J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 10, Number 4, April 2018, pages 321-329

The Celiac Trunk and Its Anatomical Variations: A Cadaveric Study

Figure 1. True tripod, “tripus Halleri”. LGA, CHA and SA have a common origin (Panagouli type I, form 1). CT: celiac trunk; LGA: left gastric artery; SA: splenic artery; CHA: common hepatic artery.

Figure 2. False tripod, the LGA is the first branch of the CT (Panagouli type I, form 2a). AA: abdominal aorta; CT: celiac trunk; LGA: left gastric artery; SA: splenic artery; CHA: common hepatic artery.

Figure 3. False tripod, the CHA is the first branch of the CT (Panagouli type I, form 2b) AA: abdominal aorta; CT: celiac trunk; LGA: left gastric artery; SA: splenic artery; CHA: common hepatic artery.

Figure 4. Hepatosplenic trunk, the LGA arises from the AA (Panagouli type II, form 1). AA: abdominal aorta; CT: celiac trunk; LGA: left gastric artery; SA: splenic artery; CHA: common hepatic artery.

Figure 5. Splenogastric trunk, the CHA arises from the SMA (Panagouli type II, form 5). AA: abdominal aorta; CT: celiac trunk; LGA: left gastric artery; SA: splenic artery; CHA: common hepatic artery; SMA: superior mesenteric artery.

Figure 6. Hepatogastric trunk, the SA arises from the SMA (Panagouli type II, form 8). AA: abdominal aorta; CT: celiac trunk; LGA: left gastric artery; SA: splenic artery; CHA: common hepatic artery; SMA: superior mesenteric artery.

Figure 7. False tripod, the LGA is the first branch of the CT. There are two additional branches, separated RIFA and LIFA (Panagouli type III, form 4). AA: abdominal aorta; CT: celiac trunk; LGA: left gastric artery; SA: splenic artery; CHA: common hepatic artery; RIPA: right inferior phrenic artery; LIPA: left inferior phrenic artery.

Figure 8. False tripod, the LGA is the first branch of the CT. The RIPA and LIPA arise from a common trunk (Panagouli type III, form 5). AA: abdominal aorta; CT: celiac trunk; LGA: left gastric artery; SA: splenic artery; CHA: common hepatic artery; RIPA: right inferior phrenic artery; LIPA: left inferior phrenic artery; SMA: superior mesenteric artery.

Figure 9. False tripod, the LGA is the first branch of the CT. There are four additional branches, LIPA, LMAA, RIPA and GDA (heptafurcated CT, Panagouli type III form 14). AA: abdominal aorta; CT: celiac trunk; LGA: left gastric artery; SA: splenic artery; CHA: common hepatic artery; LIPA: left inferior phrenic artery; LMAA: left middle adrenal artery; RIPA: right inferior phrenic artery; GDA: gastroduodenal artery.

Figure 10. External diameter (mm) of the celiac trunk in the present series (n = 138). Data are presented as mean and standard deviation (P > 0.05). The two cases of splenogastric trunk giving rise to a common inferior phrenic trunk (Panagouli type IX) are not included.

Table 1. Celiac Trunk Patterns According to the Panagouli Classification in Our Series (n = 140)

Type

Form

Description

Gender

Total

Male

Female

CT: celiac trunk; LGA: left gastric artery; CHA: common hepatic artery; SA: splenic artery; AA: abdominal aorta; SMA: superior mesenteric artery.

Trifurcation of the CT into LGA, CHA and SA

True tripod - common origin of LGA, CHA and SA

4.3

6/140

2.9

4/140

7.1

10/140

False tripod - division into two branches

The LGA is the first branch

32.1

45/140

2.9

4/140

49/140

The CHA is the first branch

1.4

2/140

1.4

2/140

The SA is the first branch

Bifurcation of the CT

Hepatosplenic trunk, LGA arising from the AA

1.4

2/140

1.4

2/140

2.9

4/140

Hepatosplenic trunk, no normal LGA

Hepatosplenic trunk, and gastromesenteric trunk

Splenogastric trunk, CHA arising from the AA

0.7

1/140

0.7

1/140

Splenogastric trunk, CHA arising from the SMA

2.1

3/140

2.1

3/140

Splenogastric trunk and hepatomesenteric trunk

Hepatogastric trunk, SA arising from the AA

0.7

1/140

0.7

1/140

Hepatogastric trunk, SA arising from the SMA

0.7

1/140

0.7

1/140

Hepatogastric trunk and splenomesenteric trunk

III

Additional branches

41.4

58/140

6.4

9/140

47.9

67/140

Celiac-mesenteric trunk (CT and SMA)

