A Rare Clinical Case of Celiac Trunk Anatomy in a Patient with Siewert III Cardioesophageal Junction Cancer

Abstract

Abstract Purpose: The normal anatomy of the celiac trunk (CT) is characterized by splitting into three branches in approximately 80% of cases. In other cases, multiple anatomical variations can be observed. The purpose of this study was to review the clinical case featuring an extremely rare location of common hepatic artery (CHA) and to emphasize the importance of being familiar with possible anatomical variations of the hepatic artery through preoperative imaging in preparation for oncological surgery. Methods: We report a rare anatomical variation of replaced common hepatic artery, when it is located as VI type of Hiatt’s classification – CHA branching from abdominal aorta (AA). It was discovered during contrast-enhanced computed tomography and illustrated by 3D reconstruction of vascular architectonics of the celiac trunk. Results: A 71-year-old patient presented with Siewert III cardioesophageal junction cancer with liver metastases (T2N2M1, stage IV). Preoperative contrast-enhanced computed tomography (CECT) showed that the CHA branched from the AA. The operation included the proximal resection of the stomach and abdominal esophagus, D2 lymph nodes dissection, peritumoral liver resection, and extramucosal pyloroplasty. Conclusion: This case shows the importance of preoperative preparation using CECT to identify anatomical variations of the CHA, particularly for patients with locally advanced and metastatic cancer. This is due to the fact that the CHA is an important intraoperative landmark in the process of lymph nodes dissection, and awareness of its rare anatomical variation allowed us to shorten the operation time and reduce the risk of intra- and postoperative complications.