Anatomy of the splenic artery: what does the surgeon need to know?

OBJECTIVE: to determine the prevalence and describe the main morphological and metric variations of the splenic artery in terms of its origin, path and polar and terminal branches. METHODS: cross-sectional study, carried out at Hospital de Clínicas between July and November 2020. Computed tomography scans were analyzed with intravenous contrast of the patients seen at the Radiology and Diagnostic Imaging Service. The findings were categorized as to origin, path and splenic ramifications. RESULTS: 1,235 patients were evaluated. As for the origin, the splenic artery appears in the celiac trunk in 99.11% of the individuals. Of these, 5.95% have a bifurcated celiac pattern, 92.17% trifurcated and 1.88% tetrafurcated. The mean arterial diameter was 5.92mm (±1.2), the highest one being in white men. As for the path, the splenic artery was unique in the entire sample. The suprapancreatic course was found in 75.63% of the individuals, with a higher occurrence in women, 78.87% (p<0.001). The terminal splitting pattern of the splenic artery was characterized by the bifurcated type (95.47%). The terminal branches seen most frequently were those with three arteries (34.90%) and most individuals did not have polar branches. CONCLUSION: the splenic artery presents a highly variable pattern of origin and its average caliber is influenced by sex and color. The suprapancreatic path was the most characteristic and predominant in females. The bifurcated pattern of final division, with three terminal branches and the absence of polar arteries, occurs more frequently.

Evaluación anatómica del tronco celíaco y sus ramas en una muestra de población mestiza colombiana / Anatomical evaluation of the celiac trunk and its branches in a sample of Colombian mestizo population

RESUMEN: El tronco celíaco (TC) es la rama de la arteria aorta abdominal (AA) que aporta la irrigación a la porción distal del esófago, parte media del duodeno, al estómago, páncreas, bazo y suple adicionalmente al hígado; sus diferentes expresiones anatómicas son reportadas en los diferentes grupos poblacionales con incidencia variable. Se evaluó las características morfológicas del TC y sus ramas en 26 bloques del piso supramesocólico de cadáveres masculinos adultos no reclamados, del grupo poblacional mestizo, a quienes se les practico autopsia en el Instituto de Medicina Legal de Bucaramanga - Colombia. Se observo el tipo I del TC en 23 especímenes (88,4 %), del cual correspondió 16 muestras (61,5 %). Al subtipo Ia con bifurcación y formación de tronco hepatoesplénico. Hubo un caso (3,8 %) en donde las ramas del T se originaron de manera independiente de la AA. El TC presentó una longitud promedio de 18,6 DE 7,53 mm y un diámetro externo de 7 DE 1,24 mm. De las ramas del TC, la AE presentó un diámetro promedio de 5,89 DE 1,04 mm sin diferencias estadísticamente significativa con relación al diámetro de la AHC, pero si con relación al diámetro de la AGI (P= 0,70; p<0,001 respectivamente). La gran mayoría de la muestra avaluada muestra la presencia de tronco hepatoesplénico seguido de la trifurcación en una verdadera configuración de trípode. El conocimiento de los patrones de ramificación del TC debe ser tomado en cuenta por cirujanos gastroenterólogos, radiólogos intervencionistas y oncólogos para evitar complicaciones durante los procedimientos quirúrgicos abdominales.

SUMMARY: The celiac trunk (CT) is the branch of the abdominal aorta artery (AA) that provides irrigation to the distal portion of the esophagus, the middle part of the duodenum, the stomach, pancreas, spleen and additionally supplies the liver; its different anatomical expressions are reported in the different population groups with variable incidence. The morphological characteristics of the CT and its branches were evaluated in 26 blocks of the supramesocolic floor of unclaimed adult male corpses, of the mestizo population group, who were autopsied at the Institute of Legal Medicine of Bucaramanga - Colombia. Type I CT was observed in 23 specimens (88.4 %), of which 16 samples (61.5 %) corresponded. to subtype Ia with bifurcation and formation of the hepatosplenic trunk. There was one case (3.8 %) in which the branches of the CT originated independently of the AA. The CT had an average length of 18.6 SD 7.53 mm and an external diameter of 7 SD 1.24 mm. Of the CT branches, the splenic artery presented an average diameter of 5.89 SD 1.04 mm without statistically significant differences in relation to the diameter of the AHC, but if in relation to the diameter of the IGA (P = 0.70; p <0.001 respectively). The vast majority of the sample evaluated shows the presence of a hepatosplenic trunk followed by trifurcation in a true tripod configuration. Knowledge of CT branching patterns should be taken into account by gastroenterological surgeons, interventional radiologists, and oncologists to avoid complications during abdominal surgical procedures.

