The Curious Case of a Missing Coeliac Trunk: A Case Report and Review of the Literature

Abstract

Introduction

The anatomy of the coelic trunk is highly variable. An understanding of the variations is important in general and vascular surgery due to the implications of disruption and consequent visceral ischaemia.

Case Description

A case is described of a 69-year-old woman presenting with undifferentiable abdominal pain, eventually leading to a diagnosis of aortitis and uterine cancer. Computed tomography (CT) angiography revealed a unique coeliac trunk variation with the common hepatic artery (CHA) arising directly from the abdominal aorta, and a splenogastric trunk, a relatively rare variant.

Discussion

The clinical picture was unique, with the anatomical variant complicating case. There are several clinical consequences of these anomalies, but it is critical for operative surgeons to understand the normal anatomy as well as variants to reduce surgical risks. The literature describes various classification methodologies, which assist in approaches intraoperatively. Predominantly stenting, chemoembolisation and catheterisation based procedures require a rigid understanding of the various anomalies that can be encountered, even though this case (Morita Class III) only presents in 0.23% of cases. This is sufficiently often enough that it is important to bring to light variations in the anatomy of the coeliac trunk.