RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

ANNEXURE-I

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 / NAME OF THE CANDIDATE
AND ADDRESS / Dr. SUMAN TIWARI
W/O RAVI PRASAD R K,
163/1, FLAT NO - 2A,
BALAJI LAYOUT,
29TH CROSS, KAGGADASAPURA,
CV RAMAN NAGAR,
BANGALORE - 560093.
2 / NAME OF THE INSTITUTION / KEMPEGOWDA INSTITUTE OF MEDICAL SCIENCES,
BANASHANKARI II STAGE,
BANGALORE-560070.
3 / COURSE OF STUDY AND SUBJECT / POST GRADUATION IN ANATOMY
(MD ANATOMY)
4 / DATE OF ADMISSION TO COURSE / 30-5-2008
5 / TITLE OF TOPIC / “VARIATIONS OF THE COELIAC TRUNK AND ITS BRANCHING PATTERN”
6 / BRIEF RESUME OF THE INTENDED WORK:
6.1NEED FOR STUDY
6.2REVIEW OF LITERATURE
6.3OBJECTIVES OF THE STUDY / ENCLOSED - ANNEXURE II
ENCLOSED - ANNEXURE III
ENCLOSED - ANNEXURE IV
7 / MATERIALS AND METHODS:
7.1Source of data
7.2Method of collection of data
7.3Does this study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.
7.4Has ethical clearance been obtained from your institution in case of 7.3? / ENCLOSED - ANNEXURE V
ENCLOSED - ANNEXURE V
NO
YES
8 / LIST OF REFERENCES / ENCLOSED - ANNEXURE VI
9 / SIGNATURE OF CANDIDATE
10 / REMARKS OF THE GUIDE / DR. SUMAN TIWARI, POST-GRADUATE STUDENT, IS PURSUING STUDY ON “VARIATIONS OF THE COELIAC TRUNK AND ITS BRANCHING PATTERN” AS AN ORIGINAL WORK IN THE DEPARTMENT OF ANATOMY, KIMS, BANGALORE UNDER MY GUIDANCE.
11 / NAME AND DESIGNATION OF GUIDE / DR. JEYANTHI. K, M.D
ASSOCIATE PROFESSOR ,
DEPARTMENT OF ANATOMY,
KIMS, BANGALORE.
11.1 / SIGNATURE
11.2 / CO-GUIDE (IF ANY)
11.3 / SIGNATURE
11.4 / HEAD OF THE DEPARTMENT / DR. K.S. JAYANTHI, M.S.
PROFESSOR AND HOD,
DEPARTMENT OF ANATOMY,
KIMS, BANGALORE.
11.5 / SIGNATURE
12 / REMARKS OF THE CHAIRMAN AND PRINCIPAL
12.1 / SIGNATURE

RAJIV GANDHIUNIVERSITY OF HEALTH SCIENCES, KARNATAKA

BANGALORE

ANNEXURE-II

BRIEF RESUME OF THE INTENDED WORK

6.1INTRODUCTION/NEED FOR THE STUDY:

The coeliac trunk, a wide ventral branch, about1.25 cm long,just below the aortic hiatus,passes almost horizontally forwards and slightlyright above the pancreas and splenic vein,dividing into left gastric, splenic and common hepatic arteries. It is related anteriorly to the omental bursa (lesser sac); on the right to the right coeliac ganglion and right crus of diaphragm and on the left to the left coeliac ganglion and left crus of diaphragm.Variations in the arrangement of these arteries and their branches are common and surgically important1.

The coeliac trunk may be absent; the branches usually arising from it then arise from the aorta. In one case, the splenic gave rise to the left gastric, and the common hepatic originated from the superior mesenteric. The trunk may be shorter or longer than usual2.

Past research on cadavers and living persons has shown a plethora of variations.About 15% of the population displays significantvariations from the typical branching pattern.

Investigations have shown that the coeliac trunk can divide into 2-6 branches. The variations in the anatomy of the trunk must be understood carefully to make proper adjustments in anastamosing the proper arteries in post-operative closing. The direction of coeliac trunk also varies between individuals which is influencedby the origin of the hepatic artery. Knowledge about the variations of hepatic artery are important in liver transplantation, partial hepatectomy, gastric resection and during pancreatico-duodenectomy. Furthermore the arterial variations are important when matching organ procurements for transplantation3.

The origin of inferior phrenic arteries from the coeliac trunk was observed in 31 of the 89 (34.83%) analyzed cadavers4. Knowledge about this variation avoids unintentional sectioning of small caliber arteries, as it may occur during the coeliac artery decompression in the compression syndrome of the coeliac trunk by the median arcuate ligament.

The left gastric artery may arise directly from antero-lateral aspect of aorta. This becomes important in operative procedures of the supra-colic organs, in stomach resection and during dissection of lymph node along this artery in gastric cancer5. Also the variations of coeliac trunk will be useful for surgeons dealing with gastric and duodenal ulcers and also for minimizing blood loss during surgeries.

The knowledge of variationsof coeliac trunk and their sub-types is fundamental for a correct pre-operative vascular planningin surgical and radiological abdominal procedures like, liver transplantation and hepatic arterial infusion chemotherapy via cathetersfor therapy of unresectable advanced liver malignancies6.