Variations in the configuration of the celiac trunk among South Africans: clinical relevance / Variaciones en la configuración del tronco celíaco en sudafricanos: relevancia clínica

SUMMARY: The celiac trunk is the first major unpaired branch of the abdominal aorta found at the twelfth vertebral level (T12). It gives off branches supplying the spleen, liver and the stomach. However, the branching patterns of the celiac trunk tend to vary by population throughout the world. We sought to investigate the branching patterns of the celiac trunk in a South African Caucasian sample. The celiac trunk was assessed by visual observation in 66 dissected bodies comprised of both males (n= 30) and females (n=36). These samples were obtained at the School of Anatomical Sciences, University of the Witwatersrand, Johannesburg. The celiac trunk arose directly from the abdominal aorta in all cases, with none connected to the superior mesenteric artery. We observed celiac trunk trifurcation in 84.84 % of the sample, although a celiac trunk with four branches was observed in 10.61 %. Bifurcation into the common hepatic and splenic arteries forming a hepatosplenic trunk (2 females) or into the left gastric artery and splenic artery forming a splenogastric trunk (1 male) was also observed. The results are largely comparable with other studies in Caucasians, showing a high rate of celiac trunk trifurcation (above 75 %). Our sample exhibited fewer variations than reported in previous studies worldwide. Therefore, a larger study with more samples may be required in the future to ascertain all the existing celiac trunk branching patterns in the South African Caucasian population.

RESUMEN: El tronco celíaco es la primera rama principal de la parte abdominal de la aorta en el nivel de la duodécima vértebra torácica (T12), con ramas que irrigan el bazo, el hígado y el estómago. Sin embargo a nivel mundial, las ramificaciones del tronco celíaco tienden a variar según la población. En este estudio se investigaron los patrones de ramificación del tronco celíaco en una muestra caucásica sudafricana. El tronco celíaco se analizó mediante observación visual en 66 cuerpos disecados compuestos por hombres (n = 30) y mujeres (n = 36). Estas muestras se obtuvieron en la Facultad de Ciencias Anatómicas de la Universidad de Witwatersrand, Johannesburgo. El tronco celíaco surgió directamente de la parte abdominal de la aorta en todos los casos, sin que ninguno estuviera unido a la arteria mesentérica superior. Se observó trifurcación del tronco celíaco en el 84,84 % de la muestra, aunque en el 10,61 % se observó un tronco celíaco con cuatro ramas. También se observó bifurcación en las arterias hepática y esplénica común formando un tronco hepatoesplénico (2 mujeres) o en la arteria gástrica izquierda y la arteria esplénica formando un tronco esplenogástrico (1 hombre). Los resultados son comparables con otros estudios en caucásicos que muestran una alta tasa de trifurcación del tronco celíaco (mayor al 75%). Nuestra muestra presentó menos variaciones que las reportadas en estudios previos. Por lo tanto, es posible que se requieran estudios más amplios con más muestras en el futuro, para determinar todos los patrones de ramificación del tronco celíaco en la población caucásica sudafricana.

ANATOMICAL VARIATIONS OF THE SUPERIOR MESENTERIC ARTERY AND ITS CLINICAL AND SURGICAL IMPLICATIONS IN HUMANS.

INTRODUCTION: Superior mesenteric artery (SMA) usually arises from the abdominal aorta, just below the celiac trunk and it supplies the midgut-derived embryonic structures. Anatomical variations in this vessel contribute to problems in the formation and/or absorption of this part of the intestine and its absence has been recognized as the cause of congenital duodenojejunal atresia. OBJECTIVE: To analyze SMA anatomical variations in humans and the possible associated clinical and surgical implications. METHODS: This is a systematic review of papers indexed in PubMed, SciELO, Springerlink, Science Direct, Lilacs, and Latindex databases. The search was performed by two independent reviewers between September and December 2018. Original studies involving SMA variations in humans were included. SMA presence/absence, level, place of origin and its terminal branches were considered. RESULTS: At the end of the search, 18 studies were selected, characterized as for the sample, method to evaluate the anatomical structure and main results. The most common type of variation was when SMA originated from the right hepatic artery (6.13%). Two studies (11.11%) evidenced the inferior mesenteric artery originating from the SMA, whereas other two (11.11%) found the SMA sharing the same origin of the celiac trunk. CONCLUSION: SMA variations are not uncommon findings and their reports evidenced through the scientific literature demonstrate a great role for the development of important clinical conditions, making knowledge about this subject relevant to surgeons and professionals working in this area.

Angiotomografía de la arteria cística en preoperatorio y comorbilidad en colecistectomía laparoscópica por colelitiasis / Angiotomography of the cystic artery in preoperative and comorbidity in laparoscopic cholecystectomy for cholelithiasis

La colecistectomía laparoscópica es el tratamiento de elección de la colelitiasis; sin embargo, se acompaña de comorbilidades y no está exenta de complicaciones mayores que pueden ser letales; la identificación del trígono cistohepático con disección y ligadura de la arteria cística son pasos obligatorios de la cirugía; la identificación de las variaciones de la arteria cística y los conductos biliares pueden minimizar las eventuales complicaciones. Al protocolo preoperatorio se implementó una angiotomografía con Tomógrafo Siemens Somatón Sensation ® de 64 cortes para identificar la arteria cística en pacientes con colelitiasis de la Unidad de Cirugía General del Hospital de Especialidades Teodoro Maldonado Carbo IESS de Guayaquil. Se escogieron 60 pacientes femeninos en forma aleatoria (edades 19-70 años, promedio 44,25 años) y la muestra se dividió en dos grupos de 30; al grupo estudio se aplicó angiotomografía hasta un mes antes de la cirugía y al grupo control se le aplicó el protocolo convencional. Se evaluó morbilidades relacionadas con: hemorragia operatoria por lesión de la arteria cística y en el posoperatorio: infección de herida operatoria, íleo y drenaje. La angiotomografía permitió identificar la arteria cística en el preoperatorio y contribuyó a disminuir comorbilidades que acompañan a la colecistectomía laparoscópica.

