Anat Cell Biol.  2024 Sep;57(3):370-377. 10.5115/acb.24.078.

Challenging arterial pattern of foregut and its potential impact on surgery

• Srimani P
• Saha A

• KMID: 2559750
• DOI: http://doi.org/10.5115/acb.24.078

Abstract

Anticipating a wide range of morphological variations of arterial anatomy of foregut derivatives beyond the classical pattern, a precise understanding is pertinent to preoperative diagnosis, operative procedure and to avoid potentially devastating post-operative outcome during various traumatic and non-traumatic vascular insult of foregut. The study aimed to revisit the morphological details and update unusual configurations of arteries of foregut to establish clinico-anatomical correlations. This study described the detailed branching pattern of coeliac trunk (CT) as principal artery of foregut with source & course of hepatic, gastric, duodenal and pancreatic branches in 58 cadaveric dissections. Based on morphology, different types and subtypes were made. The descriptions were explained using figures and pertinent tables. Among classical branches of CT, splenic artery was found as most stable whereas other two branches were found to be most variable with missing common hepatic artery in 11 cases. In addition to classical trifurcation (65.52%), different types of bifurcation (12.07%) and tetrafurcations (22.41%) of CT were observed. Regarding variations of hepatic arteries (27.59%), both non-classical origin and accessory hepatic branches were found. In case of gastric branches, more variant origins were seen with right gastric (50%) as compared to left gastric artery (34.48%). Other morphological variations included non-classical origin of gastro-duodenal artery (18.96%) along with presence of accessory pancreatic (17.13%) and duodenal arteries (6.38%). Awareness of anatomical variations regarding circulatory dynamics of foregut is worth knowing in order to facilitate successful planning of surgery involving upper abdominal organs with least complications.

Keyword

Foregut; Celiac artery; Hepatic artery; Variations

Figure

• 

  Fig. 1 Classical picture of coeliac trunk. 1, coeliac trunk; 2, splenic artery; 3, left gastric artery; 4, common hepatic artery; 5, proper hepatic artery; 6, gastro-duodenal artery.

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  Fig. 2 Variations of branching pattern of coeliac trunk. (A) Bifurcation Type I. (B) Tetrafurcation Type I. (C) Bifurcation Type II. (D) Tetrafurcation Type II. 1, coeliac trunk; 2, hepatosplenic trunk; 3, hepatogastric trunk; 4, common hepatic artery; 5, splenic artery; 6, left hepatic artery; 7, left gastric artery; 8, proper hepatic artery; 9, gastro-duodenal artery; 10, superior pancreatico-duodenal artery; 11, accessory right hepatic artery; 12, right gastric artery; 13, accessory left hepatic artery; 14, right hepatic artery; 15, pancreatic branch; 16, abdominal aorta.

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  Fig. 3 Schematic diagram of variations of branching pattern of (A) coeliac trunk and (B) hepatic artery. 1, coeliac trunk; 2, hepatosplenic trunk; 3, hepatogastric trunk; 4, common hepatic artery; 5, splenic artery; 6, left hepatic artery; 7, left gastric artery; 8, proper hepatic artery; 9, gastro-duodenal artery; 10, superior pancreaticoduodenal artery; 11, accessory right hepatic artery; 12, right gastric artery; 13, accessory left hepatic; 14, right hepatic artery; 15, pancreatic branch; 16, abdominal aorta; 17, middle hepatic artery; 18, common trunk for middle and left hepatic artery; 19, common trunk for supraduodenal and superior pancreatoduodenal artery; 20, accessory duodenal artery; 21, supraduodenal artery.

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  Fig. 4 Variations of branching pattern of common hepatic artery. (A) Trifurcation Type I. (B) Trifurcation Type II. (C) Trifurcation Type III. (D) Tetrafurcation Type I. (E) Tetrafurcation Type II. (F) Tetrafurcation Type III. a, proper hepatic artery; b, gastro-duodenal artery; c, left hepatic artery; d, right hepatic artery; e, superior pancreatico-duodenal artery; f, middle hepatic artery; g, common trunk for left and middle hepatic artery; h, right gastric artery; i, accessory left hepatic artery; j, common trunk for supra duodenal and superior pancreatico-duodenal; k, pancreatic branch; l, accessory duodenal branch; m, supra duodenal artery; CHA, common hepatic artery.

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