Prehepatocholedochal proper hepatic artery. Rare anatomical variant. Surgical considerations. Case report

Area of Science:

• Anatomy
• Surgical Anatomy
• Vascular Anatomy

Background:

• The proper hepatic artery (PHA) typically arises from the common hepatic artery (CHA) after the gastroduodenal artery (GDA) branches off.
• The PHA is usually located to the left of the hepatocholedochal duct (HCD).
• Anatomical variations in hepatic arterial supply are well-documented.

Observation:

• A case report of a 57-year-old woman with acute lithiasic cholecystitis, hypersplenism, and hypertension.
• The patient presented with an unusual topographic anatomy of the PHA.
• The PHA was observed to be positioned anterior to the HCD with a diameter of 5-7 mm.

Findings:

• The proper hepatic artery (PHA) exhibited an abnormal anterior positioning relative to the hepatocholedochal duct (HCD).
• This aberrant PHA presented a diameter that could lead to confusion with the HCD, particularly during laparoscopic surgery.
• A review of medical literature was conducted to identify similar anatomical variants.

Implications:

• This rare anatomical variant of the PHA poses a risk of misidentification during surgical procedures, especially celioscopy.
• Awareness of this specific PHA topography is essential for surgeons to prevent potential iatrogenic injuries.
• Accurate preoperative identification and understanding of such vascular anomalies are critical for patient safety in hepatobiliary surgery.