Laparoscopic cholecystectomy is the treatment of cholelithiasis of choice; however, it is accompanied by comorbidities and is not exempt from major complications that can be lethal; the identification of the cystohepatic trigone with dissection and ligation of the cystic artery are mandatory steps of surgery; the identification of the variations of the cystic artery and the bile ducts can minimize the possible complications. The preoperative protocol was implemented with an angiotomography with Siemens Somatón Sensation ® 64-slice Tomograph to identify the cystic artery in patients with cholelithiasis of the General Surgery Unit of the Teodoro Maldonado Carbo IESS Specialty Hospital of Guayaquil. 60 female patients were chosen at random (ages 19 -70 years, average 44.25 years) and the sample was divided into two groups of 30; Angiotomography was applied to the study group up to one month before surgery and the conventional protocol was applied to the control group. Morbidities related to: operative haemorrhage due to cystic artery and postoperative injury: operative wound infection, ileus and drainage were evaluated. Angiotomography allowed to identify the cystic artery in the preoperative period and contributed to decrease comorbidities that accompany laparoscopic cholecystectomy.

Anatomical variations of the superior mesenteric artery and its clinical and surgical implications in humans / Variações anatômicas da artéria mesentérica superior e suas implicações clínicas e cirúrgicas em humanos

ABSTRACT Introduction: Superior mesenteric artery (SMA) usually arises from the abdominal aorta, just below the celiac trunk and it supplies the midgut-derived embryonic structures. Anatomical variations in this vessel contribute to problems in the formation and/or absorption of this part of the intestine and its absence has been recognized as the cause of congenital duodenojejunal atresia. Objective: To analyze SMA anatomical variations in humans and the possible associated clinical and surgical implications. Methods: This is a systematic review of papers indexed in PubMed, SciELO, Springerlink, Science Direct, Lilacs, and Latindex databases. The search was performed by two independent reviewers between September and December 2018. Original studies involving SMA variations in humans were included. SMA presence/absence, level, place of origin and its terminal branches were considered. Results: At the end of the search, 18 studies were selected, characterized as for the sample, method to evaluate the anatomical structure and main results. The most common type of variation was when SMA originated from the right hepatic artery (6.13%). Two studies (11.11%) evidenced the inferior mesenteric artery originating from the SMA, whereas other two (11.11%) found the SMA sharing the same origin of the celiac trunk. Conclusion: SMA variations are not uncommon findings and their reports evidenced through the scientific literature demonstrate a great role for the development of important clinical conditions, making knowledge about this subject relevant to surgeons and professionals working in this area.

RESUMO Introdução: A artéria mesentérica superior (AMS), normalmente, tem sua origem a partir da aorta abdominal, um pouco abaixo do tronco celíaco e é responsável pela irrigação das estruturas derivadas, embrionariamente, do intestino médio. Variações anatômicas nesse vaso contribui para defeitos na formação e/ou absorção dessa parte do intestino e a sua ausência tem sido reconhecida como a causa da atresia duodenojejunal congênita. Objetivo: Analisar as variações anatômicas dela em humanos e as possíveis implicações clínicas e cirúrgicas associadas. Métodos: Trata-se de uma revisão sistemática de artigos indexados nas bases de dados PubMed, SciELO, Springerlink, Scienc Direct, Lilacs e Latindex. A busca ocorreu por dois revisores independentes entre setembro e dezembro de 2018. Foram incluídos artigos originais envolvendo as variações da AMS em humanos. Considerou-se para este estudo a presença/ausência da AMS, o nível, local de origem e seus ramos terminais. Resultados: Ao final da busca foram selecionados 18 artigos, caracterizados quanto à amostra, método para avaliar a estrutura anatômica e principais resultados. O tipo de variação mais comum foi aquele cuja AMS se originou da artéria hepática direita (6,13%). Dois estudos (11,11%) evidenciaram a artéria mesentérica inferior originando-se a partir da AMS, enquanto outros dois (11,11%) constataram ser ela compartilhada na mesma origem do tronco celíaco. Conclusão: Variações na AMS não são achados incomuns e seus relatos evidenciados através da literatura científica demonstram grande importância para o desenvolvimento de condições clínicas importantes, tornando o conhecimento sobre esse assunto relevante para os cirurgiões e profissionais atuantes nesta área.

PREVALENCE OF HEPATIC ARTERIAL VARIATIONS WITH IMPLICATIONS IN PANCREATODUODENECTOMY.

