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DOI: 10.17354/SUR/2016/20
Original Article
Variations in Origin of Gastroduodenal Artery:
A Cadaveric Study
Maneesh Joleya1, Seema Suryavanshi2, Dhananjay Sharma3
Assistant Professor, Department of Surgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India,
Associate Professor, Department of Surgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India,
3
Professor, Department of Surgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
1
2
Abstract
Background: Gastroduodenal artery (GDA) is usually the first branch of the common hepatic artery from celiac trunk. In
patients with chronic pancreatitis visceral artery aneurysms, incidence of up to 10% has been reported. The aneurysms occur
most frequently in the splenic artery (10.4%); the common hepatic, gastroduodenal (1.5%), and pancreaticoduodenal arteries
are affected.
Material and Methods: It was a cross-sectional study conducted in the Department of General Surgery and Forensic
Medicine, N.S.C.B. Medical College, Jabalpur during the period from August 2012 to August 2013. Abdomen of the cadaver
will be accessed by the standard postmortem midline incision (sternum to pubes). Vascular anatomy of the GDA and vein
will be dissected out in-situ using standard surgical instruments. The distance from the pylorus to the GDA will be measured
by measuring tape.
Results: In our study, out of total 31 cadavers, 19 (61.2%) were of male and 12 (38.8%) were of females. In all the cases, the site
of origin of GDA is from the celiac axis of the common hepatic artery. Out of total 19 male cadavers, 17 (89%) showed a distance
of 2.5-3 cm between pylorus and GDA and remaining 2 (11%) showed a distance of 3-3.5 cm.
Conclusion: In our study, GDA has been seen arising from common hepatic artery from the celiac axis in 100% of cases.
Previous studies have also given very less percentage of rare sites of origin but with the advent of newer modalities of
investigations such as Doppler studies and computed tomography angiograms this very less percentage of rare variations
can be diagnosed if there are knowledge and suspicion. This will help a lot to prevent major catastrophe during surgeries and
radiological interventions.
Keywords: Arterial steal syndrome, Cadaver, Common hepatic artery, Gastroduodenal artery, Superior pancreaticoduodenal artery
INTRODUCTION
G
astroduodenal artery (GDA) is usually the first
branch of the common hepatic artery from celiac
trunk. Arising posterior and superior to the first part of
the duodenum, it is short and wide. At the lower border
of the first part of the duodenum, it divides into the
right gastroepiploic and superior pancreaticoduodenal
arteries.1
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Month of Submission: 02-2016
Month of Peer Review: 03-2016
Month of Acceptance : 04-2016
Month of Publishing : 05-2016
The anatomical variations of the celiac trunk are due to
the unusual embryological development of the ventral
splanchnic branches of the aorta.2
In patients with chronic pancreatitis visceral artery
aneurysms, incidence of up to 10% has been reported.
The aneurysms occur most frequently in the splenic artery
(10.4%); the common hepatic, gastroduodenal (1.5%),
and pancreaticoduodenal arteries are affected.3,4
The superior pancreaticoduodenal artery descends
between the contiguous margins of the duodenum and
pancreas. It supplies both these organs. Its first branch is
posterior superior pancreaticoduodenal artery originating
at approximately the superior border of the duodenum
which courses along the concavity of the duodenum
posteriorly and anastomoses with the posterior inferior
Corresponding Author: Dr. Seema Suryavanshi, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India.
Phone: +91-9826619478. E-mail: [email protected]
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IJSS Journal of Surgery | May-June 2016 | Volume 2 | Issue 3
Joleya, et al.: Variations in Origin of Gastroduodenal Artery
pancreaticoduodenal artery. Just caudal to the origin
of superior pancreaticoduodenal artery three to five
branches arise from GDA which supplies posterior wall
of the duodenum to the anterior surface of the head
of the pancreas; this is the beginning area of fixation of the
superior surface of the duodenum. A lateral arcade, the
anterior superior pancreaticoduodenal artery turns
abruptly lateral to descend along the anterior concave
border of the duodenum and anastomoses with the
anterior inferior pancreaticoduodenal artery.
Because of this typical location and anatomical relation
of GDA, it’s good anatomical knowledge will be helpful
in dealing with cases of bleeding peptic ulcer which
requires gastroduodenal ligation. Peptic perforation
occurring at the bifurcation creates a three-vessel
operative problem.
Anatomical arrangement characteristic of the GDA
complex consists of the right angled anastomosis of the
transverse pancreatic artery with the GDA or either of its
two branches. Perforation at this junction creates a second
three-vessel situation.
To avoid early rebleeding, operative control of these openended arteries requires separate circumferential ligation.
Such circumferential ligation is establishing the presence
of a T or three-vessel complex. The consequent bleeding
must be then controlled by tying the third ligature (the
“U” stitch) proving that the ligatures have been properly
placed.
