A rare type of hepatobiliary arterial system in man - presence of accessory left and replaced right hepatic arteries and double cystic arteries

In addition to the normal textbook description, the hepatobiliary arterial system in man shows many anatomical variations thathave definite clinical importance. The presence of aberrant hepatic and cystic arteries may lead to a number of iatrogenic injuriesduring some open surgical or endoscopic procedures. In the course of routine students' dissection of a 62-year-old Caucasianfemale cadaver, an interesting pattern of the arterial supply to the liver and gallbladder was described. In the case reported, anunusually small proper hepatic artery was identified supplying the left liver lobe. In addition, an accessory left hepatic artery wasalso observed arising from the left gastric artery. Another large variant artery to the liver was also dissected that started from thefirst portion of the superior mesenteric artery - known as replaced right hepatic artery. The gallbladder, in this case, had twosupplying arteries of different origin arising from the small proper hepatic artery and replaced right hepatic artery. This rare andcomplicated arterial variation might be of considerable importance for liver and gallbladder resections, liver transplants andlaparoscopic procedures in this area.

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Clemente CD, editor. Anatomy of the human body. 30th ed. Philadelphia: Lea and Febiger; 1985. p. 731-48.

Michels NA. Newer anatomy of the liver and its variant blood sup- ply and collateral circulation. Am J Surg 1966;112:337-47.

Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg 1994;220:50-2.

Adachi B. Anatomie der Japaner I. Das Arteriensystem der Japaner. Bd II: Aorta thoracalis bis Arcus plantaris profundus. Kyoto: Verlag der Keiserlich-Japanischen Universität zu Kyoto; 1928. p. 18-66.

Covey AM, Brody LA, Maluccio MA, Getrajdman GI, Brown KT. Variant hepatic arterial anatomy revisited: digital subtraction angiog- raphy performed in 600 patients. Radiology 2002;224:542-7.

Abdullah SS, Mabrut JY, Garbit V, De La Roche E, Olagne E, Rode A, Morin A, Berthezene Y, Baulieux J, Ducerf C. Anatomical varia- tions of the hepatic artery: study of 932 cases in liver transplantation. Surg Radiol Anat 2006;28:468-73.

Prabhasavat K, Homgade C. Variation of hepatic artery by 3-D reconstruction MDCT scan of liver in Siriraj Hospital. J Med Assoc Thai 2008;91:1748-53.

Ugurel MS, Battal B, Bozlar U, Nural MS, Tasar M, Ors F, Saglam M, Karademir I. Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography. Br J Radiol 2010;83: 661-7.

Gielecki Gielecki J, Zurada A, Sonpal N, Jablo?ska B. The clinical relevance of coeliac trunk variations. Folia Morphol (Warsz) 2005; 64:123-9.

Mugunthan N, Jansirani D, Felicia C, Anbalagan J. Anatomical varia- tions in the arterial supply of liver. International Journal of Anatomical Variations 2012;5:107-9.

Nayak SB, Vasudeva SK. Vascular variations of liver and gallbladder: a case report. Anat Cell Biol 2013;46:217-9.

Singh B, Anand M, Gupta S. A rare variant angioarchitecture of upper abdomen. Anat Cell Biol 2014;47:73-6.

Anson BJ. Anatomical considerations in surgery of the gall bladder. J Mich State Med Soc 1956;55:671-2.

Hugh TB, Kelly MD, Li B. Laparoscopic anatomy of the cystic artery. Am J Surg 1992;163:593-5.

Sugita R, Yamazaki T, Fujita N, Naitoh T, Kobari M, Takahashi S. Cystic artery and cystic duct assessment with 64-detector row CT before laparoscopic cholecystectomy. Radiology 2008;248:124-31.

Loukas M, Fergurson A, Louis RG Jr, Colborn GL. Multiple varia- tions of the hepatobiliary vasculature including double cystic arteries, accessory left hepatic artery and hepatosplenic trunk: a case report. Surg Radiol Anat 2006;28:525-8.

Ding YM, Wang B, Wang WX, Wang P, Yan JS. New classification of the anatomic variations of cystic artery during laparoscopic chole- cystectomy. World J Gastroenterol 2007;13:5629-34.

Nagral S. Anatomy relevant to cholecystectomy. J Minim Access Surg 2005;1:53-8.

Fathy O, Zeid MA, Abdallah T, Fouad A, Eleinien AA, el-Hak NG, Eleibiedy G, el-Wahab MA, Sultan A, Anwar N, Ezzat F. Laparoscopic cholecystectomy: a report on 2000 cases. Hepato- gastroenterology 2003; 50:967-71.

Torres K, Chroscicki A, Golonka A, Torres A, Staskiewicz G, Palczak R, Ceja-Sanchez JM, Ceccaroni M, Drop A. The course of the cystic artery during laparoscopic cholecystectomy. Folia Morphol (Warsz) 2009;68:140-3.

Duca S, Bãlã O, Al-Hajjar N, Lancu C, Puia IC, Munteanu D, Graur F. Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations. HPB (Oxford) 2003;5: 152-8.

Chaib E, Ribeiro MA Jr, Saad WA, Gama-Rodrigues J. The main hepatic anatomic variations for the purpose of split-liver transplanta- tion. Transplant Proc 2005;37:1063-6.