This diagnostic image is a contrast-enhanced sagittal CT scan of the abdomen, specifically focusing on the vascular anatomy and the vertebral column. The image demonstrates a rare anatomical variant where the superior mesenteric artery (SMA) originates from the celiac axis rather than directly from the abdominal aorta. A white arrow points to this common celiac-mesenteric trunk, showing the joint origin and the subsequent anterior descent of the SMA. Visible landmarks include the hyperdense vertebral bodies and intervertebral discs of the lumbar spine, the abdominal aorta running anterior to the spine, and portions of the liver and gastrointestinal tract with varying soft tissue densities. This clinical imaging is essential for preoperative surgical planning, particularly in pancreatic or hepatobiliary procedures, as the variant significantly alters the vascular supply to the midgut. The educational focus is on identifying vascular anomalies and understanding their relationship to the central abdominal organs.

Two diagnostic angiograms (a and b) demonstrating normal arterial anatomy of the upper gastrointestinal region. Image (a) is a selective celiac trunk angiogram showing the celiac artery and its major branches: the tortuous splenic artery extending to the left and the hepatic artery giving rise to the gastroduodenal artery (GDA), indicated by a black arrow. Image (b) shows the superior mesenteric artery (SMA) and the origin of the inferior pancreaticoduodenal artery (IPDA). Both images demonstrate smooth arterial contours with uniform contrast opacification. There are no visual signs of vascular pathology, such as pseudoaneurysms, arterial stenosis, or active contrast extravasation (hemorrhage). This set of images serves as a clinical reference for normal mesenteric and celiac vasculature in the context of screening for postoperative complications like visceral artery pseudoaneurysms.

This diagnostic image comprises a series of axial contrast-enhanced CT scans comparing anatomical structures before and after radical surgery for esophageal cancer. The images are organized into five anatomical levels: the heart section, gastroesophageal junction section, left gastric artery side section, celiac section, and superior mesenteric artery section. The 'before surgery' column displays normal mediastinal and upper abdominal anatomy, including the esophagus and stomach in their typical positions. The 'after surgery' column demonstrates significant postoperative anatomical remodeling of the inferior mediastinum and epigastrium. Key changes include the transposition of a gastric conduit into the mediastinum (pull-up), causing a shift in heart and lung position at the thoracic level. At the abdominal levels, there is a notable loss of definition and displacement of vascular landmarks, such as the celiac artery and superior mesenteric artery, often obscured by transposed gastrointestinal tissue. These images illustrate the challenges in postoperative radiotherapy planning, as surgical distortion can shift high-risk lymph node stations (e.g., para-aortic and celiac groups) relative to their preoperative anatomical markers.

This diagnostic image is a contrast-enhanced computed tomography (CT) scan of the abdomen and pelvis in a sagittal reconstruction view. The image displays the lumbar spine posteriorly and the abdominal aorta as a hyperdense, vertically oriented vessel. A significant vascular pathology is identified at the origin of the celiac artery (ostium). White arrows indicate a focal dissection and associated pseudoaneurysm at the celiac axis. The pseudoaneurysm appears as a localized, irregular outpouching of contrast material protruding beyond the expected vessel wall boundary, with evidence of wall disruption. The superior mesenteric artery (SMA) is visible just inferior to the celiac artery origin. This imaging is critical for diagnosing mesenteric vascular emergencies and guiding conservative or surgical management in cases of isolated visceral artery dissection. The educational focus is on the radiological presentation of rare vascular abnormalities in the upper gastrointestinal arterial supply.

This clinical anatomical photograph displays a dissected hepatobiliary region and the celiac trunk branches in a cadaveric specimen. The image demonstrates the complex spatial relationships within the cystohepatic triangle (Calot's triangle). Centrally, the portal vein (PV) is visible, with the common hepatic artery (CHA) branching into the left hepatic artery (LHA) and gastroduodenal artery (a.). A significant anatomical variation is shown where the right hepatic artery (RHA) courses deep to the gastroduodenal artery and the common hepatic duct (CHD). The RHA is seen positioned between the portal vein and the common bile duct (CBD). Additionally, two cystic arteries (Cystic aa.) are identified originating from the RHA near the junction of the cystic duct (CD) and CHD. Other visible vascular structures include the splenic artery and the left gastric artery (LGA). This visual is intended for surgical education, specifically for understanding vascular and ductal variations during cholecystectomy or hepatobiliary surgery.

