Long coeliac trunk and its low origin and unusual branches : a case report

Introduction Coeliac trunk supplies the derivatives of the foregut. Knowledge of its variations is useful for surgeons, gastroenterologists and radiologists. We report a case of low origin, unusual length and branches of coeliac trunk. Case report The coeliac trunk had a low origin (at the level of L2 vertebra) and was 5 cm in length. It gave origin to the right and left inferior phrenic arteries and terminated by giving splenic, left gastric and common hepatic arteries. Conclusion Unusual length and branches of coeliac trunk might cause confusions in diagnostic and surgical procedures. Introduction The coeliac trunk (CT) is the first ventral splanchnic branch of the abdominal aorta. It supplies the derivatives of the foregut. It originates from the ventral aspect of the abdominal aorta at the level of junction between T12 and L1 vertebrae. It is about1.5–2 cm in length1. It usually terminates by dividing into three main branches: left gastric, common hepatic and splenic arteries. Reported variations of the CT include its congenital absence2, bifurcation3 and presence of collateral branches4. Long coeliac trunk and its low origin and unusual branches:


Introduction
The coeliac trunk (CT) is the first ventral splanchnic branch of the abdominal aorta.It supplies the derivatives of the foregut.It originates from the ventral aspect of the abdominal aorta at the level of junction between T12 and L1 vertebrae.It is about1.5-2cm in length 1 .It usually terminates by dividing into three main branches: left gastric, common hepatic and splenic arteries.Reported variations of the CT include its congenital absence 2 , bifurcation 3 and presence of collateral branches 4 .

Long coeliac trunk and its low origin and unusual branches:
a case report

Case report
During regular dissection classes for undergraduate medical students, we found variations in the upper abdominal arteries in an adult male cadaver aged approximately 65 years.The CT was 5 cm in length and took its origin opposite the second lumbar vertebra.It ran upwards behind the stomach and trifurcated into splenic, common hepatic and left gastric arteries.Before its trifurcation, close to its origin, it gave rise to the right and left inferior phrenic arteries (Figures 1 and 2).The inferior phrenic arteries ran upwards through the coeliac plexus, in front of the corresponding crus of the diaphragm to reach and supply the diaphragm.There were no variations in the course and distribution of the major branches of the CT.

Discussion
The CT is the first ventral branch of the abdominal aorta.It supplies all the derivatives of the foregut situated in the abdomen.Several variations of CT have been reported in the past.It exhibits normal branching pattern in about 89% of cases 5 .The additional branches of the CT, other than its normal three branches are referred to as collaterals.CT gives collaterals in 23.7% cases 3 .Reported collaterals of CT are the gastroduodenal artery, inferior phrenic artery, superior mesenteric artery, middle colic artery and left superior and middle suprarenal artery 6 .It is very rare to have the origin of inferior phrenic artery from CT bilaterally.However, a case of origin of inferior phrenic artery from CT has been reported 7 .Origin of the inferior phrenic artery and left gastric artery as a common trunk from the CT has also been reported 8 .It is extremely rare to have a long CT, but a case of long CT has also been reported 9 .
Low level of origin of CT is an extremely rare variation.The current case is unique because of the presence of a long CT that took origin from the abdominal aorta at the level of the second lumbar vertebra.The knowledge of variations in its level of origin and branching pattern is of utmost importance for radiologists.It is very useful for radiologists and surgeons dealing with hepatic tumours and liver transplant surgeries 10 .Extremely long CT and its low origin reported in the current case might lead to its iatrogenic injuries during surgeries of kidney, stomach and duodenum.It can also impede the invasive radiological procedures.