Anat Cell Biol.  2014 Mar;47(1):73-76. 10.5115/acb.2014.47.1.73.

A rare variant angioarchitecture of upper abdomen

• Singh B
• Anand M
• Gupta S

• KMID: 2168859
• DOI: http://doi.org/10.5115/acb.2014.47.1.73

Abstract

Vascular anomalies are frequently encountered in abdomen. But they are usually asymptomatic and diagnosed accidently during angiography or surgery leading into severe complications. Thus knowledge of angioarchitecture in abdomen, whether normal or variant, is considered prerequisite for successful, uncomplicated surgeries and interventional radiology. This case report describes one of such varying branching pattern of celiac trunk and superior mesenteric artery. During routine abdominal dissection, gastroduodenal artery was seen arising from celiac trunk along with its usual three branches. Common hepatic artery continued as left hepatic artery after giving rise the right gastric artery and a tortuous replaced right hepatic artery arose from superior mesenteric artery. An unusually long cystic artery arose from left hepatic artery and gave rise to 2-3 small anastomotic branches towards hepatic flexor of colon, in addition to its normal gallbladder supply. Awareness of such variations would certainly be helpful in upper abdominal surgeries.

Keyword

Hepatic artery; Celiac trunk; Superior mesenteric artery; Vascular anomaly

MeSH Terms

Abdomen*
Angiography
Arteries
Colon
Gallbladder
Hepatic Artery
Mesenteric Artery, Superior
Radiology, Interventional

Figure

• 

  Fig. 1 Photograph showing multiple anomalies of celiac trunk (CT) and superior mesenteric artery (SMA) and their branches with stomach and part of common hepatic artery (CHA)/left hepatic artery (LHA) removed (represented by a dotted line). CA, cystic artery; GB, gallbladder; GDA, gastroduodenal artery; LGA, left gastric artery; RHA, replaced right hepatic artery; SA, splenic artery.

• 

  Fig. 2 Schematic representation of Fig. 1 showing multiple variations in arterial anatomy as observed in present case. CA, cystic artery; CHA, common hepatic artery; CT, celiac trunk; GDA, gastroduodenal artery; LGA, left gastric artery; LHA, left hepatic artery; RGA, right gastric artery; RHA, replaced right hepatic artery; SA, splenic artery; SMA, superior mesenteric artery.

Reference

1. Raikos A, Paraskevas GK, Natsis K, Tzikas A, Njau SN. Multiple variations in the branching pattern of the abdominal aorta. Rom J Morphol Embryol. 2010; 51:585–587.

2. Gielecki J, Zurada A, Sonpal N, Jabłońska B. The clinical relevance of coeliac trunk variations. Folia Morphol (Warsz). 2005; 64:123–129.

3. Loukas M, Shah R, Tubbs S, Merbs W. Multiple variations of the hepatobiliary vasculature including a splenomesenteric trunk. Singapore Med J. 2010; 51:e6–e8.

4. Kalthur SG, Sarda R, Bankar M. Multiple vascular variations of abdominal vessels in a male cadaver: embryological perspective and clinical importance. J Morphol Sci. 2011; 28:152–156.

5. Tandler J. Uber die Varietaten der Arteria coeliaca und deren Entwickelung. Anat Hefte. 1904; 25:473–500.

6. Mehta V, Dave V, Suri RK, Rath G. Quadrifurcation of the hepatic artery proper in conjunction with double right gastric arteries. Singapore Med J. 2012; 53:e211–e213.

7. Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg. 1966; 112:337–347.

8. Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. 1994; 220:50–52.

9. Baliyan R, Mehta V, Suri RK, Arora J, Rath G. Anatomic divergence in the hepatic arterial branching pattern: clinical viewpoint value to hepatologists. Br J Med Health Sci. 2012; 1:39–45.

10. Anson BH. The aortic arch and its branches. In : Luisada AA, editor. Cardiology. Vol. 1. New York: McGraw-Hill;1963. p. 119.