PREVALENCE OF COMMON AND UNCOMMON ANATOMICAL VARIENTS OF CELIAC TRUNK BRANCHES ON MULTIDETECTOR COMPUTED TOMOGRAPHY ANGIOGRAPHY AND THEIR CLINICAL IMPLICATION IN A TERTIARY CARE CENTRE AT CHENNAI

Abstract

Background: The celiac trunk is the unpaired branch of abdominal aorta, originating from the level of T12- L1 vertebrae supplying the structures developed from the embryological foregut.  Normally the celiac trunk trifurcates into three branches (tripus Halleri) according to von Haller the common hepatic, the splenic and the left gastric artery. From the literature search, there have been many reported cases of anatomical variations in the celiac trunk's branching pattern.  Knowledge of variations of the celiac trunk is important for planning surgical and endovascular interventional procedures.

Objectives:

• To analyze the prevalence of different types of celiac trunk variants in asymptomatic patients.
• To analyze the probable gender influence on anatomical variation.

Methods: A retrospective study involving 200 patients from Chennai-Kanchipuram districts were included in the study.

All the patients who are referred to the department of radiology for contrast enhanced computed tomography abdomen are included in the study however the patients with pathological conditions which could cause alteration in abdominal vasculature especially the celiac trunk as excluded from the study.

Prevalence of variations in the celiac trunk branching pattern was evaluated based on Uflacker classification and E. Pellagoni proposed classification of celiac trunk anomalies.

Results: Out of the 200 Contrast enhanced CT abdomen examined in this study, it was observed that trifurcation pattern of the celiac trunk with True tripod pattern (tripus Halleri) was more common ( 52.5% &  54.5% according to Panagouli and Ulfacker’s classification respectively) than false tripod pattern (37.7% and 36% according to Panagouli and Ulfacker’s classification respectively). Fair share of population with varying anatomical vascular variants were seen with Type II-Hepatosplenic trunk & Type V-gastro-splenic trunk were the commonest variants (3.7%) seen  according to Ulfacker’s classification. Additional branches (Panagouli type III) were observed in 4% of the study population. Subtle gender influence on anatomical variant among the classic pattern and anatomical variants were seen.

Conclusion: Multidetector computed tomography (MDCT) angiography is an effective tool for evaluating the variant anatomy of the celiac trunk branching pattern. Bifurcation pattern and celiac trunk with additional branches can be commonest variants second only to tripod pattern. Pre-surgical and pre-endovascular interventional evaluation of such variants is very important in order to avoid the vascular complications.