IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)

e-ISSN: 2279-0853, p-ISSN: 2279-0861. Volume 8, Issue 6 (Jul.- Aug. 2013), PP 60-65
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Study of Coeliac Trunk – Length and Its Branching Pattern

Suman Tiwari1, K. Jeyanthi2
1
(Department of Anatomy, MVJ Medical college, Bangalore India)
2
(Department of Anatomy, Kempegowda Institute of Medical sciences, Bangalore India)

Abstract: The coeliac trunk is a surgically significant artery of the abdomen which supplies the supracolic
organs. Variations of these arteries are important from a surgical perspective. In the present study, the length
of coeliac trunk and its branching pattern was noted in 50 embalmed human cadavers. The length of coeliac
trunk was correlated with its branching pattern. The specimens were studied by dissection method at the
Department of Anatomy, KIMS and other medical colleges in and around Bangalore. The maximum number of
specimens of coeliac trunk had a length ranging from 1.3-1.8 cm which was observed in 20 (40%) specimens.
84% of the specimens studied showed trifurcation. Quadrifurcation was seen in 8%, pentafurcation in 6% and
bifurcation in 2% specimens. A smaller length of coeliac trunk was associated with varying branching pattern.
This knowledge of the varied branching patterns forms the basis for surgical and radiological procedures in the
upper abdomen.
Keywords: Branching pattern, common hepatic artery, left gastric artery, splenic artery, variations of coeliac
trunk.

I. Introduction
The coeliac trunk is a wide ventral branch of abdominal aorta measuring about 1.25 cm in length and
arising just below the aortic hiatus opposite the lower border of T12. It passes almost horizontally forwards and
slightly right above the pancreas and splenic vein, dividing into left gastric, splenic and common hepatic
arteries. [1]
The most common classical type of variation of coeliac trunk is known as trifurcation and was first
observed by Haller as tripus Halleri. It was, and still is, considered to be the normal appearance of coeliac trunk.
According to Haller, coeliac trunk divides into common hepatic, splenic and left gastric arteries, while the other
divisions of coeliac trunk rarely occur in human populations. Past research on cadavers and living persons has
shown a plethora of variations. About 15% of the population displays significant variations from the typical
branching pattern.
Investigations have shown that the coeliac trunk can divide into 2-6 branches. Depending on the
number of divisions that are made, there are 6 main categories of coeliac trunk variation. They are bifurcation,
trifurcation, quadrifurcation, pentafurcation and even hexafurcation. One of the important variations is the
origin of dorsal pancreatic artery from coeliac trunk. This variation is significant to a surgeon during different
pancreatic procedures, splenectomies and resections for which knowledge of the gastric arteries is required. [2]
The variations in the anatomy of the trunk must be understood carefully to make proper adjustments in
anastamosing the proper arteries in surgeries of the supracolic region. The knowledge of variations of coeliac
trunk and their sub-types is fundamental for a correct pre-operative vascular planning in surgical and
radiological abdominal procedures like liver transplantation and hepatic arterial infusion chemotherapy via
catheters for therapy of unresectable advanced liver malignancies. [3]
Petrella [4] examined 89 cadavers and observed the length of the coeliac trunk and variation of its branches.
The mean length of the coeliac trunk was 1.23 cm in males and 1.18 cm in females. In 73 (82.02%) out of the
89 cadavers, the coeliac trunk emitted the left gastric, splenic and common hepatic arteries and in the remaining
16 (17.98%) variations were observed.
Mburu [5] studied 123 specimens of coeliac trunk in Kenyan population and found that the coeliac
trunk was trifurcated in 76 (61.7%), bifurcated in 22 (17.9%) and gave collateral branches in 25 (20.3%). The
frequency of occurance of variations of branching pattern of coeliac trunk is variable in the literature. The
present work has been undertaken to describe length of coeliac trunk, variations in its branching pattern and to
correlate the length of the coeliac trunk with its branching pattern in south Indian adult population.

