Absence of the celiac trunk: Case report and review of the literature

Abstract

The authors report a rare variation of the absence of the celiac trunk in a Japanese cadaver, with the left gastric, splenic, common hepatic, and superior mesenteric arteries arising independently from the abdominal aorta in the routine dissection of a 95-year-old Japanese male cadaver. The incidence and developmental and clinical significance of this variation is discussed with a detailed review of the literature. Knowledge of such case has important clinical significance in an abdominal operation or invasive arterial procedure, that is, Appleby procedure and liver transplantation, laparoscopic surgery, and radiological procedures in the upper abdomen.

Variant Anatomy of the Celiac Trunk and its Branches

“…The usual pattern of classical trifurcation of CT into left gastric (LGA), splenic (SA) and common hepatic artery (CHA) is observed in 87.6% while incomplete division or bifurcation is seen in 12.2% of individuals, and very rarely complete absence of CT is seen in 0.2% of cases (Yi et al, 2008). Anatomical variations of CT and its branching pattern, especially the hepatic and left gastric arteries have been reported by many authors (Adachi, 1928;Hiatt et al, 1994;Munshi et al, 2006;Yi et al, 2008;Chen et al, 2009). …”

Absence of the celiac trunk in a rectal cancer patient: case report

“…[11] Furthermore, with the advance of interventional techniques for hepatic tumors and the increasing frequency of endovascular procedures and advanced hepatopancreatobiliary surgical procedures such as liver transplantation from the living donors accurate depiction of the CT and its branches has become more important. [5,7,8,11,12] The anatomical variations of CT have been studied in detailed and classified into six types for the first time in 1928 by Adachi. [13] However, not all variations of CT branching have been described in Adachi's classification.…”

Ring-shaped variation of the coeliac trunk branches

“…Common procedures that involve the left gastric and left hepatic artery include Appleby's procedure, which involves resection of pancreatic tumours and possible reconstruction of the hepatic artery [13]. Other procedures include liver transplantation, laparoscopic surgery, and vascular procedures for abdominal aortic aneurysms [14]. Hence, it is important for doctors to identify and precisely map any variations when interpreting radiological imaging [9,10].…”

“…Due to the high clinical significance of these branches many studies have documented the arterial variations of the major unpaired arteries that originate from the aorta. Some studies offer classifications with the types and frequency of these variations, in an effort to illustrate the extensive variety [1,3,[5][6][7][8]14]. In a review of the literature, on 2141 cadavers, 87.6% of coeliac trunks had the classical trifurcation, 12.2% presented an incomplete bifurcated coeliac trunk and in 0.2% was absent [14].…”

“…It seems there is a prevalence of Korean and Japanese populations presenting coeliac trunk variations more frequently than Caucasians [8]. In rare cases, the coeliac branches may arise independently from the anterior wall of the abdominal aorta [4,6,14]. Knowledge of such variations has important clinical significance especially in regards to certain abdominal, invasive arterial, and radiological procedures.…”