This clinical photograph from a gross anatomical dissection displays the hepatobiliary vasculature and biliary tree within the cystic triangle (Calot's triangle). The image illustrates a variation of the right hepatic artery (RHA), which is shown coursing between the portal vein (PV) and the common bile duct (CBD). Labeled structures include the liver (superiorly), gallbladder (inferiorly), cystic duct (CD), common hepatic duct (CHD), and common bile duct (CBD). The arterial supply is represented by the celiac trunk (CT), common hepatic artery (CHA), and the gastroduodenal artery. The educational focus of this image is to demonstrate the complex spatial relationships and anatomical variations of the hepatic artery in relation to the portal venous system and the extrahepatic biliary ducts, which is critical for surgical procedures like cholecystectomy. The RHA is seen moving laterally and anteriorly relative to the PV as it enters the cystic triangle to supply the gallbladder and right liver lobe.

This clinical photograph displays a surgical dissection of the hepatobiliary region in a cadaveric specimen, illustrating the complex anatomy of the cystohepatic triangle (Calot's triangle). The image shows the liver retracted superiorly to reveal the portal triad and its branches. Key anatomical structures are labeled: the Right Hepatic Artery (RHA), Portal Vein (PV), Common Bile Duct (CBD), Common Hepatic Duct (CHD), Cystic Duct (CD), and Cystic Artery (CA). In this specific variation, the RHA follows a course between the PV and the CBD. Within the boundaries of the cystic triangle, a single CA is seen branching off the RHA to supply the gallbladder. Surgical forceps are visible, highlighting the dissection plane. This anatomical illustration serves as a reference for identifying vascular and biliary variations critical for preventing iatrogenic injury during cholecystectomy or hepatobiliary surgery. The educational focus is on the spatial relationships and variable branching patterns of the hepatic arterial system relative to the biliary tree.

Anatomical dissection of the hepatobiliary region in a human cadaver, demonstrating the spatial relationships within the cystohepatic triangle (Calot's triangle). The image shows the right hepatic artery (RHA) coursing laterally toward the liver, where it gives rise to the cystic artery. The cystic artery is seen branching from the RHA and extending to the gallbladder wall. Key landmarks labeled include the liver (superiorly), gallbladder (inferiorly), common bile duct (CBD), and common hepatic duct (CHD). The portal vein (PV) is visible posterior to the arterial structures, while the left hepatic artery (LHA) and gastroduodenal artery are shown in their respective anatomical positions. This clinical photograph illustrates a standard anatomical configuration where the cystic artery originates from the RHA within the cystic triangle, a critical area for identification during cholecystectomy to avoid iatrogenic injury to the biliary tree or hepatic vasculature.

This clinical photograph provides a high-resolution surgical view of the pelvic retroperitoneal structures following a nerve-sparing radical hysterectomy. The image illustrates the complex neurovascular anatomy of the female pelvis, emphasizing the Inferior Hypogastric Plexus (IHP) and its branches. Major vascular landmarks include the external iliac artery (EIA) and vein (EIV) positioned superior-laterally, the umbilical artery (UMA), and the ligated uterine artery (UA). Critical neurological structures are meticulously exposed: the genitofemoral nerve (GFN) lies atop the psoas major muscle (PMM); the hypogastric nerve (HN) descends toward the presacral space (PrS); and the pelvic splanchnic nerves (PSN) contribute to the IHP. A primary educational focus is the preservation of the bladder nerve branches (BNBs), which are shown coursing toward the vaginal cuff (VC) and bladder base, lateral to the rectum (R) and the rectal plexus (RcP). The image demonstrates the anatomical relationships necessary for preserving autonomic function during oncological pelvic surgery, specifically identifying the distal ureter (Ur) and its proximity to the uterovaginal plexus (UtVP).

