剖学变异有关，了解此征象对于指导介入插管有一定价值。     

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.     

腹腔镜下肠系膜下血管的临床解剖学

目的:探讨腹腔镜直肠癌根治术中肠系膜下血管的局部解剖学特征及定位标志。方法:对接受腹腔镜直肠癌根治术的105例直肠癌患者进行活体解剖学观察。结果:切开中线侧Toldt’s线,在主动脉分权头侧的Toldt’s间隙内可顺利定位肠系膜下动脉(inferior mesenteric artery,IMA)起点。牵引乙状结肠系膜使IMA与主动脉保持垂直状态,可形成系膜后操作窗,顺利暴露IMA根部。肠系膜下静脉(inferior mesenteric vein, IMV)在乙状结肠结肠系膜后位可清晰暴露和游离,结合系膜前位游离,可高位离断。结论:Toldt’s间隙是定位IMA的正确外科平面,主动脉分权可作为定位标志。结肠系膜后位和前位解剖法相结合,是识别和定位IMV的有效手段。     

Mile′s根治术后重建人工肛门的应用解剖学

根据Mile's根治术后重建人工肛门的需要,在32例成人尸体上重点观测了从直肠腹膜返折线至髂嵴的肠管长度、肠系膜下动脉及其分支和边缘动脉的外径。设计了既能满足结肠保留部下移重建人工肛门的长度,又能保证血液供给的二种手术方案。     

A hepatomesenteric trunk,in association with left gastric and splenic arteries arising independently from the abdominal aorta: A case report using MDCT angiography

We present a case of a 73-year-old male with peripheral vascular disease of the lower limbs, who on shown MDCT angiography, to have a hepatomesenteric trunk (HMT), and left gastric artery (LGA) and splenic artery (SpA) arising independently from the abdominal aorta (AA), and with additional right renal arteries. The HMT with a length of 5 mm (with an aspect of a common stem origin of common hepatic artery (CHA) and superior mesenteric artery (SMA) arose from the anterior wall of the AA at the level of upper one-third of the L2 vertebral body. The CHA originating from the superior part of the right edge of the HMT, have an ascendent path in front of AA, and finally fork in gastroduodenal artery and hepatic artery proper. With a descending path the SMA across the left renal vein, uncinate process, and inferior part of the duodenum (D3) made an aortomesenteric angle of 61°. The aortomesenteric distance at the level of the L3 vertebral body was 51 mm. The present case is only the 13th reported HMT in association with an independently arising LGA and SpA from the AA, the first case report with this condition using MDCT angiography. Knowledge of the variations in origin and distribution of the HMT is important for planning and performing procedures such as duodenopancreatectomy, liver transplantation, and chemoembolization of the pancreas and hepatic tumors.     

Tortuosity of the human splenic artery

Arantius (1571) was the first to describe tortuosity of the splenic artery. The present study investigated the variations in its tortuosity in man, and possible relationships with age, sex, and presence of atheroma. Twenty-nine cadaveric specimens and forty-four celiac angiograms were studied. The straight distance from the origin of the splenic artery, from the celiac trunk, to the point of commencement of the hilar branches was measured, as was the total length of the artery between these two points. The ratio of these two measurements is called the “index of tortuosity.” The cadaveric arteries were then opened and graded for the presence of atheroma on a scale of 0 to 3. Marked variation in the index was found in both the cadavers and the angiograms. No definite relationship was found with sex. However, there was a suggestion of increasing tortuosity with age, although in one 10-year-old girl, marked tortuosity was demonstrated on angiography. No significant correlation was shown between increased tortuosity and the extent of atheroma. At present, there is apparently no satisfactory explanation for tortuosity of the splenic artery. © 1995 WiIey-Liss, Inc.