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Origin of the Celiac and Superior Mesenteric Arteries in a Common Trunk

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Origin of the Celiac and Superior Mesenteric Arteries in a Common Trunk Origin of the celiac andOkajimas superior mesentericFolia Anat. arteries Jpn., 91 in(2): a common 45–48, August, trunk 201445 (Case Report) Origin of the Celiac and Superior Mesenteric Arteries in a Common Trunk – Description of a Rare Vessel Variation of the Celiacomesenteric Trunk with a Literature Review By Jun YAN1, Yoshie NAGASAWA1, 2, Masato NAKANO1, and Jiro HITOMI1 1Department of Anatomy, School of Medicine, Iwate Medical University, Iwate, Japan 2JoSai University, Tokyo, Japan –Received for Publication, August 25, 2014– Key Words: Celiac artery, Superior mesenteric artery, Celiacomesenteric trunk, Blood supply variation, Human Summary: A variation artery was observed in a Japanese cadaver. The celiac and superior mesenteric arteries arose from a common trunk (also referred to as the celiacomesenteric trunk), but not from the abdominal aorta, respectively. From the common trunk, the common hepatic artery was distributed in the right part of the liver, and the left hepatic artery arose from the left gastric artery, which also arose from the common trunk. The left inferior phrenic artery arose from the common trunk, but the right inferior phrenic artery arose from the right middle suprarenal artery. This information regarding the branch pattern in this variation artery is useful for clinical examination and treatment. Introduction years old; cause of death: acute respiratory failure). After opening the thoracic and abdominal cavity, the In the anatomy textbooks that are commonly used, main abdominal organs (digestive tract from the esoph- the celiac and superior mesenteric arteries arise from agus to descending colon, liver, and pancreas with spleen) the abdominal aorta1–5). However, variations in the were removed. First, the esophagus was cut at the collat- blood supply of the supramesocolonic organs have eral vagus nerve in the lower 1/3; then, the inferior vena been frequently reported6–15). With the development cava was cut at the low margin of the liver (cranial of the of imaging technology, such as computed tomography suprarenal vein). The descending colon was cut at the (CT), magnetic resonance imaging (MRI), and angiog- transition with the sigmoid colon. Finally, the celiac and raphy methods, information regarding vessel variation superior mesenteric arteries (generally, it did exist) were has become very important. In addition, understanding cut at the origin(s) from the abdominal aorta. This dissec- of vessel variation in the celiac and superior mesen- tion method is useful for the students to observe all of the teric arteries is also useful for the surgical treatment and vessels that are distributed on the main abdominal organs. clinical examination of the supramesocolonic organs16- 20). This report aimed at documenting vessel variation throughout the supramesocolonic organs to aid clinical Observations treatment and examination. As shown in Figures, there is only 1 origin of the celiac and superior mesenteric arteries from abdominal Material and Methods aorta. Of note, the branches in this case were as follows: 1) Celiacomesenteric trunk: The celiac and superior During the dissection course for medical students (42 mesenteric arteries arose with a common short trunk cadavers), a variation vessel supplying blood to suprame- from the abdominal aorta (Fig. 1 and 2). socolonic organs was observed in 1 cadaver (woman; 88 2) Left hepatic artery: The artery arose from the left Corresponding author: Jun Yan, Department of Anatomy, School of Medicine, Iwate Medical University, 2-1-1, Nishi-Tokuta, Yahaba-cho, Shiwa- Gun, Iwate, 028-3694, Japan. E-mail: [email protected] 46 J. Yan et al. Fig. 1. A: Sketch of the photo (B) to show the celiac and superior mesenteric artery arises from a common trunk (celiacomesenteric trunk). Note the blue arrow indicates the stump of the common trunk. The left inferior phrenic artery arises from the common trunk. Red arrow shows the left inferior phrenic vein pour into the left suprarenal vein. x: the stump of the left inferior phrenic artery and vein. B: The photo showing the stumps of the common trunk and left inferior phrenic artery and vein. gastric artery, with its origin in the celiacomesenteric 2. The typical pattern involves the left hepatic artery trunk (Fig. 2). arising from the proper hepatic artery5), but it can also 3) Common hepatic artery: The arterial branch, as a short arise from the common hepatic, left gastric, celiac, or trunk, arose from the celiacomesenteric trunk (Fig. 2). superior mesenteric artery6). This artery is important to The cystic, gastroduodenal, and right gastric arteries complete the excision of the celiac axis, when neces- arose from the arterial branch. sary16). The reported incidences are 11%23), 17.9%6), 4) Left and right inferior phrenic arteries: