Significance of the dissection of common hepatic arterial lymph nodes in patients with oesophageal carcinoma: a multicentre retrospective study

ObjectivesTo explore the significance of intraoperative common hepatic arterial lymph node dissection in patients with ooesophageal squamous carcinoma (ESCC) without coeliac trunk lymph node metastasis indicated by abdominal enhanced CT.MethodsPatients aged 18–75 years who underwent oesophagectomy in three medical centres from June 2012 to June 2015, for whom R0 resection was completed and lymph node metastasis in the abdominal trunk was not identified before the operation were retrospectively analysed. The effects of the application value of common hepatic arterial lymph node dissection on survival were evaluated in patients with ESCC without coeliac trunk lymph node metastasis indicated by preoperative CT. According to the eighth version ofAmerican Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging, we selected patients with a Pathological Tumor Node Metastasis (pTNM) stage ranging from IA to IVA for analysis.ResultsAmong the 816 qualified patients, 577 did not have coeliac trunk lymph node metastasis based on preoperative abdominal enhanced CT, and common hepatic arterial lymph node dissection was performed during the operation (observation group). Two hundred and thirty-nine preoperative CT examinations indicated no coeliac trunk lymph node metastasis, and common hepatic arterial lymph node dissection was not performed during the operation (control group). A multifactor Cox proportional hazards model showed no risk factors for overall survival (OS) (adjusted HR (HRadj)=0.91; p=0.404) or disease-free survival (DFS) (HRadj=0.86; p=0.179), regardless of whether common hepatic arterial lymph node dissection was performed. For patients with positive left gastric arterial lymph node metastasis, a multifactor Cox proportional hazards model indicated that common hepatic arterial lymph node dissection was a risk factor for OS (HRadj=0.63; p=0.035) and DFS (HRadj=0.58; p=0.026).ConclusionsFor patients with ESCC without celiac trunk metastasis indicated by abdominal enhanced CT, common hepatic arterial lymph node dissection conferred no survival benefits. However, for patients with left gastric arterial lymph node metastasis, common hepatic arterial lymph node dissection was beneficial.

Median arcuate ligament syndrome and a laparoscopic coeliac trunk first approach: a literature review and a proposed algorithm

Median arcuate ligament syndrome (MALS) is a rare condition where chronic recurrent abdominal pain is related to the compressive effects of the median arcuate ligament on the coeliac artery. The mechanism behind this phenomenon is incompletely understood but thought to be both ischemic and neuropathic in nature. As a result, the management of this condition remains controversial. Furthermore, while there have been a variety of options both radiological and interventional described for the investigation of MALS, there has yet to be a consensus in how patients exhibiting symptoms should be assessed and worked up. In this article, we described a laparoscopic coeliac trunk first approach in a young female patient and following review of the literature, propose an algorithm that can be used in the assessment and management of suspected MALS.

Anatomical Variations of Celiac Trunk and Its Branching Pattern with Special Reference to Surgical Implications in Mysore Based Population

BACKGROUND Celiac trunk (CT) is the first major abdominal branch of the aorta. Anatomic variations and accessory vessels have been reported with variable percentages. We report here a particularly rare variant involving absence of the celiac trunk in association with trifurcation of the common hepatic artery (CHA). The purpose of this study was to report the pattern of the celiac trunk and its anatomic variations in a sample of Mysore population. METHODS Celiac trunk dissection was performed in 10 fresh cadavers and 50 cases of contrast enhanced computed tomography (CECT) images of Mysore based subjects at JSS Medical College and Hospital aged 18 years and above were included. Celiac trunk variations, length, diameter, accessory vessels, and vertebral level of origin were described. RESULTS The branching pattern of coeliac trunk was observed in 60 cases (37 males, 23 females) by dissection and CECT scan method. Type I was found in 48 cases (80 %), Type I form 2a was found in 2 cases (3.3 %). Type II form 1 in 6 cases (10 %). Type III was observed in 1 case and in another case left hepatic artery (LHA) arising from coeliac trunk, Type VII was found in 2 cases (3.3 %). The length and diameter of coeliac trunk were analysed using descriptive statistics and mean ± SD for length was 1.8 ± 0.4 and diameter 0.5 ± 0.2 respectively. CONCLUSIONS Awareness of CT variations is important in surgical resection, transplantation, and interventional radiology procedure. KEY WORDS Celiac Trunk, Variations, Morphometry, Contrast Enhanced Computed Tomography Scan Method

New perspective on median arcuate ligament syndrome. Case reports

A large group of patients with significant asymptomatic or low-symptomatic coeliac trunk stenosis require deeper consideration. On angiography, CT and MRI, 10–24% of examined patients are found to have their coeliac trunk compressed by the median arcuate ligament of the diaphragm. The associated median arcuate ligament syndrome, which is also called coeliac trunk compression syndrome or Dunbar syndrome, is rarely fully symptomatic. It is estimated that there are up to 7% of patients with such a clinical presentation. An asymptomatic or low-symptomatic course of the disease in patients with the syndrome is mainly explained by a developed collateral circulation, particularly involving the arterial arcades of the head of pancreas. In such cases, CT angiography detects collateral circulation in 22–69.6% of examined patients. The present authors often observed coeliac trunk blood flow to normalise in a standing position. According to them, the main causative factor for this phenomenon is the deflection of the coeliac trunk and its compression against the aorta by a lowered left lobe of the liver. The researchers observed it in many individuals; in this study, 5 cases are presented.

Extensive thrombosis after COVID-19 vaccine: cause or coincidence?

A 62-year-old Caucasian female patient presented with abdominal pain, vomiting and fever 1 day after administration of COVID-19 vaccine. Bloodwork revealed anaemia and thrombocytosis. Abdominal CT angiography showed a mural thrombus at the emergence of the coeliac trunk, hepatic and splenic arteries, and extensive thrombosis of the superior and inferior mesenteric veins, splenic and portal veins, and the inferior vena cava, extending to the left common iliac vein. The spleen displayed extensive areas of infarction. Aetiological investigation included assessment of congenital coagulation disorders and acquired causes with no relevant findings. Administration of COVID-19 vaccine was considered a possible cause of the extensive multifocal thrombosis. After reviewing relevant literature, it was considered that other causes of this event should be further investigated. Thrombosis associated with COVID-19 vaccine is rare and an aetiological relationship should only be considered in the appropriate context and after investigation of other, more frequent, causes.