Challenging arterial pattern of foregut and its potential impact on surgery

Anticipating a wide range of morphological variations of arterial anatomy of foregut derivatives beyond theclassical pattern, a precise understanding is pertinent to preoperative diagnosis, operative procedure and to avoid potentiallydevastating post-operative outcome during various traumatic and non-traumatic vascular insult of foregut. The study aimedto revisit the morphological details and update unusual configurations of arteries of foregut to establish clinico-anatomicalcorrelations. This study described the detailed branching pattern of coeliac trunk (CT) as principal artery of foregut withsource & course of hepatic, gastric, duodenal and pancreatic branches in 58 cadaveric dissections. Based on morphology,different types and subtypes were made. The descriptions were explained using figures and pertinent tables. Among classicalbranches of CT, splenic artery was found as most stable whereas other two branches were found to be most variable withmissing common hepatic artery in 11 cases. In addition to classical trifurcation (65.52%), different types of bifurcation (12.07%)and tetrafurcations (22.41%) of CT were observed. Regarding variations of hepatic arteries (27.59%), both non-classical originand accessory hepatic branches were found. In case of gastric branches, more variant origins were seen with right gastric (50%)as compared to left gastric artery (34.48%). Other morphological variations included non-classical origin of gastro-duodenalartery (18.96%) along with presence of accessory pancreatic (17.13%) and duodenal arteries (6.38%). Awareness of anatomicalvariations regarding circulatory dynamics of foregut is worth knowing in order to facilitate successful planning of surgeryinvolving upper abdominal organs with least complications.