The arteries involved in gastrointestinal (GI) hemorrhage
in order of frequency include the splenic (40%),
gastroduodenal (30%), pancreaticoduodenal (20%),
gastric (5%), and hepatic arteries (2%).5
GDA aneurysm may present clinically with abdominal
pain, massive bleeding in the upper GI tract, jaundice,
or hemorrhage. Rarely is it discovered at laparotomy
performed for a different condition. In patients with
chronic pancreatitis presenting with acute upper GI
bleeding apart from common causes of bleeding, a rare
possibility of GDA aneurysm should be suspected. In
patients with chronic pancreatitis, any unexplained
bleeding in this location particularly if associated with
the sudden appearance of an abdominal mass with a
bruit should alert for the possibility of GDA aneurysm.6
The GDA steal syndrome during liver transplantation
was reported by Nishida et al.7 GDA is cannulated in the
procedure of hepatic arterial infusion pumps in hepatic
arterial chemotherapy and for liver and/or colon
resection. If the cannulated GDA is arising directly from
the celiac axis, the chemotherapeutic agents may reach
the left gastric or splenic arteries.
Arterial steal syndrome (ASS) after liver transplantation
has been reported. ASS causes arterial hypo-perfusion of
the graft liver and devastating consequences. However,
the diagnosis tends to be delayed. Most of the cases are
related to the splenic artery (lienalis steal syndrome).
However, some cases of GDA steal syndrome have also
been reported.8-10
Keeping in view the clinical significance and applied
importance of gastroduodenal anatomy and to add some
more knowledge to the existing ones, the present study
was undertaken, to know in detail the site of origin and
variations in the course.
MATERIALS AND METHODS
Type of Study
Cross-sectional study.
Place of Study
Department of General Surgery and Forensic Medicine,
N.S.C.B. Medical College, Jabalpur.
Ethical Clearance
Clearance will be obtained from the Institutional Ethics
Committee.
Duration of Study
August 2012 to August 2013.
Number of Cases
31 cadavers.
Inclusion Criteria
All fresh cadavers ≥18 years of age.
Exclusion Criteria
Cadavers of patients who had suffered blunt abdominal
trauma wherein presence of hematomas may mask the
vascular pattern.
Technique
Abdomen of the cadaver will be accessed by the standard
postmortem midline incision (sternum to pubes). Vascular
anatomy of the GDA and vein will be dissected out in-situ
using standard surgical instruments. The distance from the
pylorus to the GDA will be measured by measuring tape.
RESULTS
In our study, out of total 31 cadavers, 19 (61.2%) were
of male and 12 (38.8%) were of females. In all the cases,
the site of origin of the GDA is from the celiac axis of the
common hepatic artery. Distribution of the origin of the
GDA is given in Table 1.
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Joleya, et al.: Variations in Origin of Gastroduodenal Artery
Table 1: Site of origin of GDA
Site of origin
Common hepatic artery
Celiac axis
Male
cadavers
19
19
Female
cadavers
12
12
Total
(n=31)
31
31
computed tomography (CT) angiograms by Rawat.17
Peschaud et al., reported a retroportal common hepatic
artery.18
CONCLUSION
GDA: Gastroduodenal artery
Table 2: Distance from the pylorus to the GDA
Distance
Male
Female
2.5‑3 cm
17
11
3‑3.5 cm
2
1
GDA: Gastroduodenal artery
In our study, out of total 19 male cadavers, 17 (89%)
showed a distance of 2.5-3 cm between pylorus and GDA
and remaining 2 (11%) showed a distance of 3-3.5 cm
between pylorus and GDA. Distribution of the origin of
the GDA is given in Table 2.
DISCUSSION
In our study, the most common site of origin of the GDA
in both sex was from the common hepatic artery from
the celiac axis.
Lipshutz reported that the GDA was originated from the
common hepatic artery in 92.3% of cases.11 He observed
the origin of the GDA as the celiac trunk in 3 (3.61%)
out of the 83 cadavers.
The superior pancreaticoduodenal artery descends
between the contiguous margins of the duodenum and
pancreas. It supplies both these organs; it’s first branch is
posterior superior pancreaticoduodenal artery originating
at approximately the superior border of the duodenum
which courses along the concavity of the duodenum
posteriorly and anastomoses with the posterior inferior
pancreaticoduodenal artery. Just caudal to the origin
of superior pancreaticoduodenal artery three to five
branches arise from GDA, which supplies posterior wall
of the duodenum to the anterior surface of the head of
the pancreas, our study is in concordance with the above
findings.
Michels reported five cases (2.5%) in 200 dissections
with the GDA originating from the celiac trunk or the
superior mesenteric artery, without specifying the number
of origins from each artery.12,13
In the cadaveric study of Petrella et al., a higher incidence
of 6.74% was reported.14 Daseler et al., observed a single
case of GDA from the celiac trunk in 500 dissections.15
GDA arising from superior mesenteric artery has been
reported by Huu et al.16 GDA arising from right or left
hepatic artery has been reported in a study of 125
8
In our study, The GDA has been seen arising from common
hepatic artery from the celiac axis in 100% of cases.
Previous studies have also given very less percentage
of rare sites of origin but with the advent of newer
modalities of investigations such as Doppler studies and
CT angiograms this very less percentage of rare variations
can be diagnosed if there are knowledge and suspicion.
This will help a lot to prevent major catastrophe during
surgeries and radiological interventions.
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ligation of the hepatic artery and removal of the celiac axis.
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How to cite this article: Joleya M, Suryavanshi S, Sharma D.
Variations in Origin of Gastroduodenal Artery: A Cadaveric Study.
IJSS Journal of Surgery 2016;2(3):6-9.
Source of Support: Nil, Conflict of Interest: None declared.
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