Celiac Trunk

The celiac trunk is a short, unpaired arterial branch arising from the anterior aspect of the abdominal aorta. It is the first major unpaired visceral branch of the abdominal aorta and provides the principal arterial supply to structures derived from the embryological foregut.

The vessel usually arises just inferior to the aortic hiatus of the diaphragm, near the T12-L1 vertebral level. After a short course, it typically divides into three major branches: the left gastric artery, splenic artery, and common hepatic artery.

Because these branches supply the stomach, liver, spleen, pancreas, proximal duodenum, and portions of the abdominal esophagus, the celiac trunk is a central component of the arterial circulation of the upper abdomen.

Origin

The celiac trunk arises from the anterior surface of the abdominal aorta shortly after the aorta passes through the diaphragm.

Its origin is usually located near the level of the T12 vertebra or T12-L1 intervertebral region, although the exact level varies among individuals.

Relationship to the Aortic Hiatus

The abdominal aorta enters the abdomen through the aortic hiatus of the diaphragm at approximately the T12 vertebral level.

The celiac trunk arises shortly inferior to this opening, making it one of the first major branches encountered along the abdominal aorta.

Course

The celiac trunk is usually a relatively short vessel, commonly measuring only a few centimeters or less before dividing.

It passes anteriorly from the aorta and rapidly gives rise to its major branches in the upper retroperitoneal region.

Major Branches

The classic branching pattern of the celiac trunk consists of three arteries.

Branch	Principal Distribution
Left gastric artery	Abdominal esophagus and lesser curvature of stomach
Splenic artery	Spleen, pancreas and portions of stomach
Common hepatic artery	Liver, gallbladder, stomach, duodenum and pancreas through its branches

Left Gastric Artery

The left gastric artery is usually the smallest of the three principal branches of the celiac trunk.

It ascends toward the gastroesophageal region and then follows the lesser curvature of the stomach.

Esophageal Branches

The left gastric artery gives branches to the lower abdominal portion of the esophagus.

These vessels participate in arterial anastomoses with esophageal branches arising from thoracic vessels.

Gastric Distribution

Along the lesser curvature, the left gastric artery supplies the stomach and anastomoses with the right gastric artery.

This anastomosis contributes to the rich arterial network of the gastric wall.

Splenic Artery

The splenic artery is typically the largest branch of the celiac trunk.

It follows a characteristically tortuous course toward the left, running along the superior border of the pancreas toward the spleen.

Relationship to the Pancreas

The splenic artery travels closely along the superior border of the pancreas.

During its course it gives multiple pancreatic branches that contribute to the arterial supply of the gland.

Short Gastric Arteries

Near the spleen, branches of the splenic artery give rise to the short gastric arteries.

These vessels supply the fundus and adjacent superior portions of the stomach.

Left Gastro-Omental Artery

The splenic artery also gives rise to the left gastro-omental artery, also called the left gastroepiploic artery.

This vessel follows the greater curvature of the stomach and anastomoses with the right gastro-omental artery.

Common Hepatic Artery

The common hepatic artery typically passes toward the right from the celiac trunk.

Its branches contribute to the arterial supply of the liver, gallbladder, stomach, proximal duodenum, and pancreas.

Proper Hepatic Artery

The common hepatic artery continues through its branching pattern to form the proper hepatic artery.

The proper hepatic artery ascends within the hepatoduodenal ligament toward the liver and usually divides into right and left hepatic arteries.

Gastroduodenal Artery

The gastroduodenal artery usually arises from the common hepatic artery and descends posterior to the proximal duodenum.

Its branches contribute to the arterial supply of the stomach, duodenum, and pancreas.

Right Gastro-Omental Artery

The right gastro-omental artery usually arises from the gastroduodenal artery.

It follows the greater curvature of the stomach and anastomoses with the left gastro-omental artery.

Superior Pancreaticoduodenal Arteries

The gastroduodenal artery gives rise to superior pancreaticoduodenal branches that supply the proximal duodenum and head of the pancreas.

These vessels anastomose with inferior pancreaticoduodenal branches from the superior mesenteric artery.

