Atypical origin of the common hepatic artery

INTRODUCTION

Anatomical variations of the hepatic artery are commonly found during radiological examinations and abdominal operations^{1 , 89} It is estimated that the variation index reach 45% of the population⁸. The significant prevalence gives this type of variation major medical importance, and justifies the surgeon know it to avoid iatrogenic injury.

The usual blood vessel anatomy is the common hepatic artery ascend from the celiac trunk⁸; however, this arrangement may change due to embryonic variations. These variations, from most to least frequent are: 1) the right hepatic artery ascend from the superior mesenteric artery; 2) the left hepatic artery ascend from the left gastric artery; 3) the two events occur simultaneously; and 4) the common hepatic artery ascend from the superior mesenteric artery.

In this article, is reported the occurrence of the fourth situation. According to the literature, there is no consensus on the criteria for designation of this variation. Therefore, it can be described in two ways: consider it a hepatomesenteric trunk - giving rise to the superior mesenteric artery and common hepatic artery - or it can be said that the common hepatic artery arises as a branch of the superior mesenteric artery.

The objective of this paper is to present a case and emphasize the prevalence of anomalous positions of the hepatic arteries and their possible implications.

CASE REPORT

It was observed in a male corpse, common hepatic artery originating from the superior mesenteric artery, located 3.5 cm lower and lateral from the celiac trunk, forming a hepatomesenteric trunk. The other branches of the celiac trunk were normal and exhibited the typical path (Figure 1).

Figure 1 -
A) Photograph of the abdominal cavity of the corpse with some vessels in evidence: the left renal vein (double arrow), celiac trunk (single arrow) and the hepatomesenteric trunk (indicated by *); B) illustration of the same photo, highlighting the hepatomesenteric trunk (indicated by *).

DISCUSSION

Variations of the hepatic artery have embryological basis¹⁰. During intrauterine development, there is the formation of four ventral splanchnic vessels, connected by a ventral longitudinal anastomosis. With the maturation of these, the two central roots degenerate. Thus, the first and fourth roots which form respectively the celiac artery and superior mesenteric artery anastomoses remain. If the separation between them occurs at different level of the standard pattern, any vessel in the celiac trunk can be shifted to the superior mesenteric artery. This situation appears in this case report: with the anomalous roots separation, there was formation of a hepatomesenteric trunk and other gastrosplenic.

Several studies^{1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11} report different variations. The most representative of them is to Hiatt et al.⁵ with a sample of 1000 people. The variation here presented (common hepatic artery + superior mesenteric artery) is of uncommon occurrence with an average of 2%. This value agrees well with the values ​​found in other articles, ranging from 1.6% to 3.5%.

ACKNOWLEDGEMENTS

The authors thank Priscilla Vieira Ely Hattori, technique laboratory of the Federal University of Grande Dourados (Dourados, Mato Grosso do Sul) for logistical support offered to the writing of this Letter to the Editor.

REFERENCES

• ¹
  Arjhansiri K, Charoenrat P, Kitsukjit W. Anatomic variations of the hepatic arteries in 200 patients done by angiography (resumo). J Med Assoc Thai. 2006 Sep; 89 Suppl 3: S161-8,.
• ²
  Bertevello P L, Chaib E. Variações do sistema arterial hepático e sua aplicabilidade na bipartição do fígado: estudo anatômico em cadáveres. Arq. Gastroenterol. 2002, vol.39, n.2 [cited 2010-12-04], pp. 81-85.
• ³
  Chen H, Yano R, Emura S, Shoumura S. Anatomic variation of the celiac trunk with special reference to hepatic artery patterns (resumo). Ann Anat. 2009 Oct; 191(4): 399-407.
• ⁴
  Freitas A C T, Coelho J C U, Matias J E F et al. Anatomia arterial hepática: estudo em 150 transplantes hepáticos. Rev. Col. Bras. Cir. 2001, vol.28, n.1 [cited 2010-12-04], pp. 13-16.
• ⁵
  Hiatt J R, Gabbay J, Busuttil R W. Surgical anatomy of the hepatic arteries in 1000 cases (resumo). Ann Surg., 1994 Jul, 220(1): 50-2.
• ⁶
  Koops A, Wojciechowski B, Broering D C. Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surg Radiol Anat, 2004 Jun, 26(3): 239-44.
• ⁷
  Lopez-Andujar R, Moya A, Montalva E, Berenguer M Et Al. Lessons learned from anatomic variants of the hepatic artery in 1,081 transplanted livers (resumo). Liver Transpl, 2007 Oct 13(10): 1401-4.
• ⁸
  Soares R V, Coelho J C U, Matias Jef, Zeni Neto C, Freitas A C T, Godoy J L. Anatomia da artéria hepática em doadores e receptores de transplante hepático intervivos. Rev Col Bras Cir. 2006 Mar-Abr; 33(2) .
• ⁹
  Mburu K S, Alexander O J, Hassan S, et al. Variations in the Branching Pattern of the Celiac Trunk in a Kenyan Population. Int. J. Morphol. 2010, vol.28, n.1 [citado 2010-12-05], pp. 199-204 .
• ¹⁰
  Ottone N E, Agustín A M, Domínguez M L et al. Arterias Hepáticas Aberrantes: Estudio en 64 Cadáveres Disecados. Int. J. Morphol. 2006, vol.24, n.4 [citado 2010-12-05], pp. 581-585 .
• ¹¹
  Song S Y, Chung J W, Yin Y H et al. Celiac axis and common hepatic artery variations in 5002 patients: systematic analysis with spiral CT and DSA. Radiology, , 2010 Apr 255(1): 278-88.

• Financial source: none

Publication Dates

• Publication in this collection
  Nov-Dec 2014

History

• Received
  29 Aug 2013
• Accepted
  21 Aug 2014