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Spectrum of variations in branching of coeliac trunk--a cadaveric study.

BACKGROUND

Coeliac trunk initially originates from the dorsal aorta at the seventh cervical level and drifts caudally to the twelfth thoracic level due to the descent of viscera supplied in the abdomen. [1] The coeliac trunk supplies the stomach, duodenum, liver, gallbladder, spleen and the pancreas. The arterial variations of the coeliac trunk cannot often be ignored in particular to the operative procedures as it is a surgically significant artery. The rotation of the midgut, physiological herniation, leftward migration of the spleen and haemodynamic changes in the abdominal viscera, the persistence of some parts of the longitudinal channels or due to the disappearance of parts that commonly persist can be some of the possible explanations for such a variations in the coeliac trunk. [2] Previous reports on the anatomy of the coeliac trunk display significant differences from the typical branching pattern. [3-10] A study of the pattern of branching of the coeliac trunk gives an insight into the probable variations that might occur. Knowledge of these variations is indispensable for surgical and diagnostic procedures within the abdomen. Considering the points as mentioned earlier, we decided to study the branching pattern of the coeliac trunk.

MATERIALS AND METHODS

In this descriptive study design, we observed the course of coeliac trunk spectrum of variations in its branching pattern in 50 embalmed cadavers during the routine dissection for educational purposes in the Department of Anatomy at Gandhi Medical College and Osmania Medical College between the years 2004 to 2006. A long midline incision was given from xiphisternum to the pubic symphysis extending across the thoracic cage and a second Incision was given along the inguinal ligament extending from pubic symphysis to the anterior superior iliac spine. All the abdominal viscera were identified and removed according to the instruction given in Cunningham's Practical Manual.

Statistical Analysis

Data was collected in the preformed template, and then it was transferred to Microsoft spread sheet 2007. Observations were presented as actual numbers and percentages.

RESULTS

The present study evaluated the occurrence of the branching pattern of the coeliac trunk and found that the most common pattern of branching of the coeliac trunk was the hepatolienogastric type in 71% (39/50) of cadavers and variants in another 22% (12/50) cadavers. The inferior phrenic artery arising from the coeliac trunk was observed more on left side, 12% (6/50) (figure-1). However, such an observation was not found on the right (Table-1). Both the inferior phrenic arteries arising from the coeliac trunk was in 4% (2/50) (Figure-2). The other observed variants are the left gastric artery arising from the abdominal aorta (Figure-3), a very small common hepatic artery bifurcating immediately into the hepatic proper and the gastroduodenal artery (Figure-4) and common coeliac-mesenteric trunk (Figure-3) in 1% each (Figure-5).

DISCUSSION

The coeliac trunk takes its origin from the abdominal aorta and supplies the stomach, duodenum, liver, gallbladder, spleen and pancreas through its three branches namely splenic artery, left gastric artery and common hepatic artery. Earlier studies have noted the significant variations from the typical branching pattern of the coeliac trunk. [2-10,11-23] The hepatolienogastric pattern of branching is considered to be the most commonly occurring pattern of branching of the coeliac trunk. Its occurrence varied across the studies from 75% to 88%. [11],[8] Similarly, we also found this pattern in 78% of cadavers.

Inferior phrenic artery arises from abdominal aorta as its one of the lateral branches. The knowledge of anomalous origin and course of the inferior phrenic artery is essential while dealing with the procedures like arterial chemoembolisation in patients with hepatic carcinoma and transarterial embolisation in patients with severe haemoptysis. [10] A recent study using CT scan reports that the origin of IPA may widely differ in the presence of coeliac axis variation. [12]

In the present study, the variations in the origination of inferior phrenic artery were observed. The left side inferior phrenic artery was from the coeliac trunk in 12% of cadavers. However, we did not find the origin of only the right inferior phrenic artery from the coeliac trunk. Instead, it was observed that both the right and the left inferior phrenic arteries arose from the coeliac trunk in 4%. A similar observation was found by Cicekcibasi AE et al. [16] Sajeed et al [8] found common inferior phrenic trunk originating from the coeliac trunk which further divided into the right and the left inferior phrenic arteries. Nakamura Y et al [6] observed left inferior phrenic artery arising from the gastrosplenic trunk. However, such a pattern was not seen in our study.

