45Origin of the celiac and superior mesenteric arteries in a common trunk

Introduction

In the anatomy textbooks that are commonly used, the celiac and superior mesenteric arteries arise from the abdominal aorta1–5). However, variations in the blood supply of the supramesocolonic organs have been frequently reported6–15). With the development of imaging technology, such as computed tomography (CT), magnetic resonance imaging (MRI), and angiog-raphy methods, information regarding vessel variation has become very important. In addition, understanding of vessel variation in the celiac and superior mesen-teric arteries is also useful for the surgical treatment and clinical examination of the supramesocolonic organs16-

20). This report aimed at documenting vessel variation throughout the supramesocolonic organs to aid clinical treatment and examination.

Material and Methods

During the dissection course for medical students (42 cadavers), a variation vessel supplying blood to suprame-socolonic organs was observed in 1 cadaver (woman; 88

years old; cause of death: acute respiratory failure). After opening the thoracic and abdominal cavity, the

main abdominal organs (digestive tract from the esoph-agus to descending colon, liver, and pancreas with spleen) were removed. First, the esophagus was cut at the collat-eral vagus nerve in the lower 1/3; then, the inferior vena cava was cut at the low margin of the liver (cranial of the suprarenal vein). The descending colon was cut at the transition with the sigmoid colon. Finally, the celiac and superior mesenteric arteries (generally, it did exist) were cut at the origin(s) from the abdominal aorta. This dissec-tion method is useful for the students to observe all of the vessels that are distributed on the main abdominal organs.

Observations

As shown in Figures, there is only 1 origin of the celiac and superior mesenteric arteries from abdominal aorta. Of note, the branches in this case were as follows:1) Celiacomesenteric trunk: The celiac and superior

mesenteric arteries arose with a common short trunk from the abdominal aorta (Fig. 1 and 2).

2) Left hepatic artery: The artery arose from the left

Okajimas Folia Anat. Jpn., 91(2): 45–48, August, 2014

Origin of the Celiac and Superior Mesenteric Arteries ina Common Trunk – Description of a Rare Vessel Variation of

the Celiacomesenteric Trunk with a Literature Review

By

Jun YAN1, Yoshie NAGASAWA1, 2, Masato NAKANO1, and Jiro HITOMI1

1Department of Anatomy, School of Medicine, Iwate Medical University, Iwate, Japan2JoSai University, Tokyo, Japan

–Received for Publication, August 25, 2014 –

Key Words: Celiac artery, Superior mesenteric artery, Celiacomesenteric trunk, Blood supply variation, Human

Summary: A variation artery was observed in a Japanese cadaver. The celiac and superior mesenteric arteries arose from a common trunk (also referred to as the celiacomesenteric trunk), but not from the abdominal aorta, respectively. From the common trunk, the common hepatic artery was distributed in the right part of the liver, and the left hepatic artery arose from the left gastric artery, which also arose from the common trunk. The left inferior phrenic artery arose from the common trunk, but the right inferior phrenic artery arose from the right middle suprarenal artery. This information regarding the branch pattern in this variation artery is useful for clinical examination and treatment.

Corresponding author: Jun Yan, Department of Anatomy, School of Medicine, Iwate Medical University, 2-1-1, Nishi-Tokuta, Yahaba-cho, Shiwa-Gun, Iwate, 028-3694, Japan. E-mail: junyan@iwate-med.ac.jp

(Case Report)

46 J. Yan et al.

gastric artery, with its origin in the celiacomesenteric trunk (Fig. 2).

3) Common hepatic artery: The arterial branch, as a short trunk, arose from the celiacomesenteric trunk (Fig. 2). The cystic, gastroduodenal, and right gastric arteries arose from the arterial branch.

4) Left and right inferior phrenic arteries: The left infe-rior phrenic artery arose from the beginning of the celiacomesenteric trunk and anastomosed with the right inferior phrenic artery. Then, after passing through the diaphragm, it anastomosed with the supe-rior phrenic artery (Fig. 2). The right inferior phrenic artery arose from the right middle suprarenal artery, but not the celiacomesenteric trunk (Fig. 2).

Discussion

1. Generally, the celiac and superior mesenteric arteries arise from the abdominal aorta5). However, this pattern varies considerably in humans6). The reported inci-dences of a celiacomesenteric trunk are 2.38% 7), 1.00%21), and 2.70% 22). The incidence in the present study was also 2.38% (1/42 bodies), although this incidence was based on fewer cases.

