Unusual development of the celiac trunk and its clinical significance / Desenvolvimento incomum do tronco celíaco e sua importância clínica

Abstract We describe a case of unusual development of the celiac trunk observed in the cadaver of 1-year old male child. The celiac trunk branched into five vessels: the splenic, common hepatic and left gastric arteries, the left inferior diaphragmatic artery, and a short trunk that branched into the right inferior diaphragmatic artery and right accessory hepatic artery. Additionally, the manner of branching of the vessel was unusual: it was possible to distinguish two branching points that corresponded to its s-shaped trajectory. There were also other variations of vascular supply, such as the presence of a left accessory hepatic artery, an additional superior pancreatoduodenal artery, and others. It should be noted that multiple developmental variations can be common in clinical practice and clinicians should be aware of them during diagnostic and interventional procedures.

Resumo Apresentamos um relato de caso de desenvolvimento incomum do tronco celíaco em um cadáver do sexo masculino de 1 ano de idade. O tronco celíaco ramificou-se para cinco vasos: as artérias esplênica, hepática comum e gástrica esquerda, a artéria diafragmática inferior esquerda e um tronco pequeno que se ramificou para a artéria diafragmática inferior direita e para a artéria hepática direita acessória. Além disso, a forma como o vaso se ramificou foi incomum: é possível distinguir dois pontos de ramificação que correspondem à trajetória em formato de S. Também houve outras variações do suprimento vascular, como a presença da artéria hepática esquerda acessória, da artéria pancreaticoduodenal superior acessória e outras. Cabe observar que a variação de desenvolvimento múltipla pode ser comum na prática clínica, e os médicos devem estar cientes dela durante os procedimentos de diagnóstico e intervenção.

Origin of accessory left hepatic artery from left gastric artery.

Liver is supplied by the branches of celiac trunk. Common hepatic artery which is a branch of celiac trunk continues as proper hepatic artery after giving gastroduodenal artery. Proper hepatic artery enters the liver at Porta hepatis after diving into right and left hepatic artery. The knowledge of branching patterns of arteries and their variations is important in various surgical and radiological procedures. During routine dissection conducted in the Department of Anatomy, MMC&RI, Mysore, an accessory left hepatic artery was seen arising from left gastric artery in an elderly male cadaver aged around 60 years. An accessory left hepatic artery was arising from left gastric artery and was entering the left lobe of liver. In less than 1% of cases, the accessory left hepatic artery supplies the part of left lobe of liver or whole liver. Knowledge of anomalous origin of left hepatic artery is important for successful liver transplant surgeries, hepatobiliary operations, gastrectomies, hiatal surgery for gastro esophageal reflex, bariatric surgeries and in selective arterial chemotherapy for liver cancers. Ligation or laceration of this artery during surgeries causes fatal ischemic necrosis of left lobe of liver.