Hepatosplenic Trunk Research Articles

Hepatosplenic Trunk Associated with Tortuous Course of Right Hepatic Artery Forming Caterpillar Hump

Celiac trunk usually trifurcates and supplies the organs in the supracolic compartment. The vascular variations are common in this region. There are reports on the variant course of right hepatic artery (RHA). The tortuous RHA forming a caterpillar hump is a rare finding and also its providing origin to gastroduodenal artery (GDA) is an important observation. During routine dissection of abdomen of approximately 60-year-old male cadaver, concurrent arterial variations were observed. The celiac trunk bifurcated into splenic and common hepatic arteries. The left gastric artery arose from the abdominal aorta. The common hepatic artery was tortuous and divided into right and left hepatic arteries in front of portal vein. The RHA gave origin to GDA and then made a characteristic loop around the bile duct with the convexity to the right side. Knowledge of arterial variations of celiac trunk and its branches is useful in planning and executing the radiological interventions and surgeries in the supracolic abdominal compartment.

Gastrointestinal: Absent coeliac axis

A66-year old man with obstructive jaundice was found to have an unresectable pancreatic tumour on contrast-enhanced CT scan. Sagittal (Figure 1) and 3-D (Figure 2) reconstructions of the CT scan images revealed complete agenesis of the coeliac axis, with the splenic and hepatic arteries arising directly from the superior mesenteric artery. The arterial supply of the gastrointestinal tract develops in week 4 of embryological life. The future blood vessels of the GI tract are formed from the vitelline system, which is composed of two bilateral arterial plexuses which coalesce to form arteries from the dorsal aorta to GI tract. Above the diaphragm the vitelline channels amalgamate to form about 5 pairs of arteries which supply the thoracic oesophagus. Below the diaphragm the vitelline system condenses to form the three major abdominal arteries of the foregut, midgut and hindgut. The coeliac artery is the most superior of these arteries; it leaves the aorta at the seventh cervical level in the embryo but later descends to the twelfth thoracic level during development. In addition to supplying the abdominal foregut proper, the coeliac artery also supplies its endodermal derivatives; the hepatic diverticulum (future liver), the cystic diverticulum (future gallbladder), and the dorsal and ventral pancreatic bud (future pancreas). It also supplies the mesodermally derived spleen. The anatomical variation in the celiac trunk is assumed to be caused by different patterns of vitelline reduction. However, some animal studies have suggested that the major abdominal arteries arise from medial umbilical roots of the dorsal aorta. Anomalies of the coeliac axis have been described in up to 28% of subjects. The commonest variation appears to be a common hepatosplenic trunk with a separate left gastric artery. Complete absence of the coeliac axis, with the splenic and hepatic arteries originating from the superior mesenteric artery is rare. Identification of these anomalies is particularly important in the event of angiographic or surgical intervention and organ harvest for transplantation, and can be achieved using reconstructions derived from multi-detector CT images.

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.

Multidetector-row CT angiographic imaging of the celiac trunk: anatomy and normal variants

To evaluate the ability of MDCT reformations in describing the celiac trunk vascular anatomy and variations. A total of 555 MDCT angiographies of the abdominal aorta performed between January 2002 and July 2005 were retrospectively reviewed to assess the celiac trunk vascular anatomy and variations. All the patients with pathological condition likely to affect normal vascular anatomy as well as CT exams technically inadequate were excluded from our study. A total of 524 MDCT angiographies of abdominal aorta were included in our study. The classical configuration of the celiac trunk was detected in 72.1%. The hepato-splenic trunk was detected in 50.4% of cases; the hepato-gastro-splenic trunk was detected in 19.4% of cases; the gastro-splenic trunk was detected in 2.3% of cases. The hepato-spleno-gastric trunk associated with hepatic arteries variants were found in 15.4%. The hepato-splenic trunk, the hepato-gastric trunk, the hepato-splenic-mesenteric trunk, and the spleno-gastric trunk were found in 2.7, 5, 0.4, and 3.6%, respectively. In 0.6%, we found an absent celiac trunk. The knowledge of the type of anatomical variants and their subtypes is fundamental for a correct pre-operative vascular planning in surgical or radiological abdominal procedures. Multidetector-row CT (MDCT) provides high-quality 3D-reconstructed images and allows non-invasive assessment of normal anatomy and anatomic variants of celiac trunk.

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.

Anomalous branching pattern of celiac trunk

Variations in the origin and branches of the celiac trunk are well established. We are reporting a rare case of celiac trunk with two main branches, hepatosplenic trunk and left gastric artery in the place of the three classic branches. The left gastric was giving left inferior phrenic, left suprarenal superior suprarenal and left gastroepiploic arteries. The presence of this type of variation is clinically important in laparoscopic surgery. It is important to know the variations of hepatosplenic trunk for the success of surgical operations to the liver and radiological investigations of those regions.

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.

Aneurysm of an Aberrant Celiac Axis: Revascularization of Hepatic and Splenic Arteries—A Case Report

In a fifty-three-year old Japanese woman, a 3-cm-diameter saccular, calci fied aneurysm was detected beneath the pancreas during surgery for cholelithi asis. She was then referred to the authors' institution, where an aneurysm was detected on the medial wall of an anomalous celiac axis, that is, the hepato splenic trunk as a branch of an anomalous hepatosplenomesenteric trunk. This vascular anomaly was identified as type III in Adachi's classification of the structural variation of the celiac axis. The aneurysm was resected, and revascu larization of the hepatic and splenic arteries was successful following insertion of an autogenous vein graft.