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Findings: Selective superior mesenteric artery (SMA) injection was unremarkable. However, selection of the celiac trunk proved very difficult, so anteroposterior and lateral aortograms were performed, demonstrating a common origin of the celiac trunk and SMA. Selective injection of the celiac trunk subsequently demonstrated only spasm of the common hepatic and splenic arteries. The site of the patient's lower GI bleeding was never visualized.

Diagnosis: Common origin of the celiac trunk and SMA.

Discussion: Normally, the first major branch of the abdominal aorta is the celiac trunk which arises from the ventral surface of the aorta at the level of T12 or L1. The SMA usually arises at the L1 level and can be located 1-20 mm below the celiac axis. Classically, the celiac trunk trifurcates with the splenic, common hepatic, and left gastric arteries; however, multiple anatomic variants exist, particularly involving the hepatic arteries. The right hepatic artery arises from the SMA in 15% of people. The left hepatic artery arises from the left gastric 10% of the time. An accessory left hepatic artery from the left gastric artery can be seen in 8% of subjects, and an accessory right hepatic artery arises from the SMA with no supply from the celiac trunk 2% of the time. The anatomic variation demonstrated in this case, common origin of the celiac trunk and the SMA, is relatively uncommon and is seen in less than 1% of people.

References:
Crain MR and Mewissen MW. Abdominal Aortography. In: Abram's Angiography,
Volume II, 4th Edition. Ed. Baum S. Little, Brown and Company, Boston; 1997:1017-1020.

Rosenblum JD, et al. The Mesenteric Circulation. Anatomy and Physiology. Surg Clin North
Am April 1997; 77(2):289-306.

Weissleder R, et al. Primer of Diagnostic Imaging, 2nd Edition. Mosby, St. Louis; 1997:624-625.

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