Not many studies have been done on coeliac trunk and its variations in Karnataka population. Hence this study becomes essential.

ANNEXURE-III

6.2REVIEW OF LITERATURE:

  1. The coeliac trunk about 1.25 cm long originating below the aortic hiatus divides into left gastric, splenic and common hepatic arteries. It may also give off one or both inferior phrenic arteries. The superior mesenteric may arise with the coeliac trunk, or the latter’s usual branches may be direct independent branches of the aorta. An accessory left gastric artery may arise from the left branch of the hepatic artery. Hepatic artery may arise from superior mesenteric artery. Variations of hepatic artery which include the origin of common hepatic from superior mesenteric are common and surgically important.
  1. In the Compendium of Human Anatomic Variations, the following principal variations have been reported in coeliac trunk. The trunk may have only two branches, usually the splenic and the common hepatic, more rarely the left gastric and splenic, or it may have more than 3 branches. The additional branch may be one of the inferior phrenics, a gastro duodenal, a second left gastric, a superior mesenteric, a middle colic, a dorsal pancreatic artery, a trunk common for the inferior phrenics, or for inferior phrenic and left gastric artery. Cases of coeliac trunk in form of splenogastric trunk or a Hepatosuperior mesenteric trunk have been reported.
  1. The accessory left hepatic artery arising from coeliac trunk can replace the left branch of proper hepatic artery or provide additional source of vasculature supplying the liver. Sometimes accessory hepatic arteries were the only source of oxygenated blood supply. Hence knowledge of this is important during pancreatico-duodenectomy and operations of the biliary tract.
  1. Study done on abdominal cavity of 89 cadavers which were dissected in the laboratories of Anatomy of Federal university of Sao Paulo and Santo Amaro university showed that in 19 out of the 89 cadavers (21.35%) the inferior phrenic artery originating at the left contour of the celiac axis , in five cadavers (5.62%) , the phrenic artery presented its origin at the right contour and seven (7.86%) presented two phrenic arteries of which five were independently originated from each side of the coeliac trunk and two from one axis.
  1. During the dissection of a 48 year old male cadaver, the left gastric artery was observed directly originating from the abdominal aorta while the common hepatic and splenic arteries arose as a common trunk. The rare occurrence of this variation (0.5-15%) is due to the unusual embryologic development of the ventral splanchic arteries.
  1. A total of 555 Multidetector-row CTangiographies of the abdominal aorta done at Department of ClinicalScience and Bio-imaging, Italy were retrospectively reviewed to assess the coeliac trunk vascular anatomy and variations. The classical configuration of the coeliac trunk was detected in 72.1%; Hepato-splenic trunk in 5.4% of cases; Hepato-gastro-splenic trunk in 19.4% of cases and Gastro-splenic trunk in 2.3% of cases. Hepato-spleno-gastric trunk associated with hepatic arteries variants were found in 15.4% and in 0.6% absence of celiac trunk.

ANNEXURE-IV

6.3OBJECTIVES OF THE STUDY:

To study the variations of the coeliac trunk and its branching pattern under the following headings:

  1. Level of origin.
  1. Length of the trunk.
  1. Diameter of the trunk.
  1. Direction of the trunk
  1. Relations.
  1. Branching pattern.

ANNEXURE-V

7.1SOURCE OF DATA:

Abdomen of embalmed human cadavers from the Department of Anatomy, KIMS and other medical colleges in and around Bangalore.

INCLUSION CRITERIA:

Adults irrespective of male or female.

EXCLUSION CRITERIA:

New born, infants, children and cadavers with scar over the abdomen.

7.2METHOD OF COLLECTION OF DATA:

The study will be conducted on 50 adult human cadavers irrespective of their sex. Gross dissection of abdomen will be done by following the guidelines of Cunningham’s manual. The retroperitoneal coeliac trunk arising from abdominal aorta will be identified. Relevant findings regarding its level of origin, direction, branching pattern and immediate relations of the trunk will be noted. The external diameter of coeliac trunk and its length from its origin to the point where coeliac trunk gives off main branches will be measured. Statistical analysis will be done based on these measurements.

ANNEXURE-VI

LIST OF REFERENCES:

  1. Williams P. L, Bannister L. H,BerryM. M, Collins P, Dyson M,Dussek J.E.et.al.Gray’s anatomy 38thedition, churchill livingstone,2000,1548-1552.
  1. BergmanR. A, AfifiA.K,MiyauchiR, Coeliac trunk arteries.Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Abdomen. (
  1. Gielecki J, Zurada A, Sonpal N, Jabtonska B,2005“The clinical relevance of coeliac trunk variations.” Folia Morphol,64(3):123-129.
  1. Petrella S, Rodrigues C.F.S, Sgrott E.A, Fernandez G.J.M, Marques S.R Prates J.C, 2006 “Origin of inferior phrenic arteries in the coeliac trunk.”Int. J. Morhology, 24(2):275-278.
  1. Yildirim M., Ozan H., Kutoglu T,2005 Anatomic variations “Left gastric artery originating directly from the aorta”, Journal of surgical andradiological anatomy, 20(4):303-305.
  1. Iezzi.R, Cotroneo A.R,Giancristofaro D, Santoro M, Storto M. L,2008 “Multidetector-row CT angiographic imaging of the coeliac trunk:anatomy and normal variants”30(4):303-310.