ABSTRACT
SUMMARY: The stomach receives a rich blood supply from five sets of arteries, all of which originate from the celiac trunk. During the dissection of a female cadaver that had been fixed with formalin, an atypical branching pattern was observed. An accessory left gastric artery was found to originate from the left hepatic artery and send small branches to the esophagus, cardia, and fundus of the stomach. However, there was no anastomosis between the lower accessory left gastric artery and the left gastric artery. This is a rare variant of the gastric artery that has not been previously described in detail. It is important to recognize this variation for safe and effective interventional diagnosis and treatment techniques if dealing with the liver or gastric arteries.
El estómago recibe un rico suministro de sangre de cinco conjuntos de arterias, todas las cuales se originan en el tronco celíaco. Durante la disección de un cadáver femenino que había sido fijado con formalina, se observó un patrón de ramificación atípico. Se encontró una arteria gástrica izquierda accesoria que se originaba en la arteria hepática izquierda y enviaba pequeñas ramas al esófago, el cardias y el fondo del estómago. Sin embargo, no hubo anastomosis entre la arteria gástrica izquierda accesoria inferior y la arteria gástrica izquierda. Se trata de una variante rara de la arteria gástrica que no se ha descrito previamente en detalles. Es importante reconocer esta variación para la aplicación de técnicas de diagnóstico y tratamiento intervencionistas seguras y efectivas a nivel del hígado o las arterias gástricas.
Subject(s)
Humans , Female , Aged , Anatomic Variation , Gastric Artery/anatomy & histology , CadaverABSTRACT
Objective:To investigate the histopathological and immunohistochemical changes of gastric fundus and duodenum after bariatric embolization of left gastric artery and gastroduodenal artery in obesity New Zealand rabbit models.Methods:Twenty obesity New Zealand rabbit models were successfully established and divided into two groups using stratified randomization. Left gastric artery and gastroduodenal artery were embolized with gelatin sponge (350-560 μm) in experimental group, left gastric artery and gastroduodenal artery were perfused with normal saline in control group. All animals were sacrificed for pathological, immunohistochemical examination and Western Blot analysis 4 weeks post embolization, the density of ghrelin producing cells and the gray ratio of ghrelin protein band were measured and compared by the independent sample t test. Results:Macropathological examination showed ulceration in the anterior wall of the gastric body in one rabbit, histopathological examination showed mucosa ulceration in the gastric body in 3 rabbits in experimental group. Immunohistochemical examination showed that the ghrelin producing cells of gastric fundus and duodenum in the experimental group were significantly less than those in the control group (10.0±5.1 vs.27.7±3.4, t=12.35, P<0.05;5.6±2.6 vs. 12.3±2.1, t=4.73, P<0.05). Western Blot analysis showed that the gray ratio of ghrelin bands of gastric fundus and duodenum in the experimental group were significantly lower than that in the control group (0.65±0.05 vs.1.12±0.09, t=9.62, P<0.05;0.55±0.03 vs. 0.94±0.08, t=7.98, P<0.05). Conclusions:Immunohistochemical and Western Blot analysis showed that the ghrelin-producing cells of gastric fundus and duodenum in the experimental group were significantly less than those in the control group after bariatric embolization, histopathologic analysis indicated that bariatric embolization was a safe technique.
ABSTRACT
RESUMEN: El tronco celíaco (TC) es la rama de la arteria aorta abdominal (AA) que aporta la irrigación a la porción distal del esófago, parte media del duodeno, al estómago, páncreas, bazo y suple adicionalmente al hígado; sus diferentes expresiones anatómicas son reportadas en los diferentes grupos poblacionales con incidencia variable. Se evaluó las características morfológicas del TC y sus ramas en 26 bloques del piso supramesocólico de cadáveres masculinos adultos no reclamados, del grupo poblacional mestizo, a quienes se les practico autopsia en el Instituto de Medicina Legal de Bucaramanga - Colombia. Se observo el tipo I del TC en 23 especímenes (88,4 %), del cual correspondió 16 muestras (61,5 %). Al subtipo Ia con bifurcación y formación de tronco hepatoesplénico. Hubo un caso (3,8 %) en donde las ramas del T se originaron de manera independiente de la AA. El TC presentó una longitud promedio de 18,6 DE 7,53 mm y un diámetro externo de 7 DE 1,24 mm. De las ramas del TC, la AE presentó un diámetro promedio de 5,89 DE 1,04 mm sin diferencias estadísticamente significativa con relación al diámetro de la AHC, pero si con relación al diámetro de la AGI (P= 0,70; p<0,001 respectivamente). La gran mayoría de la muestra avaluada muestra la presencia de tronco hepatoesplénico seguido de la trifurcación en una verdadera configuración de trípode. El conocimiento de los patrones de ramificación del TC debe ser tomado en cuenta por cirujanos gastroenterólogos, radiólogos intervencionistas y oncólogos para evitar complicaciones durante los procedimientos quirúrgicos abdominales.
