Prasanna S. et al / Int. J. Res. Ayurveda Pharm. 10 (2), 2019 73 Research Article www.ijrap.net COELIAC TRUNK AND ITS ANATOMICAL VARIATION: A CASE REPORT Prasanna S. 1 *, Sandeep Kashyap 2 , Megha Chandarana 2 , Nirav Patel 2 and Siddharth Roy 2 1 Associate Professor, Department of Rachana Sharira, S.D.M College of Ayurveda, Thannirhalla, Hassan, Karnataka, India 2 Post Graduate Scholars, Department of Rachana Sharir, Parul Institute of Ayurved, Parul University, Vadodara, Gujarat, India Received on: 31/12/18 Accepted on: 08/02/19 *Corresponding author E-mail: drprasanna.ayu@gmail.com DOI: 10.7897/2277-4343.100239 ABSTRACT A unique variation was noted in the Coeliac Trunk of a 65 years old male cadaver, during a routine dissection class for Under Graduate Students. In this case, the Coeliac Trunk was replaced by two separate arterial trunks. The first arterial trunk directly originated from the abdominal aorta, which was the Left Gastric Artery. The second arterial trunk was bifurcated to form the Common Hepatic Artery and the Splenic Artery (Hepatosplenic Trunk). Knowledge of such variations is important for gastroenterological surgeons and interventional radiologists, while performing major surgeries such as the Liver Transplantation. The clinical correlation and differential diagnosis of the above mentioned variation of Coeliac Trunk is discussed. Keywords: Coeliac Trunk, Cadaver, Abdominal Aorta. INTRODUCTION The Coeliac Trunk is a short and wide vessel (approximately, 1.25 cm long), which arises from the ventral aspect of the abdominal aorta, just below the aortic orifice of the diaphragm at the level of T12 and L1 vertebrae 1 . It runs forwards and towards right and gets divided into three branches- Left Gastric, Splenic Artery and Common Hepatic Artery 2 . This trifurcation was first described by ‘Von Haller’and is considered as the classic presentation of the Coeliac Trunk, which is known as “Tripus Halleri”. About 15 % of the population displays significant variations in the typical branching pattern of the Coeliac Trunk. Identifying variations of the Coeliac Trunk and its branches are important due to the surgical perspective because of the relationship it shares with the surrounding structures. Different reported variations of the Coeliac Trunk include- congenital absence, bifurcation and presence of collateral branches. In 1928, ‘Adachi’ classified the branching pattern of the Coeliac Trunk into 6 major types, namely- Table 1: Classification of Branching Pattern of Coeliac Trunk Type Branching Pattern of Coeliac Trunk 1 Normal branching – Trifurcation 2 Hepatosplenic Trunk 3 Hepatosplenomesentric Trunk 4 Hepatogastric Trunk 5 Splenogastric Trunk 6 Coeliacomesentric Trunk Procedure Following the Cunningham’s Manual of Dissection, the abdomen was opened and the anterior abdominal wall was reflected. The Stomach, Right Gastric and the Right Gastroepiploic Vessels were cut through and the Peritoneum was removed to reveal the Coeliac Trunk 3 . It was noted that the Coeliac Trunk was actually replaced by two separate arterial trunks. The first arterial trunk directly originated from the abdominal aorta, which was the Left Gastric Artery and the second arterial trunk was bifurcated to form the Common Hepatic Artery and the Splenic Artery (Hepatosplenic Trunk). Photograph of the same was taken and documented, and the specimen was preserved in the departmental museum. Case Report During a routine practical class for the Under Graduate students, we encountered a variation in the Coeliac Trunk of a 65 years old male cadaver, in the Department of Rachana Sharir (Anatomy), Parul Institute of Ayurved, Parul University, Vadodara (Gujarat). Abdominal Wall was reflected followed by which the Peritoneum was removed to reveal the Coeliac Trunk. In the present case, a well-defined Coeliac Trunk was absent, and was replaced by two separate arterial trunks. The variation was situated at the ventral aspect of the Coeliac Trunk, at the level of T12 vertebra. The Left Gastric Artery directly originated from the abdominal aorta, forming the first arterial trunk of this variation and the second arterial trunk got bifurcated into the Common Hepatic Artery and the Splenic Artery, forming the Hepatosplenic Trunk. The Left Gastric Artery after taking origin directly from the abdominal aorta runs upwards towards the left; behind the lesser sac, to reach the cardiac end of the stomach 2 . Approximately, a centimetre prior to reaching the cardiac end, it gave a branch to the Liver. We named it as an ‘Accessory Hepatic Artery’. The Left Gastric Artery entered into the lesser sac and further ran along the lesser curvature and got terminated by anastomosing with the Right Gastric Artery. The course of the Common Hepatic Artery and the Splenic Artery was traced further, and was found to be normal.