The clinical and operative impact of the hexafurcation of the celiac trunk - Report of an extremely rare case

The celiac trunk is a main splanchnic artery that supplies the intra-abdominal organs of the upper gastrointestinal system. Anatomic variations of the celiac trunk are encountered in 10% of the population, but can pose challenges to many surgical and interventional procedures. We present here a case of hexafurcation of the celiac trunk discovered preoperatively after image staging for gastric cancer. The branches of the celiac trunk were: left and right inferior phrenic artery, arc of Buhler along with the common pattern of common hepatic, left gastric and splenic artery. The highlight of the case is the rarity of this specific pattern, which is seen in less than 1% of the population, and also the presence of an anastomotic path, the arc of Bühler, as a branch of the celiac trunk. It is evident that the variations of the celiac trunk play a major role in operations of the upper abdomen, radiological interventional procedures and other uncommon cases. Thus, the surgeon must be aware of these variations and their frequency to avoid complications. Also, any physician should report any variation discovered, accidentally or not, to help the literature to be updated. Key words: Computed tomography – Arc of Bühler – Inferior phrenic arteries variations – Celiac trunk variations – Celiac trunk hexafurcation