This clinical photograph captures an intraoperative view of a nerve-sparing radical hysterectomy, focusing on the dissection of the inferior hypogastric plexus (IHP) within the female pelvis. The image demonstrates the surgical preservation of autonomic neural structures following the resection of the uterus. Key anatomical landmarks and neurovascular structures are labeled: the bladder is visible superiorly, with preserved bladder branches of the IHP extending towards it. The recto-vaginal space is exposed, showing the cut ends of the vaginal vessels along the lateral vaginal wall. Inferior to these, the cut ends of the uterine branches of the IHP are identified. Deep to these structures, the fascia pelvis visceralis is highlighted by parallel arrows. On the lateral aspect, the pelvic splanchnic nerves are visible as cord-like structures emerging from the sacral roots. This visual serves as a critical educational resource for gynecologic oncology, illustrating the precise spatial relationships required to maintain pelvic autonomic function while achieving surgical margins in radical pelvic surgery.

This composite image provides a side-by-side comparison of autonomic nerve structures in the human pelvis during cadaveric dissection (left) and laparoscopic surgery (right). The primary educational focus is the identification of key neural landmarks relevant to Total Mesorectal Excision (TME) to prevent post-operative dysfunction. Marked structures include: (1) the superior hypogastric plexus, appearing as yellowish connective tissue at the level of the promontory; (2) the hypogastric nerves, shaded in a dark bluish-grey, descending into the pelvis; and (3) the rectal nerves arising from the inferior hypogastric plexus, which are seen extending toward the posterolateral wall of the rectum. An asterisk (*) denotes the endopelvic or ureterohypogastric fascia, a critical surgical plane used to protect the hypogastric nerves during posterior and lateral dissection. The comparison demonstrates how these anatomical features transition from gross cadaveric tissue to their appearance under laparoscopic magnification and insufflation, emphasizing the importance of nerve-sparing techniques in colorectal surgery.

An anatomical diagram illustrating the distribution of gastrointestinal bleeding sites categorized by vascular territories. The diagram shows the large intestine (segmented haustra) and the small intestine (coiled loops) with superimposed colored markers. Red dots represent the superior mesenteric artery (SMA) territory, primarily involving the small intestine, cecum, ascending colon, and the proximal two-thirds of the transverse colon. Green dots indicate the inferior mesenteric artery (IMA) territory, covering the distal transverse colon, descending colon, and sigmoid colon. A single blue dot marks the internal iliac artery territory at the level of the rectum. The educational focus is on correlating anatomical bleeding locations with their respective arterial supply, which is critical for planning diagnostic interventions like angiography or embolization in cases of lower gastrointestinal hemorrhage. Key concepts include mesenteric vascular anatomy and clinical localization of bowel pathology.

This diagnostic image is an abdominal angiogram (digital subtraction angiography) highlighting the mesenteric vasculature. The superior mesenteric artery (SMA) is the central vessel of interest, showing the placement of two endovascular stents extending from the proximal to the mid-portion of the artery. Red annotations and a double-headed arrow delineate the stented segment. Branching distally from the SMA, the first jejunal artery (1st JA) and second jejunal artery (2nd JA) are visible. The 2nd JA demonstrates robust contrast filling, whereas the 1st JA exhibits diminished perfusion in its distal marginal branches, suggesting localized ischemia or compromised flow despite SMA recanalization. The image illustrates the management of acute mesenteric ischemia (AMI) via thrombectomy and secondary stenting for atherosclerotic stenosis or thrombosis. The vascular anatomy is projected against the lumbar vertebrae, with bowel gas visible in the background. This visual serves as a clinical case for interventional radiology and vascular surgery, focusing on SMA stenting outcomes and collateral circulation patterns in the small intestine.

This diagnostic image is a coronal maximum intensity projection (MIP) MDCT reconstruction focusing on the abdominal arterial vasculature. The image demonstrates the superior mesenteric artery (SMA) and its distal branches in a patient with non-occlusive mesenteric ischemia (NOMI) secondary to hemorrhagic shock and vasopressor (VCA) support. Key findings include severe, diffuse vasoconstriction and luminal irregularity throughout the main trunk of the SMA. The secondary and tertiary branches, including the vasa recta, exhibit significant attenuation and a 'string-of-beads' or pruned appearance. Specifically, the white arrows highlight severe spasm of the distal mesenteric arcades, characterized by a marked reduction in vessel caliber and abrupt termination, indicating severely compromised peripheral vascular perfusion to the small bowel. This imaging represents a classic radiological presentation of drug-induced or shock-related mesenteric vasospasm, which clinically correlated with segmental ileal necrosis in this case.