Variations in the origin of the CHA

Hepatosplenomesenteric trunk, LGA arising independently or as a branch

VII

Absence of the CT (LGA, CHA and SA arising independently)

VIII

Splenogastromesenteric trunk, CHA arising independently or as a branch

Splenogastric trunk giving rise to a common inferior phrenic trunk

1.4

2/140

1.4

2/140

Celiac-bimesenteric trunk (CT, SMA and IMA)

**Table 2.** Celiac Trunk Patterns With Additional Branches (Type III, Panagouli Classification) and Different Forms in Our Series (n = 67)
Type	Form	Tripod Description	Additional branches	Gender	Total
LGA: left gastric artery; CHA: common hepatic artery; AA: aortic artery; IPAs: inferior phrenic arteries; LIPA: left inferior phrenic artery; RIPA: right inferior phrenic artery; GDA: gastroduodenal artery; DPA: dorsal pancreatic artery; LMAA: left medial adrenal artery; SMA: superior mesenteric artery.
III	1	True tripod	Separated IPAs	1.5	1/67			1.5	1/67
	2	True tripod	Both IPAs from a common trunk	1.5	1/67	1.5	1/67	3	2/67
	3	True tripod	LIPA	1.5	1/67			1.5	1/67
	4	False tripod, LGA first	Separated IPAs	19.4	13/67	3	2/67	22.4	15/67
	5	False tripod, LGA first	Both IPAs from a common trunk	13.4	9/67	3	2/67	16.4	11/67
	6	False tripod, LGA, first	LIPA	13.4	9/67			13.4	9/67
	7	False tripod, LGA first	RIPA	16.4	11/67	1.5	1/67	17.9	12/67
	8	False tripod, LGA first	GDA	3	2/67			3	2/67
	9	False tripod, LGA first	DPA	6	4/67	1.5	1/67	7.5	5/67
	10	True tripod	Separated IPAs + DPA	1.5			1/67	1.5	1/67
	11	False tripod, LGA first	Separated IPAs + DPA	1.5			1/67	1.5	1/67
	12	False tripod, LGA first	LIPA + DPA	1.5	1/67			1.5	1/67
	13	False tripod, LGA first	RIPA + LMAA	1.5	1/67			1.5	1/67
	14	False tripod, LGA first	Separated IPAs + GDA + LMAA	1.5	1/67			1.5	1/67
	15	Hepatosplenic trunk. LGA from AA	RIPA	1.5	1/67			1.5	1/67
	16	Splenogastric trunk. CHA from SMA	LIPA	1.5	1/67			1.5	1/67
	17	Splenogastric trunk. CHA from SMA	GDA	3	2/67			3	2/67

Table 2. Celiac Trunk Patterns With Additional Branches (Type III, Panagouli Classification) and Different Forms in Our Series (n = 67)

Type

Form

Tripod Description

Additional branches

Gender

Total

Male

Female

LGA: left gastric artery; CHA: common hepatic artery; AA: aortic artery; IPAs: inferior phrenic arteries; LIPA: left inferior phrenic artery; RIPA: right inferior phrenic artery; GDA: gastroduodenal artery; DPA: dorsal pancreatic artery; LMAA: left medial adrenal artery; SMA: superior mesenteric artery.

