Celiacomesenteric trunk: a short report

Excerpt

We read with great interest the article on celiacomesenteric trunk by Bhatnagar et al. [1] published online in the April 2013 issue of the Surgical and Radiologic Anatomy. We wish to supplement our experience with this anatomic variation involving the celiac trunk. Recently, we have conducted a study on variation of celiac axis and hepatic arteries in 600 patients. Approval for the study was obtained from the ethical board of the Institution. Multidetector CT (MDCT) scans were obtained after injecting a maximum of 120 mL of nonionic iodinated contrast material (iodine concentration, 370 mg/mL) through an 18- to 20-gauge antecubital intravenous cannula at a rate of 5–7 mL/s and the images acquired in Philips Brilliance 40-slice MDCT scan machine using angiography protocol in patients sent for various liver and other abdominal pathologies in which biphasic contrast-enhanced CT was indicated. The time period of the study was from January 2012 to February 2013. A total of 600 patients were evaluated in this retrospective study. The study population comprised 413 men and 187 women (mean age 39.8 years). We excluded patients with a history of major upper abdominal surgery. The images were analyzed independently by three radiologists Radiologist 1 (B.S.—M.D., DNB) with 5 years, Radiologist 2 (M.S.—M.D.) with 20 years and Radiologist 3 (M.K.M.—M.D., FICR) with 24 years of experience in interpreting CT scans in the concerned field. We encountered normal celiac axis in 546 patients, variant celiac axis anatomy in 33 patients and ambiguous celiac axis in 21 patients. Out of the 33 cases of variant celiac axis anatomy, we encountered celiacomesenteric trunk (CM trunk) in four of patients. Other variants which we came across are common hepatosplenic trunk and left gastric artery arising separately from the aorta in 17, gastrosplenic trunk and common hepatic artery arising separately from aorta in five, gastrosplenic and hepatomesenteric trunk from aorta in four, hepatomesenteric trunk, left gastric and splenic artery arising separately from aorta in two and hepatosplenomesenteric and left gastric artery from aorta in one case, respectively (Figs. 1, 2). Song et al. [3] defined ambiguous celiac axis as congenital absence of common hepatic artery (CHA) with separate origin of hepatic arteries and gastroduodenal artery or presence of a persistent anastomotic channel. Persistent anastomotic channel is smooth, straight vessel connecting celiac axis and SMA or anastomotic channel connecting CHA to the celiac axis and the SMA. Song et al. encountered CM trunk in 53 cases (1.06 %) in their study in 5,002 patients.

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