A Case of the Splenic Artery Arising from the Superior Mesenteric Artery

Home , Dorsal pancreatic artery, Left gastroepiploic vein

Okajimas Folia Anat. Jpn., 57(4) : 241-250, October 1980

SEISAN KOU, AKIMICHI TAKEMURA, TAKASHI IRIFUNE and TADASHI IRIFUNE

Department of Anatomy, Osaka Dental University, Osaka 540 (Director Prof. Y. Ohta)

-Received for Publication, July 5, 1980-

Key Words: Abnormalities, Splenic artery, Mesenteric arteries, Celiac artery.

Summary : An anomalous case of the splenic artery arising from the superior mesenteric artery, forming a lienomesenteric trunk, was found in a 70-year-old female among cadavers for student dissection. In this case, the celiac trunk was observed as a common trunk between the left gastric and the common hepatic arteries. Related to these findings, the accessory left gastric artery arose from the left hepatic, and an arcade was formed by anastomosis between the pancreatica magna artery of the splenic and the dorsal pancreatic artery of the common hepatic. Such a case was not described in Adachi's classification (1928), but belonged to type IV '''of Morita's elassificatlon(1935)and to type IV of Michds' classification(1955).

Findings the level between the twelfth thoracic vertebra and the first lumbar vertebra, Cadaver : Japanese, poorly-nourished, the celiac artery, which formed the so-called 70-year-old female, cause of death un- hepatogastric trunk (Fig. 3), arose from known, subject for student dissection in the anterior wall of the aorta to the right 1979. anteroinferiorly. At about 15 mm distal In this subject, the splenic artery was to the origin of the previous trunk, the derived from the superior mesenteric splenic and the superior mesenteric ar- artery as the first branch and passed teries arose from the anterior wall of the behind the pancreas. Such a case was aorta to the right anteroinferiorly, via a not described in Adachi's classification of common trunk, the so-called lienomesen- variations in the branching type of the teric trunk (Fig. 3). celiac trunk, but belonged to type IV" I) Hepatogastric trunk of Morita's classification, and to type IV This trunk (ca. 5.6 mm in external dia- of Michels' classification. meter at its origin) gave off the right The structures in the vicinity of the inferior phrenic artery from its anterior artery were as follows. wall about 5.6 mm distal to its origin, and then made a slightly lateral curve to the A) The abdominal aorta right. About 18 mm distal to the origin This aorta took a normal course. At of the previous artery, the left inferior

241 242 S. Kou, A. Takemura, T. Irifune and T. Irifune phrenic artery arose from the anteroin- and ran up to the diaphragm to the right ferior wall of this trunk to the left supe- superolaterally, making a depression on riorly, and at the same level the right the anterior wall of the hepatogastric superior suprarenal artery arose from the trunk. superior wall to the right superiorly. This b) The left inferior phrenic artery trunk finally divided into the left gastric This artery (ca. 2.4 mm in external dia- and the common hepatic arteries (Fig. 3). meter at its origin, Fig. 3) trifurcated into a) The right inferior phrenic artery the superior, middle and inferior branches This artery (ca. 2 mm in external dia- about 44 mm distal to its origin, at the meter at its origin, Fig. 3) did not give level of the lower border of the twelfth off the right superior suprarenal artery, thoracic vertebra. The superior branch