II. Materials and methods

A total of 50 embalmed human cadavers were dissected. The cadavers were from south Indian adult
population and comprised of 42 males and 8 females. The gross dissection was done following the guidelines of
Cunningham’s manual. After the peritoneum was studied the peritoneal cavity was opened. The anterior layer
of peritoneum from the lesser omentum was removed close to the lesser curvature of the stomach. Left gastric

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 Study Of Coeliac Trunk – Length And Its Branching Pattern

artery was identified and traced till it curves posteriorly around the superior surface of the omental bursa. The
right gastric artery was identified and traced to the proper hepatic artery. The proper hepatic artery and its
branches to the porta hepatis were exposed and cleaned.
The coeliac trunk is identified and the dense autonomic plexus from its branches removed. The length
of the trunk from its origin up to its emission of the first branch was measured using sliding calipers. The mean
and standard deviation was calculated for the length of the trunk. The branching pattern was noted in each
specimen. After observation, the moisture over the artery and nearby areas was removed with filter paper. All
the specimens were duly numbered and photographed. The data obtained was recorded, analyzed and compared
with that of previous studies.
Descriptive statistical analysis has been carried out in the present study. Results on continuous
measurements are presented on Mean  SD (Min-Max) and results on categorical measurements are presented
in Number (%). Significance is assessed at 5 % level of significance. Student t test ( two tailed, independent)
has been used to find the significance of study parameters on continuous scale between two groups (Inter group
analysis) on metric parameters, Chi-square/ Fisher Exact test has been used to find the significance of study
parameters on categorical scale between two or more groups.

III. Results
The following observations were recorded. The length of the coeliac trunk in males and females are
shown in Table 1. The maximum number of specimens had a length ranging from 1.3-1.8 cm, which was
observed in 20(40%) specimens. This is followed by 0.6-1.2 cm which was observed in 15(30%) specimens. In
9(18%) specimens, the length was <0.6 cm and in 6(12%), the length was between 1.9-2.5 cm. Statistical
analysis showed that mean length of the coeliac trunk is more in males compared to females with P value of
0.304.
The different branching patterns that were observed are shown in Table 2. Significant deviation is
observed in females compared to males in branching pattern with P=0.076+
Trifurcation was observed in 42(84%) specimens. Out of 42(84%) specimens, 40(80%) specimens
showed classical trifurcation in which the coeliac trunk divided into common hepatic, splenic and left gastric
arteries. 1 (2%) specimen trifurcated into left gastric, splenic and right inferior phrenic arteries. The common
hepatic artery in that specimen was seen arising from the superior mesenteric artery. In another 1(2%)
specimen, the coeliac trunk trifurcated into common hepatic, splenic, right gastric arteries and left gastric artery
arose directly from the abdominal aorta. (Fig 3) Bifurcation of the coeliac trunk into common hepatic and
splenic artery was observed in 1(2%) specimen. In that specimen, the left gastric artery arose directly from the
abdominal aorta. (Fig 1) Quadrifurcation and pentafurcation of the coeliac trunk was observed in 4(8%) and
3(6%) specimens respectively. In quadrifurcation and pentafurcation, the common hepatic, splenic and left
gastric arteries are the constant branches with the addition of dorsal pancreatic, gastroduodenal and inferior
phrenic arteries. (Fig 5&7)
The length of coeliac trunk is correlated with its branching pattern. (Table 3) Length is significantly
associated with branching pattern with P=0.001** (4x4 Fisher Exact test) and showed the association of varying
branching pattern with smaller length of coeliac trunk.

IV. Discussion
The studies conducted by Saeed [6] on 20 cadavers showed that in 60% of cases, the length of the
coeliac trunk was between 1.3-1.8 cm. In the present study, in 40% of the specimens, the length of coeliac trunk
ranged from 1.3-1.8 cm. Petrella [4] had found the mean length of coeliac trunk was 1.24 cm in males and 1.18
cm in females. The results of the present study are similar to Petrella’s where the mean length was 1.24 cm in
males and 1.01 cm in females.
The prevalence of variations of branching pattern of coeliac trunk noted by previous authors in their
studies is summarized in Table 4. From the Table 4, it is evident that in the studies conducted by Petrella [4],
Urugel [7] and the present one, except Mburu [5], above 80% of cases of coeliac trunk showed classical
trifurcation.
Yildirim [8] dissected the upper abdominal region of 52 cadavers and observed in one case, a
hepatosplenic trunk with the left gastric artery directly originating from the abdominal aorta. In the present
study, in 2(4%) specimens, the left gastric artery arose directly from the abdominal aorta. The left gastric artery
is a mobile vessel whose origin may vary between the aorta and anywhere along the coeliac trunk up to a
trifurcation. The origin of left gastric artery from the aorta has importance in operative procedures on supracolic
organs, in stomach resection and during dissection of lymph nodes along this artery in gastric cancer.
Pulakunta [9] had observed the origin of inferior phrenic arteries in 4(12.5%) out of 32 cases. The
present study showed the origin of inferior phrenic arteries from coeliac trunk in 5 (10%) specimens. The
variations of inferior phrenic arteries are important for surgeons to avoid unintentional sectioning of small

