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The Absence of a Proper Hepatic Artery: A Case Report
Grant H McDaniel1, Patrick W Frank1
1University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
Insights
A rare common hepatic artery variation, with the cystic artery originating from the left hepatic artery, was found in an 80-year-old female donor. This highlights the need for awareness of anatomical variations in surgical planning.
Area of Science:
- Vascular Anatomy
- Surgical Anatomy
- Anatomical Variations
Background:
- Knowledge of common hepatic artery anatomy is crucial for pancreaticoduodenectomy, liver transplantation, and cholecystectomy.
- The common hepatic artery typically arises from the celiac trunk and bifurcates into the gastroduodenal and proper hepatic arteries.
- Anatomical variations are common, necessitating detailed understanding for surgical success.
Observation:
- A unique anatomical variation of the common hepatic artery was identified during necroscopy in an 80-year-old female donor.
- The common hepatic artery gave rise to the left hepatic artery, then bifurcated into the gastroduodenal and right hepatic arteries.
- The cystic artery originated from the left hepatic artery, with no identifiable proper hepatic artery present.
Findings:
- The case report details a novel variation of the common hepatic artery branching pattern.
- This variation involved the left hepatic artery arising directly from the common hepatic artery.
- The cystic artery's origin from the left hepatic artery, bypassing a proper hepatic artery, represents a significant deviation from standard anatomy.
Implications:
- Awareness of rare anatomical variations, such as this common hepatic artery anomaly, is vital for surgeons.
- Preoperative imaging is essential to identify and prepare for potential vascular anomalies during complex abdominal surgeries.
- Understanding these variations improves surgical planning and patient safety in procedures involving the hepatobiliary system.
Abstract:
BACKGROUND Pancreaticoduodenectomy, liver transplantation, cholecystectomy, and surgical management of traumatic injuries are all dependent on in-depth knowledge of the anatomy of the common hepatic artery and its subsequent divisions. The common hepatic artery arises from the celiac trunk, which is the first major branch of the abdominal aorta. The common hepatic artery bifurcates into the gastroduodenal artery traveling inferiorly behind the duodenal bulb and the proper hepatic artery continues laterally toward the liver within the hepatoduodenal ligament. The proper hepatic artery provides the right gastric artery before dividing into the left and right hepatic arteries. Anatomical variations in the common hepatic artery and its subdivisions are common and this case report identifies a seemingly undocumented novel variation. CASE REPORT 80-year-old female donor who died of lung adenocarcinoma presented with an anatomical variation of the common hepatic artery discovered during necroscopy. The donor had a common hepatic artery that gave rise to the left hepatic artery, then continued until it bifurcated into the gastroduodenal artery and right hepatic artery. The cystic artery originated from the left hepatic artery, traveling anteriorly over the bile duct and portal vein. The donor seems to have no proper hepatic artery and instead had a novel variation of the common hepatic artery. CONCLUSIONS The observation of this variation underscores the importance of not only being familiar with the standard anatomy but also for variations that can occur. It also furthers support of the standard of preoperative imaging for surgical patients to help identify and prepare for variations.