BACKGROUND: Pancreaticoduodenectomy is the usual surgical option for curative treatment of periampullary cancer and carries a significant mortality. Arterial anomalies of the celiac axis are not uncommon and might lead to iatrogenic lesions or requiring arterial resection/reconstruction in a pancreatoduodenectomy. AIM: Determine the prevalence of arterial variations having implications in pancreatoduodenectomy. METHODS: Celiac trunk and hepatic arterial system anatomy was retrospectively evaluated in 200 abdominal enhanced computed tomography studies. RESULTS: Normal anatomy of hepatic arterial system was found in 87% of cases. An anomalous right hepatic artery was identified in 13% of cases. In 12 cases there was a substitute right hepatic artery arising from superior mesenteric artery and in two cases an accessory right hepatic artery with similar origin. A hepatomesenteric trunk was identified in seven cases and in five there was a right hepatic artery directly from the celiac trunk. All cases of anomalous right hepatic artery had a route was behind the pancreatic head and then, posteriorly and laterally, to the main portal vein before reaching the liver. CONCLUSIONS: Hepatic artery variations, such as anomalous right hepatic artery crossing posterior to the portal vein, are frequently seen (13%). These patients, when undergoing pancreatoduodenectomy, may require a change in the surgical approach to achieve an adequate resection. Preoperative imaging can clearly identify such variations and help to achieve a safer pancreatic head dissection with proper surgical planning.

Variação anatômica do tronco celíaco e do sistema arterial hepático: uma análise por exames de imagem / Anatomical variations of the celiac trunk and the hepatic arterial system: an imaging analysis

Introdução: As variações anatômicas das artérias hepáticas e do tronco celíaco são de grande importância para cirurgias laparoscópicas, transplantes hepáticos, intervenções radiológicas e tratamento de lesões abdominais. O grande aumento de intervenções minimamente invasivas deixou os atos cirúrgicos com menos espaço para o reconhecimento de estruturas anatômicas. Métodos: Foi realizado um estudo retrospectivo do banco de dados do Hospital São Vicente de Paulo durante o ano de 2016, analisando imagens abdominais de tomografia computadorizada com contraste e angiotomografias que envolvem a aorta abdominal e seus ramos ­ um total de 461 imagens foram analisadas. Resultados: Dos 461 pacientes analisados, 86,9% apresentaram a conformação usual do tronco celíaco ­ cuja anatômica é a origem tríplice com as artérias gástrica esquerda, esplênica e hepática comum e artéria mesentérica superior se originando sozinha da aorta abdominal. Dentre as anatomias anômalas (13%), o padrão mais comum desses ramos foi a presença em 4,5% de um tronco hepatomesentérico e um tronco gastroesplênico. No sistema arterial hepático a conformação mais prevalente foram as artérias hepáticas direita e esquerda sendo ramos da hepática próprias em 66,3%. Das alterações anatômicas (33,2%), as mais comuns foram a presença de uma artéria hepática esquerda acessória ramo da artéria gástrica esquerda (7,8%). Conclusão: Variações anatômicas do sistema arterial hepático e do tronco celíaco são prevalentes, podendo apresentar diversos arranjos organizacionais. (AU)

Introduction: Anatomical variations in the hepatic arteries and the celiac trunk are of great importance for laparoscopic surgeries, liver transplants, radiological interventions and treatment of abdominal injuries. A large increase in the number of minimally invasive interventions hampered the recognition of anatomical structures in surgical procedures. Methods: A retrospective study was performed using the 2016 São Vicente de Paulo Hospital database of contrast-enhanced abdominal computed tomography images and computed tomography angiographies showing the abdominal aorta and its branches. In total, 461 images were analyzed. Results: Of the 461 patients analyzed, 86.9% had usual conformation of the celiac trunk, which trifurcates into the left gastric artery, the common hepatic artery and the splenic artery, while the superior mesenteric artery originates alone from the abdominal aorta. Among the cases of anomalous anatomy (13%), the most common pattern in these branches was the presence of a hepatomesenteric trunk and a gastrosplenic trunk in 4.5%. In the hepatic arterial system, the most prevalent conformation was the right and left hepatic arteries being branches of the hepatic artery proper in 66.3%. Of all anatomical variations (33.2%), the most common were the presence of a left accessory hepatic artery of the left gastric artery (7.8%). Conclusion: Anatomical variations in the hepatic arterial system and the celiac trunk are common, having different structural arrangements. (AU)

Prevalence of hepatic arterial variations with implications in pancreatoduodenectomy / Prevalência de variações arteriais hepáticas com implicações em pancreatoduodenectomia

ABSTRACT Background: Pancreaticoduodenectomy is the usual surgical option for curative treatment of periampullary cancer and carries a significant mortality. Arterial anomalies of the celiac axis are not uncommon and might lead to iatrogenic lesions or requiring arterial resection/reconstruction in a pancreatoduodenectomy. Aim: Determine the prevalence of arterial variations having implications in pancreatoduodenectomy. Methods: Celiac trunk and hepatic arterial system anatomy was retrospectively evaluated in 200 abdominal enhanced computed tomography studies. Results: Normal anatomy of hepatic arterial system was found in 87% of cases. An anomalous right hepatic artery was identified in 13% of cases. In 12 cases there was a substitute right hepatic artery arising from superior mesenteric artery and in two cases an accessory right hepatic artery with similar origin. A hepatomesenteric trunk was identified in seven cases and in five there was a right hepatic artery directly from the celiac trunk. All cases of anomalous right hepatic artery had a route was behind the pancreatic head and then, posteriorly and laterally, to the main portal vein before reaching the liver. Conclusions: Hepatic artery variations, such as anomalous right hepatic artery crossing posterior to the portal vein, are frequently seen (13%). These patients, when undergoing pancreatoduodenectomy, may require a change in the surgical approach to achieve an adequate resection. Preoperative imaging can clearly identify such variations and help to achieve a safer pancreatic head dissection with proper surgical planning.

