The celiac trunk (celiac axis) is a short arterial trunk (~2 cm) arising from the anterior surface of the abdominal aorta, just below the aortic hiatus of the diaphragm, at approximately the level of T12. Approaching it safely requires detailed anatomic knowledge and varies slightly depending on the surgical indication (e.g., open aortic surgery, tumor resection, celiac artery decompression, aneurysm repair).
The most common and direct approach is through a transperitoneal appraoch. Here is a detailed overview of how to approach the celiac trunk transperitoneally:
Incision & Exposure
Make a midline incision from xiphoid to umbilicus.
Retract the left lobe of the liver superiorly.
Divide or retract the left triangular ligament to mobilize the liver.
Exposure of the Lesser Sac
- Divide the gastrohepatic ligament
Identify the right crus of the diaphragm posteriorly. The crus can be safely divided to expose the subphrenic part of the abdominal aorta if an antegrade aorto-celiac / mesenteric bypass is planned.
Access the celiac artery
Retract the stomach inferiorly and to the right.
Identify the left gastric artery running superiorly—this usually comes off the celiac trunk.
- The celiac artery lies slightly on the anterior-left side of the aorta
Expose the Celiac Origin
Open the fibrous tissue overlying the aorta just above the celiac trunk.
Incise the median arcuate ligament (important if doing median arcuate ligament release).
Carefully dissect to identify the celiac origin and its three branches.
Control
Use vessel loops or bulldog clamps to control the trunk and branches as needed.
Important Anatomical Relationships
- Celiac trunk: Anterior / left to aorta T12-L1
- Median arcuate ligament: May overlie the celiac origin
- Left gastric artery: Usually first and smallest branch (superior)
- Common hepatic artery: Runs rightward along the upper pancreas
- Splenic artery: Runs leftward along pancreas’ superior border
- Left gastric vein: Crosses anterior to celiac origin
- Celiac plexus: Dense neural overlying the celiac axis
Tips for Safe Dissection
- Dissect close the lesser curvature of stomach to find the hepatic artery, the left gastric artery and the celiac axis
- Always identify and preserve the celiac ganglia and autonomic plexus when possible (unless decompressing).
- Avoid injury to the left gastric vein, pancreas, and crura.
- In aneurysmal disease, exposure of the supraceliac aorta provides a proximal control point for clamping.
- Gentle retraction of the stomach and pancreas is key to avoid injury.