Hexafurcated coeliac trunks, trifurcated common hepatic artery, and a new variant of the arc of Bühler.

BACKGROUND: The coeliac trunk (CT) is well-known as trifurcated into the left gastric (LGA), common hepatic (CHA) and splenic (SA) arteries. MATERIALS AND METHODS: Scarce reports indicate that the CT could appear quadri-, penta-, hexa-, or even heptafurcated. Reports of CTs with six branches (hexafurcated CT) are few, less than ten. The hexafurcated CT variant was documented by a retrospective study of 93 computed tomography angiograms. RESULTS: Two hexafurcated CTs were found. In one case an arc of Bühler was added to the inferior phrenic arteries, LGA, CHA and SA. In the second case the dorsal pancreatic artery was added to the other five branches. That arc of Bühler descended in front of the aorta to connect with the origin of the third jejunal artery. The CHA in that second case was trifurcated into the left and right hepatic arteries, and the gastroduodenal artery; the proper hepatic artery was absent. CONCLUSIONS: Although the hexafurcated CT, as well as the trifurcated CHA, are rarely occurring and reported anatomic variants, this doesn't mean they could not be encountered during surgical or interventional procedures, which they would complicate if not recognised. Moreover, the arc of Bühler, the embryonic remnant, was not reported previously to insert into the CT as an additional branch of it.

An arc of Bühler variant.

The celiaco-mesenteric anastomoses occur either directly between the celiac trunk and the superior mesenteric artery (SMA), or between different branches of them. A rarely occurring such anastomosis is the arc of Bühler. A new variant of arc of Bühler was found incidentally during a retrospective study of the computed tomography angiograms of a 62 y.o. male patient. In that case, the arc of Bühler left from the splenic artery and inserted into the inferior pancreaticoduodenal artery (IPDA), proximally to the IPDA division into its anterior and posterior branches. Moreover, that arc of Bühler was giving off a mesenterico-jejunal branch, which descended applied on the anterior side of the SMA. Such anatomic variants could impede on the surgical or interventional procedures in the duodenopancreatic region, or could be physiologically useful to divert the celiac flow towards the mesenteric territory, or vice versa.

Hepatomesenteric trunk, gastrosplenic trunk, coiled splenic and hepatic arteries, and a variant of Bühler's arc.

The coeliac trunk is normally divided into the left gastric artery (LGA), splenic artery, and common hepatic artery (CHA). The combination between these arteries and the superior mesenteric artery (SMA) generates various combinations. We report here such a rare anatomic variant, namely the hepatomesenteric trunk (HMT), combined with a gastrosplenic trunk (GST). The variant was identified using computed tomography angiograms of a 62-year-old woman. The GST emerged from the aorta within the aortic hiatus of the diaphragm, a previously unknown possibility. Further, an accessory left hepatic artery originated from the LGA. The phrenic arteries had independent aortic origins. The HMT divided into the CHA and the SMA posterior to the origin of the hepatic portal vein (PV), above the pancreas. The CHA initially had a right course, towards the superior border of the PV, then it descended with a transpancreatic course posterior to the PV, reached its inferior/right border, and divided antero-inferiorly to the PV into the proper hepatic and gastroduodenal arteries. The proper hepatic artery continued on the anterior side of the PV, sending off the left and right hepatic arteries. The HMT and the GST were connected by a rudimentary variant of the arc of Bühler, unreported previously. Arterial variations in the coeliac region are accurately distinguished on computed tomography angiograms. They should be evaluated by surgeons when different surgical procedures are evaluated.

Novel anatomic variation: heptafurcation of the celiac trunk.

We report here anatomic variants which were found during a retrospective study of a male patient, 54 years old, evaluated in computed tomography: heptafurcation of the celiac trunk (CT) and bilateral double renal arteries. The seven branches of the heptafurcated CT were the (1) left and (2) right inferior phrenic arteries, the (3) splenic and (4) left gastric artery, the (5) common hepatic artery, further sending off the (a) proper, continued as left, hepatic artery and (b) the gastroduodenal artery, (6) a replaced right hepatic artery and (7) the dorsal pancreatic artery. To our knowledge, heptafurcation of the CT was not reported previously. The arterial variants have great importance during various surgical and interventional procedures and should be documented prior to respective procedures.