RESUMO Racional: Pancreatoduodenectomia consiste no procedimento cirúrgico usual para tratamento curativo de neoplasias periampulares e apresenta mortalidade significativa. Variações arteriais do tronco celíaco não são incomuns e podem favorecer lesões iatrogênicas ou exigirem realização de ressecção/reconstrução arterial durante pancreatoduodenectomia. Objetivo: Determinar a prevalência de variações arteriais que apresentam implicações durante pancreatoduodenectomia. Métodos: A anatomia do tronco celíaco e sistema arterial hepático foi investigada retrospectivamente em 200 exames tomográficos contrastados do abdome. Resultados: Anatomia normal do sistema arterial hepático foi observada em 87% dos casos. Presença de uma artéria hepática direita anômala foi identificada em 13%. Em 12 casos houve uma artéria hepática direita substituta originária da artéria mesentérica superior, em dois uma artéria hepática direita acessória com origem similar. Tronco hepaticomesentérico foi identificado em sete casos e em cinco houve uma artéria hepática direita originária diretamente do tronco celíaco. Em todos casos de artéria hepática direita anômala seu curso foi por trás da cabeça do pâncreas e com trajeto passando posteriormente ao tronco da veia porta e após percorrendo sua face lateral direita antes de alcançar o fígado. Conclusões: Variações arteriais hepáticas, como artéria hepática direita anômala com trajeto posterior à veia porta, são frequentes (13%). Nestes pacientes, quando submetidos à pancreatoduodenectomia, pode ser necessária alteração na abordagem cirúrgica para ressecção adequada. Exames de imagem pré-operatórios podem claramente identificar estas variações e auxiliar na realização de dissecção segura da cabeça do pâncreas com adequado planejamento cirúrgico.

Morfometría y variantes anatómicas del tronco celíaco en población mexicana / Morphometry and anatomical variants of the celiac trunk in Mexican population

RESUMEN: Las variantes anatómicas del tronco celíaco (TC) son relevantes en el ámbito quirúrgico e intervencionista. Existen diferentes estudios a nivel mundial que han demostrado las variaciones que puede presentar el TC tanto en longitud como en estructura; dichos estudios han sido realizados predominantemente en población asiática y europea. Por lo anterior, realizamos un estudio que caracterizó esta estructura y que sea referente para la población mexicana. Se analizó una muestra de 50 especímenes cadavéricos humanos embalsamados de origen mexicano. El promedio de longitud del TC a su primera rama fue de 12,44 mm; de su origen a la segunda rama fue de 17,07 mm; y hasta la tercera fue de 19,15 mm. En la muestra de estudio se encontraron variantes en el 20 % de los especímenes, de éstos el 14 % presentaron variantes morfométricas en cuanto a longitud y 6 % en estructura. Respecto a las variantes morfométricas, destacó la presencia de un TC de 3 mm de longitud. En cuanto a las variantes morfológicas dos individuos presentaron un tronco gastro-esplénico con tronco hepato-mesentérico; y el tercero un tronco bifurcado hepato-gástrico con la arteria esplénica naciendo de la arteria hepática común. Éste último no reportado en la literatura.

SUMMARY: Anatomical variants in the celiac trunk (CT) are important in surgical and interventional fields. Studies worldwide have demonstrated length and structure variations in the celiac trunk. These studies have predominantly been carried out in Asian and European population. Therefore, we considered it necessary to realize a study to describe this structure and serve as a reference in the Mexican population. A sample of 50 human cadaveric specimens of Mexican origin was analyzed. The average length of the celiac trunk from its origin to its first branch was 12.44 mm, to the second branch was 17.07 mm, and to the third branch was 19.15 mm. In the studied sample, variants were found in 20 % of the specimens, 14 % of these presented morphometric variations in terms of length, and 6 % in terms of structure. In reference to the morphometric variants, the presence of one 3 mm length CT was noteworthy. Morphological variants were found in two specimens presenting a gastro-splenic trunk with a hepatomesenteric trunk, and a third specimen with hepatogastric bifurcated trunk, with the splenic artery originating from the common hepatic artery was observed. No reports were found in the literature concerning the latter.

ANATOMICAL VARIATIONS OF THE CELIAC TRUNK: A SYSTEMATIC REVIEW.

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.

Tronco hepato-espleno-mesentérico: descripción de una disposición anómala del tronco celíaco / Hepato-splenic-mesenteric trunk: description of an abnormal disposition of the celiac trunk

El estudio de los patrones arteriales de distribución vascular requiere un conocimiento preciso de las variaciones anatómicas, tanto de origen y distribución de las arterias, como de sus correspondientes ramas arteriales. En este trabajo se describe la presencia de un tronco hepato-espleno-mesentérico, disposición arterial altamente infrecuente. El conocimiento de las distintas posibilidades de disposición de las arterias correspondientes al tronco celíaco y sus ramas será de importancia para la interpretación adecuada de estudios imagenológicos, como así también para la planificación precisa de actos quirúrgicos e intervencionistas en la región abdominal.