Fig. 1. Schematic drawing of ramifications of the celiac artery and other vessels pertaining to it. A Case of the Splenic Artery 243 ascended towards the diaphragm along its to communicate with the pancreatica medial crus. The middle branch (the magna artery (Fig. 4). Up to the lower recurrent branch of Michels, 1955) turned border of the pancreas, this artery gave forwards immediately after the trifurcat- off a branch communicating with the ing point to supply the fundic and cardiac middle colic artery from the posterior regions of the stomach, where it com- wall about 5 mm distal to the origin of the municated with the short gastric branch above-mentioned communicating branch of the splenic and the left accessory gas- with the pancreatica magna. It finally tric of the left hepatic branch. The in- divided into the right and left branches. ferior branch ran to the left superola- The right branch ran horizontally on the terally up to the diaphragm, giving off anterior surface of the head of the pan- the left superior suprarenal artery from creas to anastomose with a small left its lateral wall laterally about 19 mm from branch of the anterior superior pancreati- its origin. coduodenal artery. This anastomosis c) The right superior suprarenal artery formed the prepancreatic arcade (Wood- This artery (ca. 1.0 mm in external dia.- burne, 1951), from which numerous twigs meter at its origin, Fig. 3) ran superola- supplied the pancreas. The left branch terally to the right suprarenal gland. ran along the inferior border of the body d) The left gastric artery of the pancreas as the inferior pancreatic This artery (ca. 3.4 mm in external artery (Testut, 1893) (the transverse pan- diameter at its origin, Fig. 3) ran supero- creatic artery of Haller, 1764), which ana- laterally to the right in a gentle curve stomosed with the caudal pancreatic behind the posterior layer of the omental branch of the splenic at the tail of the bursa for about 60 mm, and then ter- pancreas. minated near the cardiac region. (2) The gastroduodenal artery e) The common hepatic artery This artery (ca. 3.4 mm in external This artery (ca. 5.4 mm in external dia- diameter at its origin, Fig. 2), after giv- meter at its origin) gave off the dorsal ing off the retroduodenal artery, ended pancreatic immediately after its origin in the right gastroepiploic and the su- from its inferior wall inferiorly (Fig. 4), perior pancreaticoduodenal. and then ran in a gentle curve along the The right gastroepiploic artery did not upper border of the head of the pancreas. make any anastomosis with its counter- On reaching a position medial to the com- part, which was a branch of the splenic, mon bile duct and anterior to the portal on the greater curvature of the stomach. vein, this artery bifurcated into the he- (3) The hepatic artery proper patic proper, passing upwards in the he- This artery (ca. 4.1 mm in external dia- patoduodenal ligament, and the gastro- meter at its origin, Fig. 2) ascended an- duodenal coursing downwards. terior to the portal vein about 11 mm (1) The dorsal pancreatic artery (Mi- distal to its origin, and divided into the chels, 1945) right and left hepatic branches. The This artery (ca. 3.8 mm in external right hepatic branch, which finally sup- diameter at its origin) descended dorsal plied the right hepatic lobe, ran slightly to the neck of the pancreas and the splenic laterally to the right and gave off the vein. It gave off two branches about 15 cystic artery from its lateral wall at the mm distal to its origin ; one from its inferior end of the gallbladder. The left lateral wall to supply the uncinate pro- hepatic branch, which finally supplied the cess, and the other from its medial wall left lobe, ran anterosuperiorly to the left. 244 S. Kou, A. Takemura, T. Irifune and T. Irifune