This clinical photograph captures an intraoperative view of the upper gastrointestinal and hepatobiliary systems during a surgical procedure. The operative field focuses on the duodenum and the extrahepatic biliary tract. Key anatomical structures are labeled, including the duodenum, the common bile duct (CBD), and the ampulla of Vater. The visual evidence shows a partial avulsion of the common bile duct near its insertion point at the duodenum. Clinical findings include significant tissue disruption, hematoma formation, and active bleeding in the periductal area, suggesting traumatic injury. The duodenum appears edematous and erythematous. A gloved hand is visible performing surgical retraction to expose the site of injury, and green surgical drapes border the inferior aspect of the field. This image serves as a clinical specimen illustration for hepatobiliary surgery, emergency trauma management, and the anatomical relationship between the biliary tree and the second part of the duodenum.

Two intraoperative clinical photographs (A and B) demonstrate key anatomical dissections during a nerve-sparing radical hysterectomy. Image A shows the transection of the vaginal vein (VV) and the medial mobilization of the uterine pedicle (UtP) to expose the ureteral tunnel. The ureter (Ur) is visible laterally as it courses toward the bladder. Image B illustrates the development of the 'Fourth space' (FS), a surgical avascular plane located between the ureter (Ur) and the vesicouterine ligament (VUL). Key vascular structures including the external iliac artery (EIA), external iliac vein (EIV), and umbilical artery (UMA) are identified. The vesical superficial vein (VSV) and vesicocervical vessels have been coagulated and transected. Notably, bladder nerve branches (NBs) are preserved, extending from the inferior hypogastric plexus toward the bladder (Bl). This educational material emphasizes surgical landmarks and planes necessary to prevent autonomic nerve injury during pelvic oncologic surgery.

**Imaging Modality:** Fluoroscopic image obtained during Endoscopic Retrograde Cholangiopancreatography (ERCP). **Anatomical Region:** Upper gastrointestinal tract and biliary system, specifically the duodenum and common bile duct (CBD). **Key Landmarks and Devices:** A flexible, radiopaque side-viewing duodenoscope is positioned within the descending duodenum. Surgical clips are visible in the right upper quadrant, suggesting prior cholecystectomy or hepatobiliary surgery. The vertebral column is visible on the right aspect of the frame. **Observed Findings:** Opacification of the extrahepatic biliary tree is achieved via contrast injection. The common bile duct (CBD) demonstrates a patent lumen with a relatively uniform diameter. There is a notable absence of high-grade focal narrowing or filling defects within the visualized segment of the duct. Contrast flow appears to transit through the biliary system without significant obstruction. **Diagnostic Features:** The image illustrates the post-intervention state of the biliary tree, confirming the resolution of a previously documented biliary stricture. The caliber of the CBD is preserved, and there is no residual proximal ductal dilation visible in this view.

Anatomical diagram illustrating a biliary reconstruction procedure using a pedicled gastric tube. The illustration shows a longitudinal cross-section of the extrahepatic biliary system and the proximal gastrointestinal tract. Key structures are labeled: (i) represents a tube inserted into the gallbladder lumen; (j) and (k) denote stents or tubes placed within the right and left hepatic ducts, respectively. These tubes converge into (m), which is the interior of a pedicled gastric tube used as a conduit for biliary drainage. Structure (l) shows the interior of the duodenum with its characteristic mucosal folds (plicae circulares) and an anastomotic site where the gastric tube connects to the small intestine. The diagram emphasizes the surgical technique of using a gastric wall segment to bridge a common bile duct defect, facilitating passage from the hepatic ducts to the duodenum. This visual material is relevant for surgical oncology and hepatobiliary surgery education, demonstrating complex biliary tract reconstruction.

