Hepatomesenteric trunk, gastrosplenic trunk, coiled splenic and hepatic arteries, and a variant of Bühler's arc.

Abstract

The coeliac trunk is normally divided into the left gastric artery (LGA), splenic artery, and common hepatic artery (CHA). The combination between these arteries and the superior mesenteric artery (SMA) generates various combinations. We report here such a rare anatomic variant, namely the hepatomesenteric trunk (HMT), combined with a gastrosplenic trunk (GST). The variant was identified using computed tomography angiograms of a 62-year-old woman. The GST emerged from the aorta within the aortic hiatus of the diaphragm, a previously unknown possibility. Further, an accessory left hepatic artery originated from the LGA. The phrenic arteries had independent aortic origins. The HMT divided into the CHA and the SMA posterior to the origin of the hepatic portal vein (PV), above the pancreas. The CHA initially had a right course, towards the superior border of the PV, then it descended with a transpancreatic course posterior to the PV, reached its inferior/right border, and divided antero-inferiorly to the PV into the proper hepatic and gastroduodenal arteries. The proper hepatic artery continued on the anterior side of the PV, sending off the left and right hepatic arteries. The HMT and the GST were connected by a rudimentary variant of the arc of Bühler, unreported previously. Arterial variations in the coeliac region are accurately distinguished on computed tomography angiograms. They should be evaluated by surgeons when different surgical procedures are evaluated.