A hepatomesenteric trunk, in association with left gastric and splenic arteries arising independently from the abdominal aorta: A case report using MDCT angiography

We present a case of a 73-year-old male with peripheral vascular disease of the lower limbs, who on shown MDCT angiography, to have a hepatomesenteric trunk (HMT), and left gastric artery (LGA) and splenic artery (SpA) arising independently from the abdominal aorta (AA), and with additional right renal arteries. The HMT with a length of 5 mm (with an aspect of a common stem origin of common hepatic artery (CHA) and superior mesenteric artery (SMA) arose from the anterior wall of the AA at the level of upper one-third of the L2 vertebral body. The CHA originating from the superior part of the right edge of the HMT, have an ascendent path in front of AA, and finally fork in gastroduodenal artery and hepatic artery proper. With a descending path the SMA across the left renal vein, uncinate process, and inferior part of the duodenum (D3) made an aortomesenteric angle of 61°. The aortomesenteric distance at the level of the L3 vertebral body was 51 mm. The present case is only the 13th reported HMT in association with an independently arising LGA and SpA from the AA, the first case report with this condition using MDCT angiography. Knowledge of the variations in origin and distribution of the HMT is important for planning and performing procedures such as duodenopancreatectomy, liver transplantation, and chemoembolization of the pancreas and hepatic tumors.