The study of arterial patterns of vascular distribution requires a precise knowledge of the anatomical variations of both origin and distribution of the corresponding arteries and arterial branches. In this work, the presence of a hepatosplenic-mesenteric trunk is described, a highly infrequent arterial disposition. The knowledge of the different possibilities of disposition of the arteries corresponding to the celiac trunk and its branches will be of importance for the adequate interpretation of imaging studies, as well as for the precise planning of surgical and interventional acts in the abdominal region.

Anatomical variations of the celiac trunk: a systematic review / Variações anatômicas do tronco celíaco: uma revisão sistemática

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.

RESUMO Introdução: O tronco celíaco (TC) surge da aorta abdominal e juntamente com as artérias mesentérica superior e mesentérica inferior participa da vascularização de vísceras abdominais por meio de uma série de anastomoses. Ausência do TC ou variação no número de ramos terminais implica em origens variadas das artérias abdominais, o que pode ter implicação em abordagens cirúrgicas. Objetivo: Analisar as variações anatômicas do TC e as possíveis implicações clínico/cirúrgicas associadas. Métodos: Trata-se de uma revisão sistemática de artigos indexados nas bases de dados PubMed, Lilacs, SciELO, Springerlink, Scienc Direct e Latindex, no período de agosto a setembro de 2017. Foram incluídos artigos originais envolvendo as variações anatômicas do TC em humanos. Considerou-se para este estudo a presença/ausência do TC, o número de ramos terminais e o local de origem de seus ramos em casos variantes do padrão anatômico normal. A coleta foi realizada por dois revisores independentes. Resultados: Ao final da busca foram selecionados 12 artigos, caracterizados quanto à amostra, método para avaliar a estrutura anatômica e principais resultados. O padrão anatômico normal foi o mais prevalente na maioria dos trabalhos (75,0%). O TC foi ausente em 41,7% dos achados. A variação anatômica mais prevalente foi a presença do TC com bifurcação (66,7%). Observou-se, ainda, a origem das artérias hepática comum e esplênica a partir das artérias mesentéricas (25,0%). A presença de apenas um ramo (16,7%) e quadrifurcação (8,33%) foram outros achados presentes. Conclusão: Variações do TC não são achados incomuns, sendo relatados diferentes variantes anatômicas. Desse modo, ressalta-se a importância sobre o conhecimento das possíveis variações dessa estrutura, o que pode ter implicação em intervenções cirúrgicas e exames de imagem relacionados à região abdominal.

Hepatic arterial pattern and celiac trunk not described in literature

Knowledge of the hepatic arterial anatomy and celiac trunk is gaining importance, since the use of minimally invasive surgeries is more frequent nowadays. This kind of procedure meant that surgeons had less room for visualization of anatomical variants and work. In addition, failure to recognize the correct anatomy of the hepatic vascularization in a transplant procedure can lead to organ failure and death. The present case aims to demonstrate an arterial hepatic celiac trunk pattern that was never described by any of the acknowledged classification systems. This pattern is challenging for the surgical management of possible upper abdominal interventions, since non-recognition may lead to iatrogenesis. (AU)

Origem e distribuição da artéria celíaca em preás (Galea spixii Wagler, 1831) / Origin and distribution of the celiac artery in yellow-toothed cavies (Galea spixii Wagler, 1831)

Para o estudo foram utilizados 20 animais, que estavam em freezer no Centro de Multiplicação de Animais Silvestres (CEMAS/UFERSA). Os animais foram descongelados, a cavidade abdominal aberta e a aorta torácica canulada no sentido caudal para injeção de solução de látex Neoprene 650 corado de vermelho e, em seguida, fixados em solução de formaldeído a 10%, por um período mínimo de 48 horas, para que pudessem ser dissecados, fotografados e os resultados analisados. A artéria celíaca originou-se da aorta abdominal e emitiu as artérias gástrica esquerda, lienal e esplênica. A artéria gástrica esquerda emitiu de dois a três ramos à região da curvatura menor do estômago. A artéria lienal emitiu quatro ramos ao parênquima do baço, de seis a doze ramos pancreáticos e a artéria gastroepiplóica esquerda. A artéria hepática emitiu de um a dois ramos pancreáticos e bifurcou-se em um curto tronco formado pelas artérias gástrica direita e hepática própria e ainda na artéria gastroduodenal, que originava a pancreaticoduodenal cranial e gastroepiplóica direita. O comportamento de trifurcação da artéria celíaca do preá assemelha-se ao encontrado em roedores, como o nutria, a cutia, o hamster e os ratos, o que sugere que este seja o padrão para a ordem.

For this study we used 20 animals that were in the freezer at the Wild Animals Multiplication Center (CEMAS/UFERSA). The animals were thawed, the abdominal cavity was opened, and the thoracic aorta cannulated caudally for the injection of red-stained latex Neoprene 650, and then fixed in formaldehyde solution 10%, for a minimum of 48 hours. Then the animals were dissected, photographed, and the results analyzed. The celiac artery originated from the abdominal aorta and issued the left gastric, splenic, and hepatic arteries. The left gastric artery issued two to three branches to the lesser curvature of the stomach. The splenic artery emitted four branches to the parenchyma of the spleen, six to twelve pancreatic branches and the left gastroepiploic artery. The hepatic artery emitted from one to two pancreatic branches and forked in a short trunk formed by right gastric and own hepatic arteries and in the gastroduodenal artery, which originated the cranial pancreaticoduodenal and right gastroepiploic. The trifurcation behavior of the celiac artery of the yellow-toothed cavy is similar to that found in rodents such as nutria, agouti, hamsters and mice, suggesting that this is the standard for the order.

