Absent celiac trunk and unusual arterial anatomy of the upper abdomen: into the deep.

The celiac trunk is the first major branch of the abdominal aorta. It originates from the ventral aspect of the aorta at the level of T12-L1 vertebrae and was originally described as an artery that branches into the common hepatic artery, left gastric artery, and splenic artery. Absence of the celiac trunk and origin of the three arteries separately from the aorta is a rare entity that is reported in 0.38% to 2.6% of cases. It is even more uncommon that this variation can be accompanied by other vascular variations of the upper abdomen as accessory arteries to the liver, stomach, and pancreas. These cases arise during embryogenesis due to decreased arterial degeneration combined with decreased arterial fusion, which results in the anatomical variations present in the current case. Complex arterial variations are both a risk for iatrogenic injury during surgical procedures and beneficial during endovascular supply as they may provide additional access for embolization and chemotherapy.

Spleen: an organ of multiple shapes

Introduction: The spleen is located in the upper part of the abdominal cavity. As an organ, the spleen can have various shapes and size. Material and methods: The human spleen was studied in 273 cadavers (154 men and 119 women) who did not have diseases of the spleen. The shape of the spleen was analyzed based on splenic index, Michels classification. Results: The most common shape of the spleen in men is the elongated one. It was encountered in 79 (51.3%) cases out of 154. In women, the most common shape was the intermediate. It was encountered in 51 (42.9%) of the 119 cases. Based on Michels classification the clinoid (wedge) shape was encountered in 102 (37.74%) cases, triangular in 59 (21.83%) and tetrahedral in 30 (11.1%). In 30.26% the shape of the spleen couldn’t be classified according to Michels classification. In 21 cases (7.77%) the spleen had a flat shape; in 27 (9.99%) – dome-shaped; in 1 case (0,37%) – Z-shape; in 18 (6.66%) – round shape; in 6 (2.22%) – irregular shape; in 2 (0.66%) - shape with a node in the hilum; in 1 (0,37%) – rhomboid shape, in 2 (0,74%) – bilobed shape and in 4 cases (1,48%) – lobular shape. The splenic fissures located on the upper edge of the organ were found in 81 (29.91%) cases, and also on the lower edge - in 41 (14.02%) cases. In 13 (4.67%) cases fissures were encountered on both sides. In 148 (51.4%) cases the spleen had no fissures on its surface. Conclusions: The spleen has various shapes beyond the classical wedge, triangular and tetrahedral. All of these shapes do not represent a pathological finding but in certain situation may require further analysis and interpretation depending on the imaging technique and experience of the physician. (AU)

Introducción: el bazo se localiza en la parte superior de la cavidad abdominal. Como órgano, el bazo puede tener varias formas y tamaños. Material y métodos: Se estudió el bazo humano en 273 cadáveres (154 hombres y 119 mujeres) que no tenían enfermedades del bazo. La forma del bazo se analizó con base en el índice esplénico, clasificación de Michels. Resultados: La forma más común del bazo en los hombres es la alargada. Se encontró en 79 (51,3%) casos de 154. En las mujeres, la forma más común fue la intermedia. Se encontró en 51 (42,9%) de los 119 casos. Según la clasificación de Michels, la forma clinoide (cuña) se encontró en 102 (37,74%) casos, triangular en 59 (21,83%) y tetraédrica en 30 (11,1%). En un 30,26%, la forma del bazo no se pudo clasificar según la clasificación de Michels. En 21 casos (7,77%) el bazo tenía forma plana; en 27 (9,99%) - en forma de cúpula; en 1 caso (0,37%) - forma de Z; en 18 (6,66%) - forma redonda; en 6 (2,22%) - forma irregular; en 2 (0,66%) - forma con un nodo en el hilio; en 1 (0,37%) - forma romboide, en 2 (0,74%) - forma bilobulada y en 4 casos (1,48%) - forma lobular. Las fisuras esplénicas ubicadas en el borde superior del órgano se encontraron en 81 (29,91%) casos, y también en el borde inferior, en 41 (14,02%) casos. En 13 (4,67%) casos se encontraron fisuras en ambos lados. En 148 (51,4%) casos el bazo no presentaba fisuras en su superficie. Conclusiones: El bazo tiene varias formas más allá de la clásica cuña, triangular y tetraédrica. Todas estas formas no representan un hallazgo patológico, pero en determinadas situaciones pueden requerir un mayor análisis e interpretación según la técnica de imagen y la experiencia del médico. (AU)