CLINICAL ANATOMY OF THE CELIAC MESENTERIC TRUNK, PERSPECTIVES OF ENDOVASCULAR EMBOLIZATION IN CASE OF GASTROINTESTINAL BLEEDING

Purpose of study. Provide Systematized data on the blood supply of the stomach and duodenum, relevant for endovascular methods of homeostasis.
Material and methods. 117 multispiral computed tomograms with bolus contrast enhancement of the arterial phase.
Results. The normal structure of the celiac trunk is established in 88.89% of cases, hepatosplenic trunk identified in 0.85% of cases, hepatogastric trunk — in 0.85% of cases, gastrosplenic trunk — in 1.71% of cases, hepato mesenteric trunk — in 5.13% of cases, celiac colon trunk — in 1.71% of cases. Stomach blood supply in 54.70% of cases was carried out mainly by the right gastric artery and the right gastroepiploic artery, in 15.34% of cases by the left gastric artery and the left gastroepiploic artery. Anastomosis between the right gastric artery and the left gastric artery, as a single vessel had a 55.55% of cases. The common hepatic artery is the source of right gastric artery in 67.52% of cases. Normal structure of hepatoduodenale arteries established in 82.2% of cases. In 91.45% of cases the celiac trunk and superior mesenteric artery combined along the duodenum by anastomosis.
Conclusion. When the source of bleeding is localized in the lesser curvature or in the antrum embolisation of the left gastric artery is advisable. When the source of bleeding is localized in the greater curvature, selective embolisation of the right gastroepiploic artery is advisable. When the source is localized in the pylorus of the stomach or in the duodenum bulb it’s necessary to embolize sequentially ostia superior pancreaticoduodenal artery and gastroduodenal artery. When the source of bleeding is localized distal to the duodenum bulb required selective embolisation superior anterior pancreaticoduodenal artery, if hemostasis is ineffective, it is necessary to embolize the ostia of the inferior anterior pancreatic-duodenal artery.

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