Origem e distribuição da artéria celíaca em preás (Galea spixii Wagler, 1831) / Origin and distribution of the celiac artery in yellow-toothed cavies (Galea spixii Wagler, 1831)

Para o estudo foram utilizados 20 animais, que estavam em freezer no Centro de Multiplicação de Animais Silvestres (CEMAS/UFERSA). Os animais foram descongelados, a cavidade abdominal aberta e a aorta torácica canulada no sentido caudal para injeção de solução de látex Neoprene 650 corado de vermelho e, em seguida, fixados em solução de formaldeído a 10%, por um período mínimo de 48 horas, para que pudessem ser dissecados, fotografados e os resultados analisados. A artéria celíaca originou-se da aorta abdominal e emitiu as artérias gástrica esquerda, lienal e esplênica. A artéria gástrica esquerda emitiu de dois a três ramos à região da curvatura menor do estômago. A artéria lienal emitiu quatro ramos ao parênquima do baço, de seis a doze ramos pancreáticos e a artéria gastroepiplóica esquerda. A artéria hepática emitiu de um a dois ramos pancreáticos e bifurcou-se em um curto tronco formado pelas artérias gástrica direita e hepática própria e ainda na artéria gastroduodenal, que originava a pancreaticoduodenal cranial e gastroepiplóica direita. O comportamento de trifurcação da artéria celíaca do preá assemelha-se ao encontrado em roedores, como o nutria, a cutia, o hamster e os ratos, o que sugere que este seja o padrão para a ordem.(AU)

For this study we used 20 animals that were in the freezer at the Wild Animals Multiplication Center (CEMAS/UFERSA). The animals were thawed, the abdominal cavity was opened, and the thoracic aorta cannulated caudally for the injection of red-stained latex Neoprene 650, and then fixed in formaldehyde solution 10%, for a minimum of 48 hours. Then the animals were dissected, photographed, and the results analyzed. The celiac artery originated from the abdominal aorta and issued the left gastric, splenic, and hepatic arteries. The left gastric artery issued two to three branches to the lesser curvature of the stomach. The splenic artery emitted four branches to the parenchyma of the spleen, six to twelve pancreatic branches and the left gastroepiploic artery. The hepatic artery emitted from one to two pancreatic branches and forked in a short trunk formed by right gastric and own hepatic arteries and in the gastroduodenal artery, which originated the cranial pancreaticoduodenal and right gastroepiploic. The trifurcation behavior of the celiac artery of the yellow-toothed cavy is similar to that found in rodents such as nutria, agouti, hamsters and mice, suggesting that this is the standard for the order.(AU)

Arterial Vascularization of the Gastrointestinal Tract of the Pampas Deer (Ozotoceros bezoarticus, Linnaeus, 1758).

Based on gross dissection of fifteen adult animals (11 females, 4 males), we described the arterial supply of the stomach and intestines of the pampas deer (Ozotoceros bezoarticus), a South American endangered species. The coeliac artery emitted the splenic, left gastric and hepatic arteries. The splenic artery directed towards the spleen, and the right ruminal artery, which is its only collateral directed towards the stomach, being the main artery of the rumen. The left gastric artery gave origin to the left ruminal, the reticular and the left gastroepiploic arteries. The left gastroepiploic artery originated the reticular accessory artery. Both arteries, gastric and left gastroepiploic, anastomosed their right counterparts derived from the hepatic artery on the curvatures of the abomasum. The cranial mesenteric artery irrigated the second half of the duodenum until the beginning of the descending colon. The thickest branch emitted by the cranial mesenteric artery was the ileocolic artery, which was destined to the ascending colon, caecum and ileum. The colic branches and the right colic arteries were irradiated on the right surface of the spiral loop of the ascending colon and distributed to both centripetal and centrifugal coils of the ascending colon; the colic branches were also anastomosed with the last jejunals and ileals and with the right colic arteries. There were no variations in the origin of any of the main branches derived from the coeliac and cranial mesenteric arteries. This species had a basic pattern of arterial distribution similar to small domestic ruminants.

Origin, ramification, and distribution of the celiac artery in Saffron finch (Sicalis flaveola) / Origem, ramificação e distribuição da artéria celíaca em canários-da-terra (Sicalis flaveola)

This research was performed aiming to describe the origin and the distribution of the celiac artery in 30 Saffron finches (Sicalis flaveola), through the completion of their circulatory system with an aqueous solution of colored latex, followed by fixation in formol for later dissection of the collateral branches. The celiac artery originated from the descending branch of the aorta, representing its first visceral branch, and was directed to the right antimere of the coelomic cavity. After issuance of the proventricular dorsal artery and the splenic artery, the celiac bifurcated in left and right branches: In all observed finches the left branch originated the proventricular ventral artery, from its left side, and the gastroduodenal and ventral gastric arteries from its right side, in order to continue as the left gastric artery characterizing it as a terminal branch; from its right side, the right branch issued, as first collateral, the right hepatic artery in all observed birds, to originate, from its opposite side, the right gastric and ileal, immediately continuing as pancreaticoduodenal, its terminal branch. From this study, we concluded that the Saffron finch follows the same pattern regarding the origin and distribution of the celiac artery proposed for birds of the genus Gallus, Anas, Columba, Crax, Mitu, and Amazona.