SUMMARY: The celiac trunk (CT) is the branch of the abdominal aorta artery (AA) that provides irrigation to the distal portion of the esophagus, the middle part of the duodenum, the stomach, pancreas, spleen and additionally supplies the liver; its different anatomical expressions are reported in the different population groups with variable incidence. The morphological characteristics of the CT and its branches were evaluated in 26 blocks of the supramesocolic floor of unclaimed adult male corpses, of the mestizo population group, who were autopsied at the Institute of Legal Medicine of Bucaramanga - Colombia. Type I CT was observed in 23 specimens (88.4 %), of which 16 samples (61.5 %) corresponded. to subtype Ia with bifurcation and formation of the hepatosplenic trunk. There was one case (3.8 %) in which the branches of the CT originated independently of the AA. The CT had an average length of 18.6 SD 7.53 mm and an external diameter of 7 SD 1.24 mm. Of the CT branches, the splenic artery presented an average diameter of 5.89 SD 1.04 mm without statistically significant differences in relation to the diameter of the AHC, but if in relation to the diameter of the IGA (P = 0.70; p <0.001 respectively). The vast majority of the sample evaluated shows the presence of a hepatosplenic trunk followed by trifurcation in a true tripod configuration. Knowledge of CT branching patterns should be taken into account by gastroenterological surgeons, interventional radiologists, and oncologists to avoid complications during abdominal surgical procedures.
Subject(s)
Humans , Male , Adult , Celiac Artery/anatomy & histology , Splenic Artery/anatomy & histology , Cadaver , Cross-Sectional Studies , Colombia , Anatomic Variation , Gastric Artery/anatomy & histology , Hepatic Artery/anatomy & histologyABSTRACT
During routine dissection of abdomen an accessory leftgastric artery was found arising from the splenic arteryin one out of 30 adult formalin fixed cadavers in theDepartment of Anatomy, Kasturba Medical CollegeManipal. The origin of left gastric artery was normal.The accessory artery was running upwards behind usualleft gastric artery and run along lesser curvature of thestomach and also gave oesophageal branch supplyingthe lower part of esophagus. Before attempting anysurgical procedure on stomach or lower end ofoesophagus, preoperative evaluation of the arterialpattern and variations is desirable for correct surgicalapproach and to reduce postoperative complications.However, accessory left gastric origin from splenicartery becomes important to be noted when the patientundergoes angiography for diagnostic bleeding orduring trans catheter therapy. Knowledge about thesevariations is also important to be noted prior to surgeryin order to prevent postoperative complications whichwould be fatal.
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Objective To explore the types of variations in the origin of left gastric artery (LGA) using MSCT angiography.Methods The abdominal MSCT angiography data of 1 500 patients were respectively reviewed,in thoses the abdominal aorta,celiac trunk,LGA,common hepatic artery (CHA),splenic artery (SA) and superior mesenteric artery (SMA)were shown clearly.The origins of the LGA and related artries were focused.A new typing method (types Ⅰ-Ⅹ) was established.And the incidence of various types was calculated.Results The normal anatomical origin (type Ⅰ) of LGAwas noted in 1 342 cases (1 342/1 500,89.47％).Eight types of LGA variant origin were identified in 70 cases (70/1 500,4.67％).LGA variant origin combined with celiomesenteric trunk (CMT) were observed in 47 cases (47/1 500,3.13％).The most common type of LGA origin variation was LGA originated from the abdominal aorta combined with CMT (type Ⅴ) which was found in 24 cases (24/1 500,1.60％).And the least common type was the namely LGA,SA,CHA and SMA arose independently from abdominal aorta (type Ⅵ) which was found in 3 cases (3/1 500,0.20 ％).LGA originated from SMA (type Ⅷ) was not found in all 1 500 cases.Conclusion There are many kinds of variations in the origin of LGA.The new typing method can contribute the comprehensive and intensive data for understanding the anatomical and radiographic features.
