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From the Left Side of the Anterolateral Wall of the Abdominal Aorta. The THE URUME MEDICAL JOURNAL Vol. 43, p. 181-184, 1996 SHORT COMMUNICATION An Anomalous Case of the Gastro-splenic and the Hepato-mesenteric Trunks Independently Arising from the Abdominal Aorta HIROSHI HARADA, KOH-ICHI YAMAKI, YOSHIAKI DOI, TSUYOSHI SAGA, TAKAHIKO SANNOMIYA, MANABU IC IGATANI AN MITSUAKI YOSHIZUKA Department of Anatomy, Kurume University School of Medicine, Kurume 880, and *Department of Anatomy, University of Occupational and Environmental Health, School of Medicine, Kitakyushu 807, Japan Received for publication March 15, 1996 Key words: human anatomy, artery, anomaly, gastro-splenic trunk, hepato- mesenteric trunk During the gross anatomy course at from the left side of the anterolateral Kurume University School of Medicine wall of the abdominal aorta. The exter- in 1995, an arterial anomaly in the nal diameter of this arterial trunk was celiaco-mesenteric region was found in approximately 4.40 mm at its origin. It an 82-year-old Japanese male cadaver. In ran inferolaterally for approximately this case, the usual celiac trunk was not 7.65 mm and divided into the left gastric identified, and the gastro-splenic and the artery (approximately 2.40 mm in external hepato-mesenteric trunks originated diameter at its origin) and the splenic independently from the abdominal aorta. artery (approximately 4.20 mm in external The left gastric and the splenic arteries diameter at its origin). arose from the gastro-splenic trunk, The hepato-mesenteric trunk arose while the common hepatic and the from the anterior wall of the abdominal superior mesenteric arteries arose from aorta at the level of the first lumbar the hepato-mesenteric trunk. In addition, vertebra, which was approximately a relatively large communicating branch 2.75 mm distal to the origin of the gastro- connected the splenic and the superior splenic trunk. The external diameter of mesenteric arteries. the hepato-mesenteric trunk was approx- A photograph of these arteries is imately 9.50 mm at its origin. It ran shown in Fig. 1 and a schematic illustra- anteriorly for approximately 10.65 mm and tion in Fig. 2. divided into the common hepatic artery The abdominal aorta followed a (approximately 5.25 mm in external diam- fundamentally normal course. eter at its origin) and the superior mesen- At the level of the twelfth thoracic teric artery (approximately 9.20 mm in vertebra, the gastro-splenic trunk arose external diameter at its origin). Correspondence to: M. Yoshizuka, MD., Department of Anatomy, Kurume University School of Medicine, Kurume 830, Japan. Tel: 0942-31-7540, 0942-35-3311 (EXT: 3135) Fax: 0942-33-3233 181 182 HARADA ET AL. Fig. 1. A photograph showing a general view of the present case. The gastro-splenic and the hepato-mesenteric trunks arise independently from the abdominal aorta. An aberrant communicating branch connects the splenic and the superior mesenteric arteries. Moreover, an aberrant communicating Fig. 2. A diagram of the vessels shown branch between the splenic artery and in Fig. 1. the superior mesenteric artery was Abbreviations: found in this case. The dorsal pancreatic AA: abdominal aorta; ab: anterior branch of artery arose from the splenic artery IPDA; CB: communicating branch; CHA: approximately 5.96 mm distal to its origin common hepatic artery; DPA: dorsal pan- as the first branch of this artery, passed creatic artery; GST: gastro-splenic trunk; behind the neck of the pancreas and HMT: hepato-mesenteric trunk; IPDA: divided into the right and the left inferior pancreaticoduodenal artery; lb: left branches. The left branch ran down- branch of DPA; LGA: left gastric artery; pb: wards and turned to the right, passed posterior branch of IPDA; rb: right branch of DPA; SA: splenic artery; SMA: superior between the neck of the pancreas and mesenteric artery the abdominal aorta and anastomosed with the posterior branch of the inferior pancreaticoduodenal artery at the infe- mately 1.80 mm and the length was rior border of the neck of the pancreas. 