Anat Cell Biol.  2013 Sep;46(3):217-219. 10.5115/acb.2013.46.3.217.

Vascular variations of liver and gallbladder: a case report

• Nayak SB
• Vasudeva S

• KMID: 2263149
• DOI: http://doi.org/10.5115/acb.2013.46.3.217

Abstract

Vascular variations in and around the porta hepatis are common. A sound knowledge of possible variations at these sites is vital for surgeons during laparoscopic cholecystectomy and surgical resection of the liver lobes. We report the case of several variations of the hepatic and cystic arteries in which, the common hepatic artery trifurcated into the gastroduodenal, right hepatic, and left hepatic arteries. The right gastric artery arose from the left hepatic artery and divided into a left and a right branch. The left branch entered the liver through the porta hepatis, while the right branch passed behind the common hepatic duct into the Calot's triangle, provided 2 branches to the gallbladder, and continued to supply the right hepatic lobe. Ligation of the right branch of the right hepatic artery in Calot's triangle during cholecystectomy could cause avascular necrosis of the liver segments it supplies.

Keyword

Cystic artery; Hepatic artery; Celiac trunk; Calot's triangle; Right gastric artery

MeSH Terms

Arteries
Cholecystectomy
Cholecystectomy, Laparoscopic
Equipment and Supplies
Gallbladder
Hepatic Artery
Hepatic Duct, Common
Ligation
Liver
Necrosis

Figure

• 

  Fig. 1 Dissection of the celiac trunk and its branches. CA, cystic arteries; CD, cystic duct; CHD, common hepatic duct; CT, celiac trunk; D, duodenum; GB, gall bladder; GDA, gastroduodenal artery; LGA, left gastric artery; LHA, left hepatic artery; LLL, left lobe of the liver; LRHA, left branch of right hepatic artery; P, pancreas; QL, quadrate lobe of the liver; RGA, right gastric artery; RHA, right hepatic artery; RLL, right lobe of the liver; RRHA, right branch of right hepatic artery; SA, splenic artery.

Reference

1. Yamaki K, Tanaka N, Matsushima T, Miyazaki K, Yoshizuka M. A rare case of absence of the celiac trunk: the left gastric, the splenic, the common hepatic and the superior mesenteric arteries arising independently from the abdominal aorta. Ann Anat. 1995; 177:97–100.

2. Vandamme JP, Bonte J. The branches of the celiac trunk. Acta Anat (Basel). 1985; 122:110–114.

3. Cavdar S, Sehirli U, Pekin B. Celiacomesenteric trunk. Clin Anat. 1997; 10:231–234.

4. Nayak S. Common celiaco-mesenterico-phrenic trunk and renal vascular variations. Saudi Med J. 2006; 27:1894–1896.

5. Abdullah SS, Mabrut JY, Garbit V, De La Roche E, Olagne E, Rode A, Morin A, Berthezene Y, Baulieux J, Ducerf C. Anatomical variations of the hepatic artery: study of 932 cases in liver transplantation. Surg Radiol Anat. 2006; 28:468–473.

6. Uva P, Arvelakis A, Rodriguez-Laiz G, Lerner S, Emre S, Gondolesi G. Common hepatic artery arising from the left gastric artery: a rare anatomic variation identified on a cadaveric liver donor. Surg Radiol Anat. 2007; 29:93–95.

7. Song SY, Chung JW, Yin YH, Jae HJ, Kim HC, Jeon UB, Cho BH, So YH, Park JH. Celiac axis and common hepatic artery variations in 5002 patients: systematic analysis with spiral CT and DSA. Radiology. 2010; 255:278–288.

8. Okada Y, Nishi N, Matsuo Y, Watadani T, Kimura F. The common hepatic artery arising from the left gastric artery. Surg Radiol Anat. 2010; 32:703–705.

9. Mishall PL, Rajgopal L. Variant right hepatic artery forming Moynihan's hump: clinical relevance. Int J Anat Var. 2010; 3:144–145.

10. Anson BH. The aortic arch and its branches. In : Luisada A, editor. Cardiology. New York: McGraw-Hill;1963. Vol. 1:p. 119.

11. Mlakar B, Gadzijev EM, Ravnik D, Hribernik M. Anatomical variations of the cystic artery. Eur J Morphol. 2003; 41:31–34.

12. Flisiński P, Szpinda M, Flisiński M. The cystic artery in human foetuses. Folia Morphol (Warsz). 2004; 63:47–50.

13. Sarkar AK, Roy TS. Anatomy of the cystic artery arising from the gastroduodenal artery and its choledochal branch: a case report. J Anat. 2000; 197(Pt 3):503–506.

14. Anjamrooz SH, Azari H. Coexistence of multiple anomalies in the hepatobiliary system. Anat Cell Biol. 2012; 45:62–65.

15. Nahrwold DL. The biliary system. In : Sabiston DC, editor. Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 15th ed. Philadelphia: W.B. Saunders and Co.;1997. p. 1117–1125.