In the course of its ascent, this branch to the hilus. sent off three branches in the following The pancreatica magna artery (Fig. 4) order : the right gastric artery from its divided into the right and left branches inferior wall inferiorly, the middle hepatic about 15 mm distal to its origin. The branch for the quadrate lobe from its right branch anastomosed with the com- lateral wall superolaterally, and the left municating branch of the dorsal pan- accessory gastric artery from its medial creatic. This anastomosis formed an wall medially. The left accessory gastric arcade, from which three pancreatic rami artery (ca. 1.0 mm in external diameter were given off (Fig. 4). The left branch at its origin) passed along the hepato- ran laterally along the upper border of gastric ligament to supply the cardiac the pancreas and sank into the body and region of the stomach on the lesser cur- tail of the pancreas. vature. The short gastric branches, four in II) Lienomesenteric trunk number, supplied the fundus of the stom- This trunk (ca. 9.6 mm in external dia- ach ; three from the superior polar branch meter at its origin, Figs. 3, 4) gave rise and the other from the superior terminal to the splenic from its anterior wall an- branch (Fig. 5). teriorly about 26 mm distal to its origin b) The superior mesenteric artery before supplying the small intestine as (1) The middle colic artery the superior mesenteric artery. In its This artery (ca. 2.5 mm in external dia- course, this trunk sent off the following meter at its origin, Fig. 3) arched an- arteries : the middle colic artery from its teroinferiorly immediately after its origin, superior wall superiorly about 4.7 mm and finally supplied the transverse colon distal to the origin of the splenic, and a after giving off a branch communicating common stem between the inferior pan- with the dorsal pancreatic from the creaticoduodenal and the first jejunal superior wall of the convexity. arteries from its lateral wall on the left (2) A common stem between the in- side inferolaterally about 10 mm distal to ferior pancreaticoduodenal and the the origin of the middle colic. first jejunal arteries a) The splenic artery This stem (ca. 3 mm in external dia- This artery (ca. 3.4 mm in external diameter at its origin) divided into the in- meter at its origin, Figs. 2, 5), showing ferior pancreaticoduodenal and the first remarkable tortuosity, ascended obliquely jejunal arteries about 3.0 mm distal to its to the left immediately after its origin, origin. The latter supplied the jejunum passing behind the neck of the pancreas as well as other jejunal arteries. The and the splenic vein up to the posterior former turned dorsally immediately after upper border of the pancreas, where it its origin and ran around the superior gave rise to the pancreatica magna artery. mesenteric artery, between the portal vein (Quin, 1848) from its anterior wall an- and the inferior vena cava, up to the teroinferiorly. posterior surface of the head of the pan- After giving off the pancreatica magna, creas, where it bifurcated into the anterior this artery meandered laterally along the and posterior inferior pancreaticoduodenal posterior upper border of the pancreas up arteries, and the respective vessels of to the splenic hilus, where it terminated which made the anterior and the posterior into two. This artery sent off the supe- pancreatic arcades (Haller, 1742). rior polar branch (Fig. 5) from its superior B) The splenic vein wall superolaterally about 45 mm proximal The splenic vein commenced from four A Case of the Splenic Artery 245 tributaries, which united to form a single (1910), 1 case by Bergmann (1933), 2 cases vessel at the splenic hilus. This vein by Morita (1936), 1 case by Ishii (1953), 3 traversed the tail and body of the pan- cases by Michels (1955), 1 case by Kato creas accompanied by the splenic artery, et al. (1974), and 1 case by Katsume et al. located between the dorsal pancreatic (1979) in the anatomical field ; and 5 cases artery and the pancreas. The vein, be- by Sasaki et al. (1973) and 1 case by Araki hind the neck of the pancreas, united at (1978) in the angiographical field. Accord- right angles with the superior mesenteric ingly, the present case may be designated vein to form the portal vein. as the 19th case. Each tributary received the short gastric As regards embryological aspects of the veins, the left gastroepiploic vein and the formation of the celiac and the superior pancreatic veins, respectively, with the mesenteric, Tandler (1904) indicated that exception of the inferior mesenteric vein. in all human embryos observed (4 to 17 mm in fetal length), the primary arteries Discussion consisted of four roots (10th to 13rd ventral segmental arteries) which could In the literature, many authors have unite via the ventral longitudinal anasto- reported findings on anatomical variations mosis running parallel with the aorta, of in the celiac and the superior mesenteric which the two middle roots (11th and arteries. In Japan, the monograph of 12th) could normally disappear in Adachi (1928) represented the most com- future but the others could remain. The prehensive and most extensively illustra- first root became a stem of the celiac via ted reference insofar as the anatomical this anastomosis and the last root became variation of the celiac axis itself was con- the stem of the superior mesenteric. cerned (6 types, 28 groups). However, In accordance with Tandler's descrip- the variational pattern observed in the tion, Morita (1936) suggested that in cases present case was not shown in it. of the present abnormal type, the first root Cases as described here have been re- (10th ventral segmental artery) could form ported previously. They have numbered 18 a hepatogastric trunk fusing between the in all, as follows (see also Table 1) 2 cases left gastric and the common hepatic via by Rossi & Cova (1904), 1 case by Descomps the ventral longitudinal anastomosis, while the last root (13rd) could form a lienome- Table 1. Case reports of the lienomesen- senteric trunk fusing between the splenic teric trunk and the superior mesenteric via the se- condary ventral longitudinal anastomosis. Our case could thus be reasonably as signed to type IV" of Morita's classification (2 types, 15 forms) in his logical basis, to type IV of Michels' classification (7 types) and to type XVI of Sasaki's (1973) classification, supplementing Adachi's descriptions. Furthermore, other cases of variation in the branching of the celiac and the superior mesenteric arteries have been reported. By surveying the frequencies of such kinds of branching, the present authors compiled Table 2. 246 S. Kou, A. Takemura, T. Irifune and T. Irifune

Table 2. Frequencies of ramifications of the celiac and the superior mesenteric arteries in the present case

It should be added also that formation 13: 369-374, 1917. of an arcade between the dorsal pancrea- 8) Haller, A. : cited from Woodburne et tic and the pancreatica magna arteries, al., 1764. has not been mentioned by previous 9) Imakoshi, N. : Studies of the celiac artery. Studies from the Dept. of Anat., authors. Faculty of Med., Univ. of Kanazawa, 37 : We wish to express our thanks to Pro- 1-14, 1949. (in Japanese) fessor Y. Ohta and Assistant Professor 10) Ishii, T.: Ein abnormer Fall von Urs- T. Tokioka for their advice in the pre- prung und Astverteilung der A. lienalis. paration of this report. (abstract) Acta Anat. Nippon., 28: 89, 1953. (in Japanese) References 11) Ishizuka, M.: An anatomical and applied anatomical investigation concerning the 1) Adachi, B: Das Arteriensystem der arteries distributed to the abdominal Japaner. Bd. II, Maruzen, Kyoto, 1928 viscera. I. The coeliac artery. Med. J. 2) Araki, S.: Surgical evaluation of the Kagoshima Univ., 10: 693-703, 1958. (in variation in celiac and hepatic arteries Japanese) demonstrated by selective angiography. 12) Ishizuka, M.: Ibid. II. The superior me- Med. Bull. Fukuoka Univ. 5: 31-37, 1978. senteric artery. Med. J. Kagoshima Univ., (in Japanese) 10: 704-709, 1958. (in Japanese) 3) Aso, S.: Uber das Gefasssystem des 13) Kato, S. and S. Morita, : Corrosions- Rumpfes bei der japanischen FOten II. anatomical studies on the arterial system Das Arteriensystem. Acta Anat. Nippon of the Japanese fetus. VII. The branches 5: 41-77, 1933. (in Japanese) of the abdominal aorta. (abstract) . Acta 4) Bergmann, L.: 'Ober einige seltene Ano- Anat. Nippon., 49 : 79, 1974. (in Japanese) malien der A. coeliaca. Zeits. Anat. U. 14) Katsume, Y., M. Yoshizuka, K. Sasaki, Entw., Bd. 101, 525-533, 1933. A. Hirotsu, T. Ariyoshi and J. Saruwa- 5) Biihler, A.: Uber eine Anastomose zwis- tari : A very rare anomalous case of the chen den Stammen der Art. coeliaca splenic artery. J. Kur. M. A., 42: 286- und der Art. mesenterica superior. Gegen- 288, 1979. (in Japanese) baurs Morph. Jb. 32 : 185-188, 1904. 15) Michels, N.: Blood supply and anatomy 6) Descomps, P.: cited from Adachi, 1910. of the upper abdominal organs. Lip- 7) Eaton, B.: The coeliac axis. Anat. Rec., pincott., Philadelphia, 1955. A Case of the Splenic Artery 247