21.18 mm. The inferior pancreaticoduodenal artery In 1904, Tandler proposed the fol- arose from the first jejunal branch of the lowing hypothesis with regard to the superior mesenteric artery approximately morphogenesis of the celiac trunk and the 17.81 mm distal to the origin of the superior mesenteric artery. He stated that superior mesenteric artery and divided 4 primitive ventral splanchnic branches into an anterior and a posterior branch arise from the abdominal aorta in early near the inferior border of the neck of human embryos, and then these branches the pancreas. The external diameter of are connected to the ventral longitudinal this communicating branch was approxi- anastomotic channels. Retention or dis- SHORT COMMUNICATION 183 appearance of parts of this primitive anastomotic channels between the splenic arterial plexus could give rise to numer- artery and the common hepatic artery, ous anomalous variations of the celiac and by independent origin of the gastro- trunk and the superior mesenteric splenic and the hepato-mesenteric trunks. artery. Based on Tandler's description, Knowledge of the distribution of the Morita (1935) classified the variational celiac and the superior mesenteric pattern of these arteries, and suggested arteries is essential for medical practice. 5 types and 15 forms (Fig. 3). According Therefore, numerous reports of vascular to this classification, the present case variations in this region have been belongs to TypelV. Previously, Adachi published. However, the anomaly of the (1928) also classified the distribution gastro-splenic and the hepato-mesen- pattern of this region and proposed 6 teric trunks independently arising from types with 28 groups. According to the abdominal aorta as in the present Adachi's classification, the present case case is relatively rare. Estimated fre- belongs to Type 5, group 23. This case quency was between 0.0% (Eaton, 1917), might be caused by absence or 0.4% (Adachi, 1928), 2.0% (Yamahira, disappearance of part of the longitudinal 1993), 3.0% (Lippert and Pabst, 1985) Fig. 3. Diagrams showing a variety of patterns of origin of the celiac trunk and of the superior mesenteric artery, based on Morita's classification (1935) (Higashi and Sone, 1986). T.C. : Typus coeliacus; T. M. : Typus coeliaco-mesentericus 184 HARADA ET AL. and 6.4% (Van Damme and Bonte, 1990). Eaton PB. The coeliac axis. Anat Rec 1917; In addition, a relatively large com- 13:369-374. municating branch between the splenic Higashi N, and Sone C. Two anomalous cases of artery and the superior mesenteric Truncus celiacus. Acta Anat Nippon 1986; artery was found in the present case. 61:709-715. (in Japanese) Lippert H, and Pabst, R. Arterial variations in Usually, the neck of the pancreas is man: Classification and frequency. Bergmann supplied by the dorsal pancreatic artery Verlag, Miinchen, 1985. arising from the splenic artery and by Morita M. Reports and conception of three the inferior pancreaticoduodenal artery anomalous cases in the area of the coeliac arising from the superior mesenteric and the superior mesenteric arteries. Igaku artery. In this case, the aberrant com- Kenkyu (Acta Medica) 1935; 9:159-172. (in municating branch might unite the left Japanese) branch of the dorsal pancreatic artery Tandler J. Uber die Varietaten der Arteria and the posterior branch of the inferior coeliaca and deren Entwickelung. Anat Hefte 1904; 25:473-500. pancreaticoduodenal artery, which arises Van Damme JP, and Bonte J. Vascular anatomy from the first jejunal branch of the in abdominal surgery. Thieme, Stuttgart-New superior mesenteric artery. York, 1990. Yamahira T. Anatomical and statistical study on the branches of the celiac trunk. Acta Sch References Med Univ Gifu 1993; 41:43-71. (in Japanese) Adachi B. Das Arteriensystem der Japaner. Bd 1. Die Kaiserlich Japanische Universitat zu Kyoto, Kyoto, 1928..
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