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Objective To explore the types of variations in the origin of left gastric artery (LGA) using MSCT angiography.Methods The abdominal MSCT angiography data of 1 500 patients were respectively reviewed,in thoses the abdominal aorta,celiac trunk,LGA,common hepatic artery (CHA),splenic artery (SA) and superior mesenteric artery (SMA)were shown clearly.The origins of the LGA and related artries were focused.A new typing method (types Ⅰ-Ⅹ) was established.And the incidence of various types was calculated.Results The normal anatomical origin (type Ⅰ) of LGAwas noted in 1 342 cases (1 342/1 500,89.47％).Eight types of LGA variant origin were identified in 70 cases (70/1 500,4.67％).LGA variant origin combined with celiomesenteric trunk (CMT) were observed in 47 cases (47/1 500,3.13％).The most common type of LGA origin variation was LGA originated from the abdominal aorta combined with CMT (type Ⅴ) which was found in 24 cases (24/1 500,1.60％).And the least common type was the namely LGA,SA,CHA and SMA arose independently from abdominal aorta (type Ⅵ) which was found in 3 cases (3/1 500,0.20 ％).LGA originated from SMA (type Ⅷ) was not found in all 1 500 cases.Conclusion There are many kinds of variations in the origin of LGA.The new typing method can contribute the comprehensive and intensive data for understanding the anatomical and radiographic features.
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Anatomical knowledge of the coeliac trunk and its branches is indispensable for surgeons in order to avoid post-surgery complications and malpractice and that’s what inspired us to review this important topic. The coeliac trunk is the first ventral branch of arising from the abdominal aorta below the aortic opening of diaphragm. It is responsible for the blood supply of the not only the foregut but also for accessory organs of gastrointestinal tract (GIT) which include liver, pancreas and biliary apparatus [1]. Anatomic variations are often responsible for a variety of clinical conditions and it’s often occurring in the coeliac trunk branches.
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Gastrointestinal autonomic nerve tumors (GANT) are uncommon stromal tumors of the intestinal tract. Their histological appearance is similar to that of other gastrointestinal stromal tumors. We report probably the first laparoscopic excision of this rare tumor from our geographical region and compare our findings with the available case reports in the medical literature. A 38 year old male patient undergoing a routine health check was diagnosed with an exophytic growth on the lesser curvature of stomach on computerized tomography and underwent an initial endoscopic biopsy which was inconclusive. He underwent a laparoscopic sleeve excision of the GANT on the lesser curvature. Radical surgical resection of gastrointestinal autonomic nerve tumors seems to be the only available curative approach and survival seems possible even in large tumors.
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Here we present a unique case of variation in the branching pattern of the coeliac trunk. In the present case, the coeliac trunk was replaced by two separate arterial trunks. The first arterial trunk bifurcated into the left gastric and the left hepatic arteries. The second arterial trunk bifurcated into a splenic artery and a hepato-gastroduodenal trunk. The hepato-gastroduodenal trunk presented an unusual course and termination. The right hepatic artery arising from the hepato-gastroduodenal trunk also showed a variant course. Such rare variations are important for gastroenterological surgeons and interventional radiologists due to increase in number of transplantation surgeries and live donor liver transplantations.
Subject(s)
Humans , Hepatic Artery , Liver Transplantation , Portal Vein , Splenic Artery , Tissue DonorsABSTRACT
Background: The coeliac trunk is an integral part of the circulatory system as it delivers blood from the heart to major organs within the abdominal cavity. The blood that it delivers is oxygenated and carries essential nutrients and immune system particles that can aid in life sustaining processes and can also prevent the development of diseases and complications from illnesses. Aims & Objective: (1) To study the anatomy of coeliac trunk, through its diameter, length related to their branches and distance from superior mesenteric artery. (2) To study the clinical implication of coeliac trunk in case of the variations and anomalous formation of coeliac trunk. Material and Methods: Morphology of coeliac trunk was studied in 100 formalin embalmed cadaver, aged between 50 to 80 years. Dissection method was use for this study. Results: Measurement of the length of the coeliac trunk up to the left gastric, Measurement of the length of coeliac trunk up to common hepatic and/or splenic artery, Measurement of coeliac trunk diameter, Distance between coeliac trunk and the superior mesenteric artery were taken. Conclusion: Knowledge of variations concerning the coeliac trunk is of extreme clinical importance in the areas of the laparoscopic surgery, and radiological procedures in the upper abdomen, and should be kept in mind by clinicians to avoid complications.
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Percutaneous endoscopic gastrostomy (PEG) is an effective method for delivering enteral nutrition to patients with dysphagia, cerebrovascular accidents, Parkinsonnism, dementia, and head and neck cancer. PEG is generally regarded as safe and it is associated with low risks of morbidity and mortality. The complications of the PEG are known to be mostly minor and they include wound infection, gastric leakage, bleeding, ileus, pneumoperitoneum and aspiration pneumonia. We recently experienced a ruptured pseudoaneurysm of the left gastric artery, which was occurred as a complication during PEG insertion in a 73-year-old female. To the best of our knowledge, this is the first case report in Korea about successful angiographic embolization for a ruptured pseudoaneurysm of the left gastric artery and this was associated with a PEG procedure.
