ANATOMICAL VARIATIONS OF THE CELIAC TRUNK: A SYSTEMATIC REVIEW

SANTOS, Priscele Viana dos; BARBOSA, Ana Beatriz Marques; TARGINO, Vanessa Apolonio; SILVA, Nathalie de Almeida; SILVA, Yanka Costa de Melo; BARBOSA, Felippe; OLIVEIRA, André de Sá Braga; ASSIS, Thiago de Oliveira

doi:10.1590/0102-672020180001e1403

ABSTRACT

Introduction:

The celiac trunk (CT) is one of the abdominal portion branches of the aortic artery and, together with the superior mesenteric and inferior mesenteric arteries, participates in the abdominal viscera vascularization through a series of anastomoses. Absence of CT or variation in the number of terminal branches implies in varied abdominal arteries origins, which may have implication in surgical approaches.

Objective:

To analyze the anatomical variations of the celiac trunk and possible associated surgical clinical implications.

Methods:

It is a systematic review of articles indexed in the PubMed, Lilacs, SciELO, Springerlink, Scienc Direct and Latindex databases from August to September 2017. Original articles involving the anatomical variations of the celiac trunk in humans were included. The presence/absence of the celiac trunk, the number of terminal branches and the place of origin of its branches in variant cases of the normal anatomical pattern, were considered for this study.

Results:

At the end of the research, 12 articles were selected, characterized by sample, anatomical structure evaluation method and main results. The normal anatomical pattern was the most prevalent in most studies (75.0%). CT was absent in 41.7% of the findings. The most prevalent anatomical variation was the presence of CT with bifurcation (66.7%). It was also observed the origin of the common and splenic hepatic arteries from the mesenteric arteries (25.0%). The presence of only one branch (16.7%) and quadrifurcation (8.33%) were other findings.

Conclusion:

CT variations are not uncommon findings, with different anatomic variants being reported. Thus, the importance of knowing the possible variations of this structure is emphasized, which may have implications for surgical interventions and imaging studies related to the abdominal region.