A origem e a distribuição da artéria celíaca de trinta canários da terra (Sicalis flaveola) foram descritas por meio do preenchimento do sistema arterial com solução de látex corado e fixação em solução de formol, para posterior dissecação de seus ramos colaterais. A artéria celíaca originou-se do ramo descendente da aorta, seu primeiro ramo visceral, direcionada para o antímero direito da cavidade celomática. Após emissão das artérias proventricular dorsal e esplênica, a artéria celíaca bifurcou-se em ramos esquerdo e direito: em todos os canários dissecados, o ramo esquerdo originou a artéria proventricular ventral a partir de sua face esquerda e as artérias gastroduodenal e gástrica ventral pela sua face direita, para em seguida continuar como artéria gástrica esquerda, seu ramo terminal. Em todas as aves, a artéria hepática direita foi o primeiro colateral originado na face direita do ramo direito, para em seguida originar, na face oposta, as artérias gástrica direita e ileal, continuando-se imediatamente como pancreaticoduodenal, seu ramo terminal. A partir desse estudo, concluiu-se que o canário da terra segue o mesmo padrão proposto quanto à origem e distribuição da artéria celíaca para aves dos gêneros Gallus, Anas, Columba, Crax, Mitu e Amazona.

Origin, ramification, and distribution of the celiac artery in Saffron finch (Sicalis flaveola) / Origem, ramificação e distribuição da artéria celíaca em canários-da-terra (Sicalis flaveola)

This research was performed aiming to describe the origin and the distribution of the celiac artery in 30 Saffron finches (Sicalis flaveola), through the completion of their circulatory system with an aqueous solution of colored latex, followed by fixation in formol for later dissection of the collateral branches. The celiac artery originated from the descending branch of the aorta, representing its first visceral branch, and was directed to the right antimere of the coelomic cavity. After issuance of the proventricular dorsal artery and the splenic artery, the celiac bifurcated in left and right branches: In all observed finches the left branch originated the proventricular ventral artery, from its left side, and the gastroduodenal and ventral gastric arteries from its right side, in order to continue as the left gastric artery characterizing it as a terminal branch; from its right side, the right branch issued, as first collateral, the right hepatic artery in all observed birds, to originate, from its opposite side, the right gastric and ileal, immediately continuing as pancreaticoduodenal, its terminal branch. From this study, we concluded that the Saffron finch follows the same pattern regarding the origin and distribution of the celiac artery proposed for birds of the genus Gallus, Anas, Columba, Crax, Mitu, and Amazona.(AU)

A origem e a distribuição da artéria celíaca de trinta canários da terra (Sicalis flaveola) foram descritas por meio do preenchimento do sistema arterial com solução de látex corado e fixação em solução de formol, para posterior dissecação de seus ramos colaterais. A artéria celíaca originou-se do ramo descendente da aorta, seu primeiro ramo visceral, direcionada para o antímero direito da cavidade celomática. Após emissão das artérias proventricular dorsal e esplênica, a artéria celíaca bifurcou-se em ramos esquerdo e direito: em todos os canários dissecados, o ramo esquerdo originou a artéria proventricular ventral a partir de sua face esquerda e as artérias gastroduodenal e gástrica ventral pela sua face direita, para em seguida continuar como artéria gástrica esquerda, seu ramo terminal. Em todas as aves, a artéria hepática direita foi o primeiro colateral originado na face direita do ramo direito, para em seguida originar, na face oposta, as artérias gástrica direita e ileal, continuando-se imediatamente como pancreaticoduodenal, seu ramo terminal. A partir desse estudo, concluiu-se que o canário da terra segue o mesmo padrão proposto quanto à origem e distribuição da artéria celíaca para aves dos gêneros Gallus, Anas, Columba, Crax, Mitu e Amazona.(AU)

Anatomic study of the collateral branches of the abdominal aorta of primate species Saguinus niger.

Saguinus niger is a primate of the family Callitrichidae, with a geographical distribution limited to northern Brazil, Guyanas, Suriname and Venezuela, where it inhabits rainforests along the coast. Three adult females from the Paragominas Bauxite Mine--PA were used, donated to the Laboratory of Animal Morphology Research (LAMR) of the Federal Rural University of Amazonia. These animals had died of natural causes. The arterial system was filled with latex, and the animals were fixed in 10% formalin. Afterwards, the abdominal aorta and its collateral branches were dissected. The arrangement of the abdominal aorta branches in this species showed a similar arrangement as domestic animals but differing in the formation of the coeliac trunk. The coeliac trunk originates from the abdominal aorta, and from this trunk, we found the hepatic, left gastric and splenic arteries, where the origin of these vessels was variable. These arteries originate from the coliac trunk or a common trunk originating from the coeliac trunk, a characteristic not described in other species. The other branches of the abdominal aorta from S. niger did not show great differences in origin when compared to other species.