Morphological Evaluation of the Splenic Artery, Its Anatomical Variations and Irrigation Territory.

BACKGROUND: Precise knowledge of the topographic features of the splenic artery and its branches in the hilum region is of practical interest due to the various interventions on the vessels of the spleen. MATERIALS AND METHODS: The anatomy of the spleen was studied by means of macroscopic dissection on 330 organ complexes, which were carefully documented and analyzed statistically. RESULTS: The analysis of the splenic artery trajectory led to identification of four types: straight (43.03%), sinusoidal (27.58%), serpentine (20.91%) and alternating (8.48%). To assess the relation between the trajectory of the splenic artery and its branches we performed a chi square test. Sinuous or serpentine trajectory was associated with the presence of long splenic artery branches (dorsal pancreatic artery or the great pancreatic artery), X2 (2, N = 330) = 12.85, p = 0.001. The artery was located suprapancreatic in 70.30% of cases, anteropancreatic in 4.55%, the vessel had an intrapancreatic course in 14.85% and in 10.00% of cases the artery was located retropancreatic. The presence of inferior polar arteries was associated with a longer pancreas (Spearman's correlation; r = 0.37; p = 0.037). In a multiple regression analysis, inferior polar arteries predicted the length of the pancreas although only a small number of cases could be explained by this model (R2 = 0.127, Adjusted R2 = 0.098; Betta = 0.357; t(330) = 2.091; p = 0.045). There were 30 (9.09%) cases of accessory spleens. CONCLUSIONS: The arterial supply of the spleen is highly variable in its trajectory, terminal branches, and relation to other organs. The splenic artery tends to be sinuous or serpentine in zones when a large artery branches off (e.g., the dorsal pancreatic or greater pancreatic artery). Multiple short branches tend to stabilize the trajectory of the splenic artery. Inferior polar arteries and accessory spleens contribute to the length of the pancreas, most likely due to increased vascular supply to the tail of the gland.

Absent celiac trunk and unusual arterial anatomy of the upper abdomen: into the deep.

The celiac trunk is the first major branch of the abdominal aorta. It originates from the ventral aspect of the aorta at the level of T12-L1 vertebrae and was originally described as an artery that branches into the common hepatic artery, left gastric artery, and splenic artery. Absence of the celiac trunk and origin of the three arteries separately from the aorta is a rare entity that is reported in 0.38% to 2.6% of cases. It is even more uncommon that this variation can be accompanied by other vascular variations of the upper abdomen as accessory arteries to the liver, stomach, and pancreas. These cases arise during embryogenesis due to decreased arterial degeneration combined with decreased arterial fusion, which results in the anatomical variations present in the current case. Complex arterial variations are both a risk for iatrogenic injury during surgical procedures and beneficial during endovascular supply as they may provide additional access for embolization and chemotherapy.

Pancreatic ductal anatomy: more than meets the eye.

PURPOSE: Anatomical variations of the pancreas are relatively frequent and often understudied. The ductal system of the pancreas has multiple variations, which are not frequently reported in the literature. MATERIALS AND METHODS: The anatomy of the pancreas was studied through macroscopic anatomical dissection on 50 organ complexes (the pancreas, spleen, and duodenum) donated to the department of human anatomy, from patients, who died of causes not related to pancreatic diseases. RESULTS: In type I, the main pancreatic duct (Wirsung's duct, MPD) and the accessory pancreatic duct (Santorini's duct, APD) were merged but most of the head was drained by the MPD (10% of cases). In type II, the MPD and APD were merged but most of the head was drained by the APD (4% of cases). In type III, the APD was absent and the head was drained by the MPD (14% of cases). In type IV, there was an inverted pancreas divisum where the ducts did not merge but each drained a part of the head (6% of cases). Classical pancreas divisum where the ducts did not merge but each drained a part of the head was considered as type V (4% of cases). In type VI, the MPD and APD merged and each drained a part of the head (48% of cases). In type VII, the MPD and APD merged but the upper part of the head was drained by the main pancreatic duct (4% of cases). In type VIII, the MPD and APD merged but the lower part of the head was drained by the main pancreatic duct (4% of cases). In the IX type, the MPD and APD merged but the head was drained by the branches of the MPD (6% of cases). CONCLUSIONS: There are several drainage patterns of the pancreas. In some cases, one of the ducts provides more drainage of the gland than the other. This is clinically relevant since blockage of the main source of drainage leads to pancreatic juice stasis. It also explains cases when partial or total blockage of the duct results in the pancreatitis of an isolated zone.