Foregut Supply

The celiac trunk is classically described as the arterial supply of the foregut.

This embryological relationship provides a useful framework for understanding its distribution.

Structures Supplied

Structure	Major Celiac-Derived Supply
Abdominal esophagus	Left gastric artery
Stomach	Gastric, short gastric and gastro-omental branches
Liver	Hepatic arterial branches
Gallbladder	Usually cystic artery from right hepatic artery
Spleen	Splenic artery
Pancreas	Splenic and pancreaticoduodenal branches
Proximal duodenum	Gastroduodenal and superior pancreaticoduodenal branches

Relationship to the Superior Mesenteric Artery

The superior mesenteric artery arises from the abdominal aorta inferior to the celiac trunk.

It primarily supplies midgut-derived structures but communicates with the celiac circulation through pancreaticoduodenal arterial arcades.

Pancreaticoduodenal Anastomosis

The superior pancreaticoduodenal arteries from the celiac system anastomose with the inferior pancreaticoduodenal arteries from the superior mesenteric artery.

This creates an important arterial connection between the foregut and midgut circulations.

Relationship to the Inferior Mesenteric Artery

The inferior mesenteric artery arises farther inferiorly from the abdominal aorta and primarily supplies hindgut-derived structures.

Together, the celiac, superior mesenteric, and inferior mesenteric arteries form the three major unpaired anterior visceral branches of the abdominal aorta.

Major Unpaired Visceral Branches

Artery	Primary Embryological Territory	Approximate Origin
Celiac trunk	Foregut	T12-L1 region
Superior mesenteric artery	Midgut	Approximately L1
Inferior mesenteric artery	Hindgut	Approximately L3

Celiac Plexus

The celiac trunk is surrounded by the celiac plexus, a major autonomic nerve network of the upper abdomen.

The plexus distributes sympathetic and parasympathetic fibers to abdominal viscera along arterial pathways.

Celiac Ganglia

The paired celiac ganglia lie near the origin of the celiac trunk and form important components of the prevertebral sympathetic system.

Preganglionic sympathetic fibers reaching this region travel mainly through the greater thoracic splanchnic nerves.

Parasympathetic Innervation

Parasympathetic fibers associated with foregut organs are primarily derived from the vagus nerves.

These fibers pass through autonomic plexuses around the celiac arterial branches toward their target organs.

Relationship to the Pancreas

The celiac trunk arises superior to the pancreas, while several of its branches have close relationships with the gland.

The splenic artery follows the superior pancreatic border, and pancreatic branches from the celiac system contribute substantially to pancreatic perfusion.

Relationship to the Stomach

Multiple branches derived from the celiac trunk form extensive arterial anastomoses along the lesser and greater curvatures and around the gastric fundus.

This rich vascular network provides multiple routes of arterial supply to the stomach.

Relationship to the Liver

The liver receives oxygenated arterial blood through hepatic arterial branches ultimately derived in the classic pattern from the common hepatic artery.

The hepatic artery travels with the portal vein and bile duct within the hepatoduodenal ligament.

Relationship to the Portal Triad

Within the hepatoduodenal ligament, the proper hepatic artery is one of the structures forming the portal triad.

The other major components are the portal vein and the bile duct.

Arterial Anastomoses

The celiac arterial system contains numerous anastomoses that provide connections among its branches and with neighboring arterial territories.

Important examples include the gastric, gastro-omental, and pancreaticoduodenal anastomoses.

Major Anastomotic Pathways

Anastomosis	Participating Vessels
Lesser curvature	Left and right gastric arteries
Greater curvature	Left and right gastro-omental arteries
Pancreaticoduodenal region	Superior and inferior pancreaticoduodenal arteries

Branching Variations

The classic three-branch pattern is common but not universal.

The origin and arrangement of the left gastric, splenic, common hepatic, and neighboring arteries can vary considerably.

Hepatic Artery Variation

Hepatic arterial anatomy is particularly variable.

Accessory or replaced hepatic arteries may arise from vessels such as the superior mesenteric artery or left gastric artery rather than following the classic pattern.