III

True tripod

Separated IPAs

1.5

1/67

1.5

1/67

True tripod

Both IPAs from a common trunk

1.5

1/67

1.5

1/67

2/67

True tripod

LIPA

1.5

1/67

1.5

1/67

False tripod, LGA first

Separated IPAs

19.4

13/67

2/67

22.4

15/67

False tripod, LGA first

Both IPAs from a common trunk

13.4

9/67

2/67

16.4

11/67

False tripod, LGA, first

LIPA

13.4

9/67

13.4

9/67

False tripod, LGA first

RIPA

16.4

11/67

1.5

1/67

17.9

12/67

False tripod, LGA first

GDA

2/67

False tripod, LGA first

DPA

4/67

1.5

1/67

7.5

5/67

True tripod

Separated IPAs + DPA

1.5

1/67

1.5

1/67

False tripod, LGA first

Separated IPAs + DPA

1.5

1/67

1.5

1/67

False tripod, LGA first

LIPA + DPA

1.5

1/67

1.5

1/67

False tripod, LGA first

RIPA + LMAA

1.5

1/67

1.5

1/67

False tripod, LGA first

Separated IPAs + GDA + LMAA

1.5

1/67

1.5

1/67

Hepatosplenic trunk. LGA from AA

RIPA

1.5

1/67

1.5

1/67

Splenogastric trunk. CHA from SMA

LIPA

1.5

1/67

1.5

1/67

Splenogastric trunk. CHA from SMA

GDA

2/67

**Table 3.** Vertebral Level of Origin of the Celiac Trunk in Our Series (n = 140)
Vertebral body level	N	%
T10: 10th vertebral thoracic body; T11: 11th vertebral thoracic body; T12: 12th vertebral thoracic body; L1: first vertebral lumbar body.
T10	1	0.7
T10 to T11	0	0
T11	8	5.6
T11 to T12	5	3.6
T12	67	47.9
T12 to L1	19	13.6
L1	40	28.6

Table 3. Vertebral Level of Origin of the Celiac Trunk in Our Series (n = 140)

Vertebral body level

T10: 10th vertebral thoracic body; T11: 11th vertebral thoracic body; T12: 12th vertebral thoracic body; L1: first vertebral lumbar body.

T10

0.7

T10 to T11

T11

5.6

T11 to T12

3.6

T12

47.9

T12 to L1

13.6

28.6

**Table 4.** Description of Celiac Trunk Hexafurcation and Heptafurcation Cases
Authors	Arteries derived from the celiac trunk	Number of branches	References
LGA: left gastric artery; SA: splenic artery; CHA: common hepatic artery; LIPA: left inferior phrenic artery; RIPA: right inferior phrenic artery; LGEA: left gastroepiploic artery; GDA: gastroduodenal artery; LSAA: left superior adrenal artery; LMAA: left middle adrenal artery; AAPD: aberrant artery supplying the pancreas and duodenum; IPA: inferior phrenic artery; DAB: duodenal arterial branch.
Cicekcibaşi et al, 2005	LGA + SA + CHA + LIPA + RIPA + LGEA	6	[26]
Chitra, 2010	LGA + SA + CHA + IPA + MCA + DAB	6	[9]
Astik and Dave, 2011	LGA + SA + CHA + RIPA + GDA + LSAA + LMAA	7	[27]
Alashkham, 2012	LGA + SA + CHA + AAPD + LIPA + RIPA	6	[28]
Agarwal et al, 2016	LGA + SA + CHA + LIPA + RIPA +DPA	6	[29]
Case 1, present series	LGA + SA + CHA + LIPA + LIPA + DPA	6
Case 2, present series	LGA + SA + CHA + LIPA + RIPA + LMAA	6
Case 3, present series	LGA + SA + CHA + LIPA + RIPA + LMAA + GDA	7

Table 4. Description of Celiac Trunk Hexafurcation and Heptafurcation Cases

Authors

Arteries derived from the celiac trunk

Number of branches

References

LGA: left gastric artery; SA: splenic artery; CHA: common hepatic artery; LIPA: left inferior phrenic artery; RIPA: right inferior phrenic artery; LGEA: left gastroepiploic artery; GDA: gastroduodenal artery; LSAA: left superior adrenal artery; LMAA: left middle adrenal artery; AAPD: aberrant artery supplying the pancreas and duodenum; IPA: inferior phrenic artery; DAB: duodenal arterial branch.

Cicekcibaşi et al, 2005

LGA + SA + CHA + LIPA + RIPA + LGEA

[26]

Chitra, 2010

LGA + SA + CHA + IPA + MCA + DAB

[9]

Astik and Dave, 2011

LGA + SA + CHA + RIPA + GDA + LSAA + LMAA

[27]

Alashkham, 2012

LGA + SA + CHA + AAPD + LIPA + RIPA

[28]

Agarwal et al, 2016

LGA + SA + CHA + LIPA + RIPA +DPA

[29]

Case 1, present series

LGA + SA + CHA + LIPA + LIPA + DPA

Case 2, present series

LGA + SA + CHA + LIPA + RIPA + LMAA

Case 3, present series

LGA + SA + CHA + LIPA + RIPA + LMAA + GDA