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 Study Of Coeliac Trunk – Length And Its Branching Pattern

caliber arteries during coeliac artery decompression in the compression syndrome of coeliac trunk by the
median arcuate ligament. [9, 10]
All these variations have embryological basis. During development, each primitive dorsal aorta gives
off ventral splanchnic arteries, lateral splanchnic arteries and somatic arteries. As the embryo continues to
develop, most of the segmental arteries regress, except for the precursors of the segmental arteries to the three
major mesenteric vessels. The 10th segmental artery forms the coeliac trunk which supplies the foregut. The
13th segmental artery becomes the superior mesenteric artery for the midgut, and the 22nd segmental develops
into the inferior mesenteric artery for the hindgut. Anatomic variations of the coeliac trunk occur as a result of
developmental changes in the ventral arteries of the visceral organs. [1, 11, 12] Some of the other important
factors that cause variable anatomy of coeliac axis include rotation of the mid-gut and its physiological
herniation during development, leftward migration of the spleen and haemodynamic changes in the abdominal
viscera. [5]
In this study, a long coeliac trunk showed only trifurcation and coeliac trunk with a smaller length
showed varying branching pattern. If coeliac trunk is of greater length than normal, the surrounding tissues
could be more susceptible to disease. Patients who present with stomach pain should be evaluated for coeliac
trunk compression syndrome arising from the probable existence of a congenitally formed extended coeliac
trunk. [2]

V. Conclusion
To conclude, the coeliac trunk which is the artery of the foregut is known for its variation. The
variations were seen in the length and branching pattern. The branching pattern varied from bifurcation to
pentafurcation with trifurcation as a common pattern. There was a significant association between short coeliac
trunk and varying branching pattern. These variations should be kept in mind during surgical and radiological
procedures in upper abdomen to avoid intraoperative and post –operative complications.

Acknowledgement
I am extremely grateful to Dr. K.Jeyanthi, Associate professor, Department of Anatomy for her
constant encouragement, patience and support.
I sincerely thank our principal of KIMS, Bangalore, for giving me permission to carry out the research
work.

References
[1] WilliamsPL.,Bannister.L.H.,Berry.M.M.,Collins.P.,Dyson.M.,Dussek.J.E.et.al. Gray’s anatomy 38 th.ed.churchill Livingstone, 2000,
1548-1552.
[2] Gielecki J., Zurada A., Sonpal N., Jabtonska B., “The clinical relevance of coeliac trunk variations.” Folia Morphol. 2005;
64(3):123-129.
[3] Iezzi.R.,Cotroneo.A.R.,Giancristofaro.D.,Santoro.M.,Storto.M.L.,“Multidetector-row CT angiographic imaging of the coeliac trunk
:anatomy and normal variants.” 2008; 30(4):303-310
[4] Petrella S, Rodriguez CFS, Sgrott EA, Fernandes GJM, Marques SR, Prates JC. Anatomy and variations of coeliac trunk. Int J.
Morphology, 2007; 25(2): 249-257.
[5] Mburu KS, Alexander OJ, Hassan S, Bernard N. Variations in the branching pattern of the coeliac trunk in Kenyan population. Int.
J. Morphol., 2010; 28(1):199-204.
[6] Saeed M, Rufal AA. Duplication of hepatic artery. Saudi J Gastroenterology 2001; 7(3):103-108
[7] Urugel MS, Battal B, Bozlar U, Nural MS, Tasar M,ORS F et al. Anatomical variations of hepatic arterial system, coeliac trunk and
renal arteries: an analysis with multidetector CT angiography. British journal of radiology June 15 2010
[8] Yildirim M., Ozan H., Kutoglu T., Anatomic variations “Left gastric artery originating directly from the aorta.” Journal of surgical
and radiological anatomy, 2005; 20(4):303-305.
[9] Pulakunta T, Potu BK, Gorantla VR, Rao MS, Madhyastha S, Vollala VR. The origin of the inferior phrenic artery: a study in 32
South Indian cadavers with a review of literature. J Vasc Bras 2007; 6(3):225-230.
[10] Petrella S, Rodrigues CFS, Sgrott EA, Fernandez GJM, Marques SR, Prates JC. “Origin of inferior phrenic arteries in the coeliac
trunk.” Int. J. Morphology., 2006; 24(2):275-278.
[11] Douard R, Chevallier J, Delmas V, Cugnenc P. Clinical interest of digestive arterial trunk anastamoses. Surg Radiol Anat 2006; 28:
219-227.
[12] Cavdar S, Sehirli U, Pekin B. Coeliacomesenteric trunk. Clinical anatomy 1997; 10:231-234.