Celiacomesenteric Variations

Rare variations can involve shared or altered origins between branches normally associated with the celiac trunk and superior mesenteric artery.

Recognition of these patterns is important during vascular imaging and upper abdominal surgery.

Clinical Significance

Celiac Artery Stenosis

Narrowing of the celiac trunk can reduce direct blood flow to its distribution.

The clinical consequences depend on severity, collateral circulation, associated vascular disease, and the involvement of other mesenteric vessels.

Median Arcuate Ligament Compression

The proximal celiac artery can lie close to the median arcuate ligament of the diaphragm.

In some individuals, the ligament crosses low enough to compress the proximal celiac artery, producing a characteristic anatomical relationship that may be visible on imaging.

Aneurysm

Aneurysmal dilation can involve the celiac trunk or its branches, including the splenic and hepatic arteries.

The anatomical consequences vary according to the vessel involved, aneurysm size, and surrounding structures.

Upper Gastrointestinal Bleeding

Several arteries derived from the celiac trunk can be sources of upper gastrointestinal hemorrhage.

Knowledge of the arterial branching pattern is essential for angiographic localization and endovascular treatment.

Peptic Ulcer Disease

Ulceration of the posterior proximal duodenum can involve the nearby gastroduodenal artery and cause significant bleeding.

This relationship is a classic example of the clinical importance of celiac-derived arterial anatomy.

Splenic Injury

The spleen has a rich arterial supply from the splenic artery and its terminal branches.

Traumatic splenic injury can therefore produce substantial intra-abdominal hemorrhage.

Pancreatic Surgery

The close relationships among the celiac branches, pancreas, duodenum, liver, and stomach are important during pancreatic and upper gastrointestinal surgery.

Arterial variation must be identified when possible because unexpected branching patterns can affect operative planning.

Liver Surgery and Transplantation

Detailed knowledge of hepatic arterial anatomy is essential during liver resection and transplantation.

Accessory and replaced hepatic arteries can significantly alter the expected vascular anatomy.

Angiography

The celiac trunk can be evaluated using catheter angiography, CT angiography, MR angiography, and other vascular imaging techniques.

Imaging demonstrates the origin, branching pattern, stenosis, aneurysm, collateral vessels, and anatomical variation.

Celiac Trunk Versus Superior Mesenteric Artery

Feature	Celiac Trunk	Superior Mesenteric Artery
Origin	Anterior abdominal aorta near T12-L1	Anterior abdominal aorta near L1
Main territory	Foregut	Midgut
Major initial pattern	Left gastric, splenic, common hepatic	Multiple intestinal and colic branches
Important connection	Superior pancreaticoduodenal arteries	Inferior pancreaticoduodenal artery

Key Anatomical Features

Feature	Key Point
Parent vessel	Abdominal aorta
Type	Unpaired anterior visceral branch
Approximate level	T12-L1 region
Embryological territory	Foregut
Classic branches	Left gastric, splenic and common hepatic arteries
Major organs supplied	Stomach, liver, spleen, pancreas and proximal duodenum
Neural relationship	Celiac plexus and ganglia
Connection with SMA	Pancreaticoduodenal arcades
Important variation	Variable hepatic and celiac branching patterns
Clinical importance	Upper abdominal surgery, angiography, stenosis and hemorrhage

Anatomical Importance

The celiac trunk is the principal arterial gateway to the foregut-derived organs of the upper abdomen. Arising from the anterior abdominal aorta near the T12-L1 region, it normally divides after a short course into the left gastric, splenic, and common hepatic arteries.

Through these branches and their extensive secondary vessels, the celiac circulation supplies the abdominal esophagus, stomach, liver, gallbladder, spleen, pancreas, and proximal duodenum. Anastomoses along the stomach and around the pancreas and duodenum create important connections within the celiac system and with the superior mesenteric circulation.

The celiac trunk is also surrounded by major autonomic neural structures and demonstrates considerable anatomical variation. These features make detailed knowledge of its anatomy essential in upper abdominal surgery, vascular imaging, interventional procedures, assessment of gastrointestinal bleeding, and evaluation of arterial compression or occlusive disease.