Subject(s)
Aged , Female , Humans , Aneurysm, False , Arteries , Deglutition Disorders , Dementia , Enteral Nutrition , Gastrostomy , Head and Neck Neoplasms , Hemorrhage , Ileus , Korea , Pneumonia, Aspiration , Pneumoperitoneum , Stroke , Wound InfectionABSTRACT
Usually in the subtotal gastrectomy, the left and the right gastric arteries, as well as the left and the right gastroepiploic arteries are ligated. Thus, to avoid a blue stomach surgeons preserve the spleen and the short gastric arteries. When a radical subtotal gastrectomy with splenectomy is performed, meticulous caution is necessary; otherwise, the subtotal gastrectomy might have to be changed to a total gastrectomy to prevent a blue stomach. We report the case of a 67-year-old woman who had distal stomach cancer with a splenic solitary mass, for which splenic meatastasis could be excluded. We planned and performed a laparoscopy-assisted radical subtotal gastrectomy with splenectomy as the diagnostic and therapeutic option. In this case, to avoid a remnant stomach infarction or total gastrectomy we saved the left gastric artery and vein with clearing perivascular soft tissue, lymphatics, and lymph nodes. Thus the radical therapeutic goal was reached, and serious complications were avoided.
Subject(s)
Aged , Female , Humans , Arteries , Gastrectomy , Gastric Stump , Gastroepiploic Artery , Infarction , Lymph Nodes , Spleen , Splenectomy , Stomach Neoplasms , Stomach , VeinsABSTRACT
The bronchopulmonary sequestration is a region of lung parenchyma that has an incomplete or no connection with the airways and is supplied by an aberrant artery arising from the aorta or one of its branches. The anatomy of supplied artery is very important during operation. We present a case of pulmonary sequestration supplied with left gastric artery. The patient was 61 years old male and had hemoptysis. The left lower lung was cystic bronchiectasis and a few air-fluid level on chest CT. Also, in aortogram, arterial supply was from left gastric artery of abdominal aorta branches. Left lower lobectomy and abnormal arterial ligation was done.
Subject(s)
Humans , Male , Middle Aged , Aorta , Aorta, Abdominal , Arteries , Bronchiectasis , Bronchopulmonary Sequestration , Hemoptysis , Ligation , Lung , Tomography, X-Ray ComputedABSTRACT
Splanchnic artery aneurysms, previously thought to be rare, are being diagnosed with incresed frequency because of development of noninvasive imaging techniques. The pathogenesis of visceral aneurysms is varied and may be secondary to arteriosclerosis (30%), trauma (25%), inflammation (11%), gestational alteration, surgery, infection, medial necrosis, collagen vascular disease, arteritis, and congenital anomalies. Clinical manifestation of visceral artery aneurysms is vague and not specific. The diagnosis and treatment for them are difficult. Preoperative arteriography may be helpful in emergency situation to detect the aneurysm and visualize multiple aneurysms. Surgical ligation, resection and/or reconstructive surgery are first choice of treatment for them. Otherwise, transarterial embolization has also been reported for them recently. We report a case of hemoperitoneum due to left gastric artery aneurysmal rupture and a rare complication of splanchnic artery aneurysm "Double rupture". The patient was treated successfully with simple ligation of the ruptured vessel.
Subject(s)
Humans , Aneurysm , Angiography , Arteries , Arteriosclerosis , Arteritis , Collagen , Diagnosis , Emergencies , Hemoperitoneum , Inflammation , Ligation , Necrosis , Rupture , Vascular DiseasesABSTRACT
Objective To offer the theoretical evidence for clinical application,we observed the changes of angiographic appearances and local pathological changes before and after embolizing the left gastric artery with mitomycin C gelatin microspheres (MMC-MS).Methods Catheter was delivered into the left gastric arteries via femoral artery and then infused MMC-MS.The angiographic appearances and local pathological changes were observed immediately,and then with follow up of 6～8h,24h,72h,1w,2w and 4w. Results The minute arterioles of tunia mucosa and tela submucosa were mainly embolized inducing edema and focal necrosis.With the degradation of MMC-MS,the damage of gastric tissue was alleviated but turned normal after 4 weeks.The results of DSA showed that no recanalization of the embolized vessels occurred after one week of emboliatdion but revealed one recanalization after two weeks and two in four weeks.Conclusions The damage of tissue induced by embolizing the left gastric artery with MMC-MS can be recovered.The application of the MMC-MS is feasible.