Unusual Variation in the Branching Pattern of the Celiac Trunk and Its Embryological and Clinical Perspective

Branching pattern variations of the celiac trunk and superior mesenteric artery in a 72-year-old white female cadaver

“…The persistence of the ventral longitudinal anastomoses connecting the ventral segmental arteries destined to become the CT, the SMA, or the IMA reasonably explains the occurrence of the LHA as a branch of the CT and RHA as a branch of the SMA [1,3,4,9]. Other factors that may contribute to abdominal vascular variations include the midgut rotation, physiological herniation, migration of the spleen leftward, and hemodynamic changes in the abdominal viscera [9].…”

“…Thus, alterations both in fusion and regression result in branching variation of the three major abdominal aortic branches. In addition, because their embryonic origins are closely related, persistence of interconnections or overlapping of the territories of the CT, SMA, and IMA are common [3,4,[8][9][10][11][12][13][14]18,30,31,34,[36][37][38].…”

“…The CT normally originates as the first ventral branch, supplying the foregut (i.e. the stomach, spleen, pancreas, liver, and part of the duodenum) [3,4,7,9,10,12,14,16,18,[24][25][26]33,34,[39][40][41][42]. Venous drainage of the foregut is principally through the portal vein (PV).…”

“…The CT, also known as the coelic artery, coelic axis or truncus coeliakus, usually arises just below the aortic hiatus at the level of the intervertebral disc between the T12 and L1 vertebrae. The CT is normally 1.5 to 2.3 cm long, and its trunk traverses horizontally forward, trifurcating into the LGA, CHA, and SA (55-100% of the population) [1,3,4,[6][7][8][9][10]12,14,16,18,[23][24][25][26]28,29,33,34,[39][40][41][42][43][44]. This trifurcation was first described by Haller in 1756 as tripus Halleri [7,8,18,21,22,24,28,30,35,45,46].…”

“…In addition to an extensive literature on origin variation, there is a substantial literature pertaining to branching pattern variation of the CT. To identify a vessel as a CT, two of the three major branches must be present ( [45]. These branch variations include: GDA (3.61%, 3.3%, 0.2%, 1.7% of cases) [20,30,49] inferior phrenic arteries (13%, 28.2%, 30-51%) [32] left or right middle suprarenal artery (3.3%) [54] left superior suprarenal artery [3] left middle suprarenal artery [3] dorsal pancreatic artery [9] RHA [4] accessory hepatic artery and retroportal artery [55] MCA (1.2-4.8%) [42]. Generally, these branch variations manifest in place of or in addition to the usual branches of LGA, CHA, and SA, and are known as replaced (aberrant) or accessory [3].…”