The left infe- 12.0%24), 3.60%25), and 16%26). rior phrenic artery arose from the beginning of the 3. The typical pattern involves the common hepatic celiacomesenteric trunk and anastomosed with the artery arising from the celiac artery5), but it can also right inferior phrenic artery. Then, after passing arise from the superior mesenteric artery, with a through the diaphragm, it anastomosed with the supe- reported incidence of 13%24). This artery has also been rior phrenic artery (Fig. 2). The right inferior phrenic named the medial hepatic artery because of the exis- artery arose from the right middle suprarenal artery, tence of left and right hepatic arteries16, 27). Hepatic but not the celiacomesenteric trunk (Fig. 2). artery variations originating from the superior mesen- teric artery present as 1 of 2 types: the pre-pancreas type and post-pancreas type, with the latter being the Discussion most common28). 4. The left and right inferior phrenic arteries can arise 1. Generally, the celiac and superior mesenteric arteries immediately below the diaphragm from the abdom- arise from the abdominal aorta5). However, this pattern inal aorta1-5); however, this pattern accounts for only varies considerably in humans6). The reported inci- 5.62% of cases29). The frequency of an independent dences of a celiacomesenteric trunk are 2.38% 7), origin of the 2 arteries on each side of the celiac artery 1.00%21), and 2.70% 22). The incidence in the present is 2.25%29). The 2 arteries can also arise from the aorta study was also 2.38% (1/42 bodies), although this or celiac artery as a common trunk30, 31). The reported incidence was based on fewer cases. incidences of the right inferior phrenic originating Origin of the celiac and superior mesenteric arteries in a common trunk 47 been previously described in the majority of reports. Conclusion Our findings regarding the variation of the celiac and superior mesenteric arteries (celiacomesenteric trunk) indicate the following: 1) the left gastric and common hepatic arteries arise from the celiacomesenteric trunk, and the left hepatic artery arises from the left gastric artery and 2) the left inferior phrenic artery arises from the celiacomesenteric trunk, but the right inferior phrenic artery arises from the right middle suprarenal artery. This information is useful for clinical treatment and examina- tion. References 1) Walls EW. The blood vascular and lymphatic system. In: Romanes GJ edt. Cunningham’s Textbook of Anatomy, 11th ed., Oxford University Press, London, 1972; 858–895. 2) Walls EW. The blood vascular and lymphatic system. In: Romanes GJ edt. Cunningham’s Textbook of Anatomy, 12th ed., Oxford University Press, New York, 1981; 893–935. 3) Gabella G. Cardiovascular system. In: Williams PL edt. Gray’s Anatomy, 38th ed., Churuchill Livingstone, New York, 1995; 1513–1545. 4) Healy J and Borley NR. Abdomen and pelvis. In: Standring S edt. Gray’s Anatomy, 39th ed., Churuchill Livingstone, Edinburgh, 2005; 1139–1188. 5) Borley NR. Abdomen and pelvis. In: Standring S edt. Gray’s Anatomy, 40th ed., Churuchill Livingstone, China, 2008; 1111– 1150. 6) Michels NA. Variations in the blood supply of the suprameseso- colonic organs. Journal of the International College of Surgeons 1949; 12:625–628. 7) Okada S, Ohta O, Shimizu T, Nakamura M and Yaso K. A rare Fig. 2. Sketch showing the main arterial branches of the common anomalous case of absence of the celiac trunk: the left gastric, the trunk. Note the left gastric and common hepatic arteries arise splenic and the common hepatic arteries arose from the abdominal from the common trunk, the left hepatic artery arises from the aorta independently. Okajimas Folia Anatomica Japonica 1983; left gastric artery, and the right and left inferior phrenic arteries 60:65–72. arise from different arterial branch(s) and anastomosed with the 8) Cavdar S, Sehirli U and Pekin B. Celiaomesenteric trunk. Clinical superior phrenic artery. Anatomy 1997; 10:231–234. 9) Saeed M and Rufai AA. Duplication of hepatic artery. The Saudi Journal of Gastroenterologu 2001; 7:103–108. 10) Song SY, Chung FW, Kwon FW, Foh FH, Shin SF, Kim HB and 32) 33) from the aorta are 57.90% and 38.00% and from Park FH. Collateral pathways in patients with celiac axis stenosis: the celiac artery are 42.10%32) and 40.00%33). The Angiographic- apiral CT correlation. RadioGraphics 2002; origin of the left inferior phrenic artery is from the 22:881–893. celiac artery in 47.00% of cases, the aorta in 45.00% 11) Koops A, Wojciechowski B, Broering DC, Adam G and Krupski of cases, the renal artery in 5.00% of cases, the left BG. Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surgical Radiolog- gastric artery in 2.00% of cases, and the hepatic artery ical Anatomy 2004; 26:239–244. in 1.00% of cases33). It has also been reported that 12) Gourley EJ and Gering SA. The meandering mesenteric artery: A the 2 arteries can arise from the left gastric (3.70%), historic review and surgical implications.
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