HEADINGS:
Abdomen; Abdominal aorta; Celiac trunk; Anatomical variation

[1] Correspondence:
Thiago de Oliveira Assis Email: thiago.oa@hotmail.com

Study (year)	Sample	Method	Main results
Araujo Neto SA et al. ²2 Araujo Neto SA, Franca HÁ, Mello Júnior CF, Silva Neto JS, Negromonte GRP, Duarte CMA, et al. Variações anatômicas do tronco celíaco e sistema arterial hepático: uma análise pela angiotomografia multidetectores. 2015; 48(6):358-362.	60 patients	Computedtomography	In 90% of the cases there was no change in CT, 8.3% of the patients had hepatosplenic trunk and 1.7% had the hepatogastric trunk.
Clement MI et al. ⁶6 Clement MI, Barco MA, Ahumada N, Simon C, Valderrama JM, Sanudo J et al. Anatomical variations of the celiac trunk: cadaveric and radiological study. Surg Radiol Anat 2016; 38(4):501-510.	43 adults corpses e 596 exams	Dissection and angiographic exams	The results were divided into celiac trunk type I (complete) in 90.5% of the sample and celiac trunk type II (incomplete) in 9.5% of the sample. In type I, the trunk was bifurcated, trifurcated or quadfurcated, in the latter, with accessory branch. Those of the incomplete type presented hepatosplenic or gastroesplenic divisions.
Fahmy D Sadek H ⁹9 Fahmv D, Sadek H. A case of absent celiac trunk: case report and review of the literature. 2015; 46(4):1021-1024	Single	Computerdtomography	Absence of celiac trunk. The gastric, splenic, hepatic and mesenteric arteries arose independently of the abdominal aorta.
Chen H et al. ⁵5 Chen H, Yano R, Emura S, Shoumura S. Anatomic variation of the celiac trunk with special reference to hepatic artery patterns. 2009; 191(4):399-407.	974 corpses	Corpse dissection	In 89.8% of the cases, classical trifurcation of the celiac trunk was observed. A common hepatosplenic trunk and a gastrohepatic trunk were observed in 4.4%. A common hepatic artery resulting from the superior mesenteric artery or directly from the aorta was present in 3.5%. A hepatosplenomesenteric trunk and a celio-mesenteric trunk were found in 0.7%.
Prakash et al. ¹⁹19 Prakash, Rajini T, Mokhasi V, Geethanjali BS, Sivacharan PV, Shashirekha M. Coeliac trunk and its branches: anatomical variations and clinical implications. Singapura Mad J 2012; 53(5):329-331.	50 corpses	Corpse dissection	The gastric, hepatic and splenic arteries appeared from the celiac trunk in 86% of the corpses. In 76% the origin of the gastric artery was proximal to the bifurcation of the celiac trunk, in the hepatic and common splenic artery. In one case, the three branches emerged directly from the abdominal aorta.
Badagabettu SN et al. ⁴4 Badagabettu SN, Padur AA, Kumar N, Reghunath D. Absence of the celiac trunk and trifurcation of the common hepatic artery: a case report. 2016; 15(3).	Single	Corpse dissection	Absence of celiac trunk. Common hepatic artery, left gastric and splenic artery with independent origin in the aorta. Trifurcation of the common hepatic artery in the right hepatic, left hepatic and gastroduodenal arteries.
Petrella S et al. ¹⁸18 Petrella S, Rodriguez CFS, Sgrott EA, Fernades GJM, Marques SR, Prates JC. Anatomy and Variations of the Celiac Trunk. 2007; 25(2):249-257.	89 corpses	Corpse dissection	In 67.90% of the sample, the left gastric artery was verified as the first branch of the celiac trunk, the splenic artery in 7.41% and in 22.22% in the three arteries forming the Haller tripod. It was observed as the last branch of the celiac trunk, the common hepatic artery in 19.12%, the splenic in 5.88%. In 82.02% the celiac trunk emitted the gastric, splenic and hepatic arteries, in addition to the three arteries, the celiac trunk emitted a gastroduodenal artery in 6.74%. The gastrosplenic trunk was observed in 3.37%, the common hepatic as the sole branch in 1.12% and in 1.12% absence of the celiac trunk.
Silveira LA et al. ²²22 Silveira, LA, Silveira FB, Fazan VP. Arterial diameter of the celiac trunk and its branches. Anatomical study. Acta Cir Bras 2009; 24(1):43-47.	21 corpses	Corpse dissection	Of the 21 cadavers, 6 (28.57%) presented anatomical variations of at least one of the branches of the celiac trunk, being the absence of the hepatic artery itself, the middle colic artery originating in the celiac trunk, the left gastric artery having origin in the abdominal aorta, the right hepatic artery originating in the superior mesenteric artery and two trunks that emerged from the abdominal aorta, a gastroesplenic and another hepatomesenteric.
Sehgal G et al.²¹21 Sehgal G, Srivastava AK, Sharma PK, Kumar N, Singh R, Parihar A, et al. Morphometry of the celiac trunk: a multidetector computed tomographic angiographic study. 2013; 62(1):23-27.	50 patients	Computed tomography	A variation in the origin site of the celiac trunk was observed in 55% of the cases. In 45.83%, the celiac trunk originated from the junction of T12-L1, in 29.17% it originated in front of the T12 vertebra, 22.92% in front of the L1 vertebra and at the junction of T11-T12 2, 08%. The length varied between 6 mm and 22 mm, and the dimensions of the trunk ranged from 4 mm to 10 mm.
Sztika D et al. ²⁵25 Sztika D, Zahoi DE, Motoc A, Farca Ureche M, Daescu E. Anatomical variations of the hepatic portal vein associated with incomplete celiac trunk. Rom J Morphol Embryol 2011;52(2):695-698.	Single	Corpse dissection	There was an incomplete celiac trunk, the hepatosplenic trunk from which the common hepatic artery and the splenic artery arise. The left gastric artery appears separately 0.5 cm from the origin of the celiac trunk, directly from the abdominal aorta.
Ugurel MS et al. ²⁶26 Ugurel MS, Battal B, Bozlar U, Nural MS, Tasar M, Ors F, et al. Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography. BR J Radiol 2010; 83(992):661-667.	100 patients	Multidetector Angiography	There was a trifurcation in the celiac trunk in 89% and bifurcation in 8% of the cases. The celiac trunk was absent in 1%, a hepatosplenomesenteric trunk was observed in 1% and a splenomasenteric trunk was present in 1%.
Zagyapan R et al. ²⁹29 Zagyapan R, Kurkçuoglu A, Bayraktar A, Pelin C, Aytekin C. Anatomic variations of the celiac trunk and hepatic arterial system with digital subtraction angiography. Turk J Gastroenterol 2014; 25(1):104-109.	152 patients	Digital subtraction angiography	There was a classic trifurcation of the celiac trunk in 62.5% of the patients. The variant right hepatic artery arose from the superior mesenteric artery in 17.8%. The hepatic artery as branch of the left gastric artery in 13.1%. The common hepatic artery resulting from the superior mesenteric branch was observed in 6.6% of the patients.

STUDIES	EVALUATION CRITERIA
STUDIES	1	2	3	4	5	6	7	8	9	10	11	12	Total (%)
Petrella et al. (2007)	2	0	1	2	2	NA	2	2	2	2	0	1	72.72
Huayue et al. (2009)	2	0	2	2	2	NA	2	2	2	2	0	1	77.27
Silveira et al. (2009)	2	2	1	2	1	NA	2	1	2	2	0	2	77.27
Ugurel et al. (2010)	2	0	1	2	2	NA	2	1	2	2	0	0	63.63
Sztika et al. (2011)	2	0	1	2	1	NA	2	2	2	2	0	1	68.18
Prakash et al. (2012)	1	0	1	1	2	NA	1	2	1	1	0	2	54.54
Sehgal, et al. (2013)	2	2	1	2	2	NA	2	2	2	2	0	2	86.36
Zagyapan et al. (2014)	2	0	1	2	2	1	2	1	2	2	0	2	70.83
Araujo et al. (2015)	2	2	1	2	2	NA	2	2	2	2	0	1	81.81
Fahmy e Sadek. (2015)	0	0	1	1	1	NA	2	1	0	1	0	0	31.81
Clement et al. (2016)	2	2	1	2	2	2	2	1	2	2	0	2	83.33
Badagabettu et al.(2016)	1	0	1	1	1	NA	2	2	1	1	0	2	54.54

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