2. The typical pattern involves the left hepatic artery arising from the proper hepatic artery5), but it can also arise from the common hepatic, left gastric, celiac, or superior mesenteric artery6). This artery is important to complete the excision of the celiac axis, when neces-sary16). The reported incidences are 11%23), 17.9%6), 12.0%24), 3.60%25), and 16%26).

3. The typical pattern involves the common hepatic artery arising from the celiac artery5), but it can also arise from the superior mesenteric artery, with a reported incidence of 13%24). This artery has also been named the medial hepatic artery because of the exis-tence of left and right hepatic arteries16, 27). Hepatic artery variations originating from the superior mesen-teric artery present as 1 of 2 types: the pre-pancreas type and post-pancreas type, with the latter being the most common28).

4. The left and right inferior phrenic arteries can arise immediately below the diaphragm from the abdom-inal aorta1-5); however, this pattern accounts for only 5.62% of cases29). The frequency of an independent origin of the 2 arteries on each side of the celiac artery is 2.25%29). The 2 arteries can also arise from the aorta or celiac artery as a common trunk30, 31). The reported incidences of the right inferior phrenic originating

Fig. 1. A: Sketch of the photo (B) to show the celiac and superior mesenteric artery arises from a common trunk (celiacomesenteric trunk). Note the blue arrow indicates the stump of the common trunk. The left inferior phrenic artery arises from the common trunk. Red arrow shows the left inferior phrenic vein pour into the left suprarenal vein. x: the stump of the left inferior phrenic artery and vein. B: The photo showing the stumps of the common trunk and left inferior phrenic artery and vein.

47Origin of the celiac and superior mesenteric arteries in a common trunk

from the aorta are 57.90%32) and 38.00%33) and from the celiac artery are 42.10%32) and 40.00%33). The origin of the left inferior phrenic artery is from the celiac artery in 47.00% of cases, the aorta in 45.00% of cases, the renal artery in 5.00% of cases, the left gastric artery in 2.00% of cases, and the hepatic artery in 1.00% of cases33). It has also been reported that the 2 arteries can arise from the left gastric (3.70%), renal (15.7%), hepatic (2.10%), or superior mesen-teric (0.30%) arteries34). In addition, the 2 arteries also reportedly originate from the spermatic35) and poste-rior suprarenal arteries36). Moreover, in the present case, the 2 arteries anasto-

mosed with the superior phrenic artery, but this has not

been previously described in the majority of reports.

Conclusion

Our findings regarding the variation of the celiac and superior mesenteric arteries (celiacomesenteric trunk) indicate the following: 1) the left gastric and common hepatic arteries arise from the celiacomesenteric trunk, and the left hepatic artery arises from the left gastric artery and 2) the left inferior phrenic artery arises from the celiacomesenteric trunk, but the right inferior phrenic artery arises from the right middle suprarenal artery. This information is useful for clinical treatment and examina-tion.

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Fig. 2. Sketch showing the main arterial branches of the common trunk. Note the left gastric and common hepatic arteries arise from the common trunk, the left hepatic artery arises from the left gastric artery, and the right and left inferior phrenic arteries arise from different arterial branch(s) and anastomosed with the superior phrenic artery.

48 J. Yan et al.

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Abbreviation

AA: abdominal aorta; CA: cystic artery; CHA: common hepatic artery; EB: esophageal branch; GDA: gastroduodenal artery; ICA: ileocolic artery; IVC: infe-rior vena cava; IMA: inferior mesenteric artery; IPD: inferior pancreaticoduodenal artery; JI(s): jejunal and ileal arteries; LGA: left gastric artery; LGM: left gastro-epiploic artery; LHA: left hepatic artery; LIPA: left infe-rior phrenic artery; LOV: left ovarian vein; LRAs: left renal artery; LRV: left renal vein; LSAs: left suprarenal arteries; LSV: left suprarenal vein; MCA: middle colic artery; PGA: posterior gastric artery; RCA: right colic artery; RGA: right gastric artery; RGM: right gastroepip-loic artery; RIPA: right inferior phrenic artery; RSAs: right suprarenal arteries; SA: splenic artery; SGA: short gastric artery; SPA: superior phrenic artery; SPD: supe-rior pancreaticoduodenal artery;