Pancreatic surface morphology and its classification.

INTRODUCTION: Anomalies and variants of development of the pancreas are relatively frequent. These variations can often lead to misdiagnosis and unnecessary medical procedures. Although, pancreatic diseases are a constantly researched field, fundamental research is relatively understudied and re-evaluation of the pancreatic morphology is performed rarely.

Spleen: an organ of multiple shapes

Introduction: The spleen is located in the upper part of the abdominal cavity. As an organ, the spleen can have various shapes and size. Material and methods: The human spleen was studied in 273 cadavers (154 men and 119 women) who did not have diseases of the spleen. The shape of the spleen was analyzed based on splenic index, Michels classification. Results: The most common shape of the spleen in men is the elongated one. It was encountered in 79 (51.3%) cases out of 154. In women, the most common shape was the intermediate. It was encountered in 51 (42.9%) of the 119 cases. Based on Michels classification the clinoid (wedge) shape was encountered in 102 (37.74%) cases, triangular in 59 (21.83%) and tetrahedral in 30 (11.1%). In 30.26% the shape of the spleen couldn’t be classified according to Michels classification. In 21 cases (7.77%) the spleen had a flat shape; in 27 (9.99%) – dome-shaped; in 1 case (0,37%) – Z-shape; in 18 (6.66%) – round shape; in 6 (2.22%) – irregular shape; in 2 (0.66%) - shape with a node in the hilum; in 1 (0,37%) – rhomboid shape, in 2 (0,74%) – bilobed shape and in 4 cases (1,48%) – lobular shape. The splenic fissures located on the upper edge of the organ were found in 81 (29.91%) cases, and also on the lower edge - in 41 (14.02%) cases. In 13 (4.67%) cases fissures were encountered on both sides. In 148 (51.4%) cases the spleen had no fissures on its surface. Conclusions: The spleen has various shapes beyond the classical wedge, triangular and tetrahedral. All of these shapes do not represent a pathological finding but in certain situation may require further analysis and interpretation depending on the imaging technique and experience of the physician. (AU)

Introducción: el bazo se localiza en la parte superior de la cavidad abdominal. Como órgano, el bazo puede tener varias formas y tamaños. Material y métodos: Se estudió el bazo humano en 273 cadáveres (154 hombres y 119 mujeres) que no tenían enfermedades del bazo. La forma del bazo se analizó con base en el índice esplénico, clasificación de Michels. Resultados: La forma más común del bazo en los hombres es la alargada. Se encontró en 79 (51,3%) casos de 154. En las mujeres, la forma más común fue la intermedia. Se encontró en 51 (42,9%) de los 119 casos. Según la clasificación de Michels, la forma clinoide (cuña) se encontró en 102 (37,74%) casos, triangular en 59 (21,83%) y tetraédrica en 30 (11,1%). En un 30,26%, la forma del bazo no se pudo clasificar según la clasificación de Michels. En 21 casos (7,77%) el bazo tenía forma plana; en 27 (9,99%) - en forma de cúpula; en 1 caso (0,37%) - forma de Z; en 18 (6,66%) - forma redonda; en 6 (2,22%) - forma irregular; en 2 (0,66%) - forma con un nodo en el hilio; en 1 (0,37%) - forma romboide, en 2 (0,74%) - forma bilobulada y en 4 casos (1,48%) - forma lobular. Las fisuras esplénicas ubicadas en el borde superior del órgano se encontraron en 81 (29,91%) casos, y también en el borde inferior, en 41 (14,02%) casos. En 13 (4,67%) casos se encontraron fisuras en ambos lados. En 148 (51,4%) casos el bazo no presentaba fisuras en su superficie. Conclusiones: El bazo tiene varias formas más allá de la clásica cuña, triangular y tetraédrica. Todas estas formas no representan un hallazgo patológico, pero en determinadas situaciones pueden requerir un mayor análisis e interpretación según la técnica de imagen y la experiencia del médico. (AU)

Posterior midline cleft of the atlas – a crucial anatomical variation in vertebral fractures / Hendidura posterior de la línea media del atlas - una variación anatómica crucial en las fracturas vertebrales

