Abstract
This study details an extremely rare vascular anomaly found incidentally in a 78-year-old male during computed tomography angiography (CTA). The patient had a hepatosplenic trunk, where the common hepatic and splenic arteries arose from the coeliac trunk, and the left gastric artery originated abnormally from the superior mesenteric artery, forming a gastromesenteric trunk. Additionally, bilateral accessory renal arteries were present. While accessory renal arteries are fairly common, the combination of hepatosplenic and gastromesenteric trunks is very rare, with only a few cases documented in the literature, and even fewer with detailed imaging. These arterial variations, though often asymptomatic, have significant implications for hepatopancreatobiliary surgery, interventional radiology, and renal transplantation. Celiac trunk anomalies can complicate dissection or embolization procedures, and accessory renal arteries increase the risk of ureteral injury, make transplantation more technically challenging, and can lead to delayed graft function and decreased graft survival. This case highlights the importance of high-resolution CTA with 3D reconstruction for preoperative vascular mapping to improve surgical planning and reduce intraoperative risks.