We found that the Left gastric artery originated from the abdominal aorta rather than from the coeliac trunk in 2% of our cadavers. Adachi [11] had observed this pattern in 6.3% of his samples and called it the hepatolienal pattern of branching.

Our study team noticed one variant, which has not been described earlier in the common hepatic artery from which the hepatic proper and the gastroduodenal arteries immediately after arising from the coeliac trunk. The length of the coeliac trunk was concise, or it can be considered as the hepatic proper and the left gastric artery bifurcating from the coeliac trunk.

We also observed the presence of common coeliacomesenteric trunk pattern in 2% of our cadavers. The coeliac trunk and the superior mesenteric artery, which are the separate branches of the abdominal aorta, arose as a common trunk from the abdominal aorta. Such a similar observation was also noted by many reports. [15],[3] Matsumoto K et al [19] and Kalra M et al [5] reported an anomalous common coeliacomesenteric trunk with a concurrent aneurysm. Cicekcibasi et al [16] observed a case of the coeliacomesenteric trunk with both the right and the left inferior phrenic arteries arising from it. The presence of coeliacomesenteric trunk may occasionally be recognised during clinical examination, particularly when using medical imaging techniques. Commonly it is involved in several pathological processes such as an aneurysm, occlusion, thrombosis, etc.

CONCLUSION

In the present study, we found a spectrum of branching patterns of the coeliac trunk and such a wealth of information could be of value to the radiologist and the surgeons as provides information on occurrence of the variations in this geographical region.

REFERENCES

[1] Gray H, Standring S, Anand N, et al. Gray's anatomy: the anatomical basis of clinical practice. Elsevier 2016.

[2] Agarwal S, Pangtey B, Vasudeva N. Unusual variation in the branching pattern of the celiac trunk and its embryological and clinical perspective. Journal of clinical and diagnostic research JCDR. 2016;10(6):AD05-7.

[3] Ailawadi G, Cowles RA, Stanley JC, et al. Common celiacomesenteric trunk: aneurysmal and occlusive disease. Journal of vascular surgery 2004;40(5):1040-3.

[4] Chen H, Yano R, Emura S, et al. Anatomic variation of the celiac trunk with special reference to hepatic artery patterns. Annals of Anatomy-Anatomischer Anzeiger 2009;191(4):399-407.

[5] Kalra M, Panneton JM, Hofer JM, et al. Aneurysm and stenosis of the celiomesenteric trunk: a rare anomaly. Journal of vascular surgery 2003;37(3):679-82.

[6] Nakamura Y, Miyaki T, Hayashi S, et al. Three cases of the gastrosplenic and the hepatomesenteric trunks. Okajimas folia anatomica Japonica 2003;80(4):71-6.

[7] Prasanna LC, Alva R, Sneha GK, et al. Rare variations in the origin, branching pattern and course of the celiac trunk: report of two cases. The Malaysian journal of medical sciences 2016;23(1):77-81.

[8] Saeed M, Murshid KR, Rufai AA, et al. Coexistence of multiple anomalies in the celiac-mesenteric arterial system. Clinical Anatomy 2003;16(1):30-6.

[9] Singh BGP, Bhatt CR, Patel SV, et al. Morphometric study of coeliac trunk specific reference to hepatic artery pattern in the West-Indian population. The Indian journal of surgery 2014;76(5):359-62.

[10] Ugurel MS, Battal B, Bozlar U, et al. Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography. The British Journal of Radiology 2010;83(992):661-7.

[11] Adachi B. Anatomie der Japaner I. Das arteriensystem der Japaner 1928:20-71.

