Celiac Trunk Quadrification, Replaced Common Hepatic Artery, and Double Cystic Arteries

Abstract

Understanding the gastrointestinal system's anatomical variants is vital for surgeons, anatomists, and those who deal with referred abdominal pain, such as physical therapists. Direct access physical therapists must diligently diagnose symptoms to determine the cause of either real musculoskeletal pain or insidious symptoms masquerading as an ischemic insult. Variants of the celiac trunk and common hepatic artery were found in an 80-year-old cadaver-donor during an educational student dissection. The objective of this study was to classify and evaluate this variant in comparison to previous literature. The celiac trunk typically (95%) branches into the left gastric, splenic, and common hepatic arteries to supply the foregut, while the superior mesenteric artery (SMA) branches supply the midgut. In place of the celiac trunk, a gastrosplenic trunk (Uflacker Type V), a common inferior phrenic trunk, and a middle suprarenal artery emerged during dissection. Additionally, a replaced common hepatic artery (RCHA) originated from the superior mesenteric artery (Michels Type IX) – the presence of the CHA as a hepatomesenteric trunk is rare, a 0.07-6% prevalence. The combination of the Uflacker Type V and the Michels Type IX has a prevalence of 0.4-4.37%, while an inferior phrenic trunk originating from the celiac trunk has a reported prevalence of 7.69-13.6%. Many reports state that the RCHA variant courses posterior to the hepatic portal vein. In this case, the RCHA and associated branches were anteromedial for most of its course. The right hepatic artery took a tortuous path posterior to the common bile duct and did not enter the hepatobiliary (Calot's) triangle. Inferior to the gallbladder, double cystic arteries emerged from the right hepatic artery, previously reported with a 2-18% prevalence. Knowledge of arterial branching patterns and the variants – both common and rare – is vital for anatomists and surgeons performing dissections or operations within the abdominal area to ensure success and maximal safety. The combination of variants reported in this case is rare and has not been reported previously. This case may provide additional evidence for future studies on the morphologic and embryologic basis of vascular development. Specifically, studies that aim to evaluate a temporal relationship of combined vascular anomalies during embryologic development.