16) Morita, M.: Reports and conception of 21) Sasaki, T., C. Kido, and M. Kaneko : three anomalous cases on the celiac and The practice of the angiographical dia- the superior mesenteric arteries' area. gnosis of abdominal organs. IV. Blood Igaku Kenkyu (Acta Med.), 9: 159-172, supply of the abdominal organs. Ishiyaku, 1935. (in Japanese) Tokyo, 17-39, 1973. (in Japanese) 17) Ditto : Three cases with variations of the 22) Tandler, J.: Zur Entwickelungsgeschi- celiac artery. (supplement) Igaku Kenkyu chte der menschlicher Darmarterien. (Acta Med.), 10: 107-112, 1936. (in Anat. Hefte., 23 : 187-209, 1903. Japanese) 23) Ditto : Uber die Varietaten der Arteria 18) Nakamura, H., H. Uchida, C. Kuroda, H. coeliaca und deren Entwickelung. Anat. Yoshida, K. Tokunaga, H. Ohi, T. Sato, Hefte., 25 : 475-500, 1904. S. Hori and T. Kitatani : Accessory left 24) Testut, L.: cited from Woodburne et al., gastric artery arising from the left 1893. hepatic artery (angiographic study). Nipp. 25) Tsukamoto, N.: Studies on the arterial Act. Radiol., 39: 685-690, 1979. (in Ja- system in the abdominal cavity of the Ja- panese) panese. Acta Anat. Nippon., 2: 780-820k 19) Quain, R.: cited from Woodburne et al., 1929. (in Japanese) 1848. 26) Woodburne, R. and L. Olsen : The ar- 20) Rossi, G. and E. Cova : Studio morfologico teries of the pancreas. An at. Rec., 111: delle arterie dello stomaco. Arch. ital. 255-270, 1951. anat. e embriol., 3: 485-524, 566-657, 1904. 248 S. Kou, A. Takemura, T. Irifune and T. Irifune

Explanation of Figures

Plate I

Fig. 2 Anterior view. The general features of the present case are shown. The right half of the pancreas and the stomach were removed. Fig. 3. Superoanterior view. The hepatogastric and the lienomesenteric trunks arise from the anterior wall of the abdominal aorta. The former trunk finally bifurcates into the left gastric and the common hepatic arteries, and the latter gives rise to the splenic artery. Fig. 4. Close-up of Figure. 2. The dorsal pancreatic artery arises from the inferior wall of the common hepatic artery and gives off two branches distal to its origin ; the one from its medial wall forms an arcade by communicating with the branch of the pancreatica magna artery. Three pancreatic rami arise from this arcade. Fig. 5. The vicinity of the splenic hilus. The splenic artery sends off the superior polar branch and terminates into two in the hilus. The short gastric branches are four in number, com- prising three from the superior polar branch and the other from the superior terminal branch.

Key to Abbreviations

aa : abdominal aorta rge : right gastroepiploic artery ch : common hepatic artery rip : right inferior phrenic artery dp : dorsal pancreatic artery rsr : right suprarenal artery hg hepatogastric trunk sa : splenic artery lg : left gastric artery sg : short gastric branches lip : left inferior phrenic artery sm : superior mesenteric artery lm : lienomesenteric trunk sp : superior polar branch mc middle colic artery P: Pancreas pm : pancreatica magna artery S: Spleen 249

Plate I

S. Kou, et al.