The anatomy of the first vertebra, namely atlas, has significant clinical implications. Atlas is situated between the occipital bone and the second cervical vertebra (axis) and is one of the main points of head movement. Most congenital anomalies of the vertebra are diagnosed incidentally during imaging investigations and can be associated with cervical spine anomalies. The neurological symptoms may include weakness in the four limbs, acute neurologic deficits such as transient quadriparesis, paraparesis, Lhermitte's sign, chronic neck pain, and headache. This anomaly is also commonly seen in gonadal dysgenesis, Klippel-Feil syndrome, Arnold-Chiari malformations, and Turner and Down syndrome. Unlike other variations, which arise due to disturbances of ossification posterior midline clefts of the atlas, are different since they are a developmental failure of chondrogenesis. We therefore present an anatomical case and analysis of the literature about posterior arch clefts of atlas. (AU)

La anatomía de la primera vértebra, a saber, el atlas, tiene importantes implicaciones clínicas. Atlas está situado entre el hueso occipital y la segunda vértebra cervical (axis) y es uno de los principales puntos de movimiento de la cabeza. La mayoría de las anomalías congénitas de las vértebras se diagnostican de manera incidental durante las investigaciones por imágenes y pueden asociarse con anomalías de la columna cervical. Los síntomas neurológicos pueden incluir debilidad en las cuatro extremidades, déficits neurológicos agudos como cuadriparesia transitoria, paraparesia, signo de Lhermitte, dolor de cuello crónico y dolor de cabeza. Esta anomalía también se observa con frecuencia en la disgenesia gonadal, el síndrome de Klippel-Feil, las malformaciones de Arnold-Chiari y el síndrome de Turner y Down. A diferencia de otras variaciones, que surgen debido a alteraciones de la osificación, las hendiduras de la línea media posterior del atlas, son diferentes ya que son una falla en el desarrollo de la condrogénesis. Por tanto, presentamos un caso anatómico y un análisis de la literatura sobre las hendiduras del arco posterior del atlas. (AU)

Unusual development of the celiac trunk and its clinical significance.

We describe a case of unusual development of the celiac trunk observed in the cadaver of 1-year old male child. The celiac trunk branched into five vessels: the splenic, common hepatic and left gastric arteries, the left inferior diaphragmatic artery, and a short trunk that branched into the right inferior diaphragmatic artery and right accessory hepatic artery. Additionally, the manner of branching of the vessel was unusual: it was possible to distinguish two branching points that corresponded to its s-shaped trajectory. There were also other variations of vascular supply, such as the presence of a left accessory hepatic artery, an additional superior pancreatoduodenal artery, and others. It should be noted that multiple developmental variations can be common in clinical practice and clinicians should be aware of them during diagnostic and interventional procedures.

Apresentamos um relato de caso de desenvolvimento incomum do tronco celíaco em um cadáver do sexo masculino de 1 ano de idade. O tronco celíaco ramificou-se para cinco vasos: as artérias esplênica, hepática comum e gástrica esquerda, a artéria diafragmática inferior esquerda e um tronco pequeno que se ramificou para a artéria diafragmática inferior direita e para a artéria hepática direita acessória. Além disso, a forma como o vaso se ramificou foi incomum: é possível distinguir dois pontos de ramificação que correspondem à trajetória em formato de S. Também houve outras variações do suprimento vascular, como a presença da artéria hepática esquerda acessória, da artéria pancreaticoduodenal superior acessória e outras. Cabe observar que a variação de desenvolvimento múltipla pode ser comum na prática clínica, e os médicos devem estar cientes dela durante os procedimentos de diagnóstico e intervenção.

Bifid Pancreatic Tail: an Anatomical Case Series and their Classification.

Anomalies and variants of development of the pancreas are relatively frequent. Bifid pancreatic tail is a rare anatomic variation with only a few cases reported in the literature. The present case series were encountered during dissection of 50 anatomical specimens of the pancreas, spleen, and duodenum. We observed four unusual cases (8%) of bifid pancreatic tail. One case was of a vertically oriented bifid pancreas tail (2%), in another case, the tails here horizontally oriented (2%) and in two cases the bifid tails were horizontally oriented but unequal (4%). The bifid tails had an arterial supply that penetrated the glands between the tails and two out of four were also supplied by the superior horizontal pancreatic artery of Popova. The ductal system usually bifurcated at the level of the tails, but a case of trifurcation was also encountered. The current cases should be taken into account in hepato-pancreato-biliary surgery to avoid misdiagnosis and to comprehensively assess the patient preoperatively.