An axial computed tomography (CT) scan of the upper abdomen illustrating postoperative anatomy following Roux-en-Y gastric bypass (RYGB) surgery. The diagnostic image identifies three key gastrointestinal structures: the small gastric pouch (P), the excluded stomach (ES), and the gastrojejunal (GJ) anastomosis. The gastric pouch is visualized as a proximal, small-volume receptacle, separated laterally from the larger, defunctionalized excluded stomach (remnant stomach). The GJ anastomosis is located anteriorly, marking the surgical connection between the gastric pouch and the jejunal limb. Surrounding landmarks, including the liver, vertebrae, and ribs, provide anatomical orientation. This imaging is clinically relevant for evaluating postsurgical anatomy, identifying potential complications such as marginal ulcers or anastomotic leaks, and investigating metabolic symptoms like hyperinsulinemic hypoglycemia in bariatric patients.

This figure illustrates the postoperative anatomy following a classic Whipple procedure (pancreaticoduodenectomy) through a comparative format. Part A is an anatomical diagram showing the reconstructed gastrointestinal tract, highlighting the gastrojejunostomy, hepaticojejunostomy, and pancreaticojejunostomy. The diagram emphasizes the resection of the pancreatic head, duodenum, and gallbladder with subsequent enteric anastomoses. Part B is a coronal CT image providing clinical correlation of these changes. In the CT scan, the stomach is labeled with an 's' and appears distended with low-attenuation fluid or contrast. A white arrow indicates the gastrojejunostomy, where the gastric antrum has been resected and the stomach is anastomosed to a jejunal loop. The imaging highlights the altered spatial relationships in the upper abdomen, specifically the positioning of the stomach and the efferent enteric loop. This material serves as an educational resource for identifying normal postoperative imaging findings and surgical landmarks after complex hepatobiliary surgery.

Historical anatomical diagram from Carl Toldt's 'Anatomischer Atlas' depicting a dissection of the human abdominal and pelvic cavity. The illustration focuses on the spatial relationships of the visceral organs and their peritoneal attachments. Key labeled structures include the spleen (Lien), shown as an oblong organ situated superior to the left colic flexure (Flexura coli sinistra) and adjacent to the jejunum. In the upper right quadrant (anatomical left), the left lobe of the liver (Lobus sinister hepatis), ligamentum teres, and gallbladder (Vesica fellea) are prominent. The gastrointestinal tract is shown with the duodenum, ileum, and cecum (Intestinum caecum). Extensive detail is provided on the mesentery and folds, including the Mesenterium commune, Mesocolon descendens, and Mesocolon sigmoideum. In the inferior pelvic region, the ovary (Ovarium) is visible. This diagram illustrates the complex organization of the peritoneum and the fixation of various abdominal organs, which is of historical and educational significance for understanding surgical anatomy and conditions such as 'wandering spleen' (splenoptosis).

Two intraoperative clinical photographs (A and B) demonstrate the surgical dissection and settlement of the recurrent laryngeal nerve (RLN) during a thyroid procedure. Image A shows the anatomical relationship between the esophagus (ESO), trachea, and RLN within the expanded pretracheal space (Level VIa). The RLN is visualized running vertically in the tracheoesophageal groove, with the prevertebral fascia (PF) located posteriorly. Image B illustrates the completion of the RLN settlement. It features white dashed lines (α and β) marking critical surgical landmarks: Line α indicates the ligation of superior thyroid vessels with exposure of the cricothyroid space (CS) and preservation of the superior parathyroid gland, while Line β shows the resection plane where the thyroid gland (TG) was separated to expose the RLN's laryngeal entry point. The images highlight the surgical planes required for safe central neck dissection and preservation of neurovascular structures during endocrine surgery.

This clinical photograph sequence depicts anatomical dissections illustrating the surgical relationship between the recurrent laryngeal nerve (RLN) and the inferior thyroid artery (ITA), a critical landmark during thyroidectomy. The set consists of three panels labeled A, B, and C, with the RLN highlighted in pink for clarity. Panel A (Posterior) shows the RLN coursing posterior to the ITA trunk. Panel B (Anterior) shows the RLN crossing superficial (anterior) to the ITA. Panel C (In-between) demonstrates the nerve passing between the terminal branches of the ITA, with blue background material used to enhance visibility of the neural-vascular junction. Key surrounding anatomical structures labeled include the trachea (Tr), esophagus (Es), and thyroid gland (T). These images demonstrate anatomical variations essential for surgeons to identify to prevent iatrogenic nerve injury during endocrine neck surgery. The anatomical orientation is indicated by a directional compass showing cranial, caudal, medial, and lateral axes.