[12] Aslaner R, Pekcevik Y, Sahin H, et al. Variations in the origin of inferior phrenic arteries and their relationship to celiac axis variations on CT angiography. Korean journal of radiology 2017;18(2):336-44.

[13] Badagabettu SN. Comments on the article rare variations in the origin, branching pattern and course of the celiac trunk: report of two cases. The Malaysian journal of medical sciences 2016;23(3):97.

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[15] Cavdar S, Cehirli U, Pekin B. Celiacomesenteric trunk. Clinical Anatomy 1997;10(4):231-4.

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[17] Higashi N, Hirai K. A case of the three branches of the celiac trunk arising directly from the abdominal aorta. Kaibogaku zasshi Journal of anatomy 1995;70(4):34952.

[18] Lin J. Celiomesenteric trunk demonstrated by 3-dimensional contrast-enhanced magnetic resonance angiography. Hepatobiliary Pancreat Dis Int 2005;4(3):472-4.

[19] Matsumoto K, Tanaka K, Ohsumi K, et al. Celiomesenteric anomaly with concurrent aneurysm. Journal of vascular surgery 1999;29(4):711-4.

[20] Michels NA. Blood supply and anatomy of the upper abdominal organs with a descriptive atlas. Philadelphia (Pa) 1955.

[21] Shoumura S, Emura S, Utsumi M, et al. Anatomical study on the branches of the celiac trunk (IV). Comparison of the findings with Adachi's classification. Kaibogaku zasshi Journal of anatomy 1991;66(5):452-61.

[22] Simana J, Slauf F. Rozhledy v chirurgii: mesicnik Ceskoslovenske chirurgicke spolecnosti. Aneurysm of an anomalous common celiac-mesenteric trunk 1997;76(6):284-6.

[23] Yuksel M, Yalin A, Weinfeld AB. Concurrent anomalies of the abdominal arteries: an extremely long coeliac trunk, an inferior phrenic trunk, and an aberrant right hepatic artery. Kaibogaku zasshi Journal of anatomy 1998;73(5):497-503.

Sujatha Bangalore Bayer (1)

(1) Assistant Professor, Department of Anatomy, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.

Financiai or Other, Competing Interest: None.

Submission 24-07-2017, Peer Review 05-08-2017, Acceptance 08-08-2017, Published 14-08-2017.

Corresponding Author: Dr. Sujatha Bangalore Bayer, Assistant Professor, Department of Anatomy, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.

E-mail: sujathagmc@yahoo.com

DOI: 10.14260/jemds/2017/1018

Caption: Fig-1-Left inferior phrenic artery arising from the celiac trunk

Caption: Fig-2-Left and Right inferior phrenic artery arising from the celiac trunk

Caption: Figure-3-left gastric artery originating directly from the abdominal aorta

Caption: Figure-4-Common hepatic artery bifurcating Into hepatic and gastroduodenal artery

Caption: Figure-5-Celiaco mesenteric anamaly

Caption: Figure-6-Normal branching of caeliac trunk
Table 1. Shows the Patterns of Branching of Coeliac Trunk in Cadavers
during Dissection in Anatomy Training

                                             Patterns of
Arteries                                      Branching    N = 50   (%)

Hepatolienogastric trunk                       Normal        39     78%

Left inferior phrenic artery arising from      Variant        8     16%
the coeliac trunk

Right inferior phrenic artery arising            --           0      0%
from the coeliac trunk

Both the right and the left inferior           Variant        2      4%
phrenic arteries arising from the coeliac
trunk

Common coeliac mesenteric trunk                Anomaly        1      2%

Left gastric artery arising from the           Variant        1      2%
abdominal aorta

Common hepatic artery bifurcating into the     Variant        1      2%
hepatic proper and the gastroduodenal
artery
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Title Annotation:Original Research Article
Author:Bayer, Sujatha Bangalore
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Date:Aug 14, 2017
Words:1880
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