Anatomical variations of the coeliac trunk: a scoping review of classification systems

Anatomical variation of the coeliac trunk (CT) has been widely documented and carries significant clinical implications. Numerous classification systems have been proposed to describe these variations; however, inconsistency in terminology and clinical focus limit their comparability and routine application. A comprehensive synthesis of these classification frameworks is required to clarify their evolution and identify barriers to standardisation. A scoping review was undertaken in accordance with PRISMA-ScR guidance and the Joanna Briggs Institute methodology. Eligibility included studies that proposed or modified classification systems of CT anatomy using cadaveric, imaging, or combined approaches. Data extraction focused on study characteristics, classification structure, intended clinical application, and reported strengths and limitations. The findings were analysed using descriptive mapping and comparative narrative synthesis. Twenty-one studies published between 1904 and 2025 met eligibility, including cadaveric (n=8), exclusively radiological, (n=7) systematic reviews (n=3) and undefined (n=3). Frameworks increasingly prioritised surgical applicability by reducing the number of variant categories. Latter multidetector computed tomography-based studies analysed larger populations and incorporated morphometric parameters yet demonstrated substantial variability in nomenclature and criteria used to define identical branching patterns. Subsequently, anatomically similar configurations were frequently classified differently. Despite this heterogeneity, most systems described a limited number of recurring CT branching arrangements. Existing CT classification systems reflect evolving anatomical knowledge and technological advances but remain fragmented and inconsistent. The findings highlight the need for a unified, imaging-validated classification grounded in embryological principles and supported by large, global, multicentre datasets. Such standardisation would enhance diagnostic clarity, procedural safety, and interdisciplinary communication.