Unusual development of the celiac trunk and its clinical significance / Desenvolvimento incomum do tronco celíaco e sua importância clínica

Abstract We describe a case of unusual development of the celiac trunk observed in the cadaver of 1-year old male child. The celiac trunk branched into five vessels: the splenic, common hepatic and left gastric arteries, the left inferior diaphragmatic artery, and a short trunk that branched into the right inferior diaphragmatic artery and right accessory hepatic artery. Additionally, the manner of branching of the vessel was unusual: it was possible to distinguish two branching points that corresponded to its s-shaped trajectory. There were also other variations of vascular supply, such as the presence of a left accessory hepatic artery, an additional superior pancreatoduodenal artery, and others. It should be noted that multiple developmental variations can be common in clinical practice and clinicians should be aware of them during diagnostic and interventional procedures.

Resumo Apresentamos um relato de caso de desenvolvimento incomum do tronco celíaco em um cadáver do sexo masculino de 1 ano de idade. O tronco celíaco ramificou-se para cinco vasos: as artérias esplênica, hepática comum e gástrica esquerda, a artéria diafragmática inferior esquerda e um tronco pequeno que se ramificou para a artéria diafragmática inferior direita e para a artéria hepática direita acessória. Além disso, a forma como o vaso se ramificou foi incomum: é possível distinguir dois pontos de ramificação que correspondem à trajetória em formato de S. Também houve outras variações do suprimento vascular, como a presença da artéria hepática esquerda acessória, da artéria pancreaticoduodenal superior acessória e outras. Cabe observar que a variação de desenvolvimento múltipla pode ser comum na prática clínica, e os médicos devem estar cientes dela durante os procedimentos de diagnóstico e intervenção.

A Case of Unusual Vascularization of Upper Abdominal Cavity' Organs.

We describe a case report of multiple arterial variations of internal organs of upper abdominal cavity in a cadaver of 63-year-old female. There were several developmental variations of the vascular supply of the stomach, pancreas, spleen, and liver. There were several accessory arteries: left gastric, left hepatic, and posterior gastric artery as well as several arteries that had abnormal origin. The variations were discovered during macroscopical dissection at the department of human anatomy. It should be noted that multiple developmental variation can be common in clinical practice and clinicians should be aware of them during diagnostic and interventional procedures.

An unusual case of colon vascularization by the inferior mesenteric artery / Um caso incomum de vascularização do cólon pela artéria mesentérica inferior

Abstract In this article we present a rare variant in which the large intestine was vascularized by the inferior mesenteric artery. It was encountered during macro and microscopic dissection of the cadaver of a 63-year-old woman at a university department of human anatomy. In this case, the ascending, transverse, descending, and sigmoid colon and rectum were vascularized by the inferior mesenteric artery, whereas the small intestine, cecum and appendix were supplied by the superior mesenteric artery.

Resumo Neste artigo apresentamos uma variação rara em que o intestino grosso era vascularizado pela artéria mesentérica inferior. A variação foi descoberta durante a dissecção macro e microscópia de um cadáver do sexo feminino, 63 anos de idade, em um departamento universitário de anatomia humana. Neste caso, o cólon ascendente, transverso, descendente e sigmoide e também o reto eram vascularizados pela artéria mesentérica inferior, ao passo que o intestino delgado, ceco e apêndice eram vascularizados pela artéria mesentéria superior.

An unusual case of colon vascularization by the inferior mesenteric artery.

In this article we present a rare variant in which the large intestine was vascularized by the inferior mesenteric artery. It was encountered during macro and microscopic dissection of the cadaver of a 63-year-old woman at a university department of human anatomy. In this case, the ascending, transverse, descending, and sigmoid colon and rectum were vascularized by the inferior mesenteric artery, whereas the small intestine, cecum and appendix were supplied by the superior mesenteric artery.

Neste artigo apresentamos uma variação rara em que o intestino grosso era vascularizado pela artéria mesentérica inferior. A variação foi descoberta durante a dissecção macro e microscópia de um cadáver do sexo feminino, 63 anos de idade, em um departamento universitário de anatomia humana. Neste caso, o cólon ascendente, transverso, descendente e sigmoide e também o reto eram vascularizados pela artéria mesentérica inferior, ao passo que o intestino delgado, ceco e apêndice eram vascularizados pela artéria mesentéria superior.