Table 1: Length of the coeliac trunk in males and females

Length of trunk Male Female Total
(cm) No % No % No %
<0.6 5 11.9 4 50.0 9 18.0
0.6-1.2 14 33.3 1 12.5 15 30.0
1.3-1.8 18 42.9 2 25.0 20 40.0
1.9-2.5 5 11.9 1 12.5 6 12.0
Total 42 100.0 8 100.0 50 100.0
Mean ± SD 1.24±0.51 1.01±0.81 1.20±0.56
Inference Mean length of coeliac trunk is more in males compared to females with P=0.304

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Table 2: Branching pattern of coeliac trunk in males and females

Male Female Total
Branching pattern
No % No % No %
Bifurcation 0 0.0 1 12.5 1 2.0
Trifurcation 37 88.1 5 62.5 42 84.0
Quadrifurcation 3 7.1 1 12.5 4 8.0
Pentafurcation 2 4.8 1 12.5 3 6.0
Total 42 100.0 8 100.0 50 100.0
Significant deviation is observed in females compared to males in branching pattern with
Inference
P=0.076+

Table 3: Correlation of length of coeliac trunk with its branching pattern

Branching pattern
Length
Bifurcation Trifurcation Quadrifurcation Pentafurcation
<0.6 1(100.0%) 5(11.9%) 0 3(100.0%)
0.6-1.2 0 11(26.2%) 4(100.0%) 0
1.3-1.8 0 20(47.6%) 0 0
1.9-2.5 0 6(14.3%) 0 0
Total 1(100.0%) 42(100.0%) 4(100.0%) 3(100.0%)
Length is significantly associated with Branching pattern with P=0.001** (4x4 Fisher Exact
Inference
test)

Table 4: Comparison of branching pattern of coeliac trunk found in earlier studies with the present study
Author Number of specimens Classical (LGA,CHA,SA) Variant
trifurcation
Petrella (2007) 89 82.02% 17.98%
Urugel(2009) 100 89% 11%
Mburu (2010) 123 61.8% 38.2%
Present 50 80% 20%
study(2010)

.
.

LGA
CT

SA
CHA

Fig 2: Diagrammatic representation of Fig 1

Fig 1: Bifurcation of coeliac trunk into common
hepatic and splenic arteries. The left gastric artery
was seen arising from the abdominal aorta.

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 Study Of Coeliac Trunk – Length And Its Branching Pattern

Fig 4: Diagrammatic representation

of Fig 3

Fig 3: Variant trifurcation of coeliac trunk into common hepatic,

splenic and right gastric arteries. The left gastric artery was seen
arising from the abdominal aorta.

Fig 5: Quadrifurcation of coeliac trunk into common hepatic, splenic, left gastric and gastroduodenal
arteries.

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 Study Of Coeliac Trunk – Length And Its Branching Pattern

Fig 7: Pentafurcation of the coeliac trunk into common hepatic, splenic, left gastric, dorsal pancreatic
and left inferior phrenic arteries

Legends for photos &tables.

CT- Coeliac Trunk
LGA- Left Gastric Artery
CHA- Common Hepatic Artery
SA- Splenic Artery
Pa- Pancreas
RGA- Right Gastric Artery.
GDA- Gastroduodenal Artery.
DPA- Dorsal Pancreatic Artery
LIPA- Left Inferior Phrenic Artery.

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