Accessory right hepatic artery and its significance for a surgeon: A case report

Right hepatic artery (RHA) is a branch of the common hepatic artery; however, there are cases documented in the literature showing anatomical variations. Accessory RHA is an incidental finding during hepatobiliary and pancreatic surgery. This artery should be identified, carefully separated, and preserved during these surgeries. We encounter the variation while doing Whipple’s procedure in a 61-year-old patient diagnosed with carcinoma of the head of the pancreas. Intra-operatively, accessory RHA was present which was arising from the superior mesenteric artery. It was identified, carefully separated, and preserved. Variations in the origin of the artery may make it vulnerable to injuries during surgical procedures if due care is not taken

Evaluación anatómica del tronco celíaco y sus ramas en una muestra de población mestiza colombiana / Anatomical evaluation of the celiac trunk and its branches in a sample of Colombian mestizo population

RESUMEN: El tronco celíaco (TC) es la rama de la arteria aorta abdominal (AA) que aporta la irrigación a la porción distal del esófago, parte media del duodeno, al estómago, páncreas, bazo y suple adicionalmente al hígado; sus diferentes expresiones anatómicas son reportadas en los diferentes grupos poblacionales con incidencia variable. Se evaluó las características morfológicas del TC y sus ramas en 26 bloques del piso supramesocólico de cadáveres masculinos adultos no reclamados, del grupo poblacional mestizo, a quienes se les practico autopsia en el Instituto de Medicina Legal de Bucaramanga - Colombia. Se observo el tipo I del TC en 23 especímenes (88,4 %), del cual correspondió 16 muestras (61,5 %). Al subtipo Ia con bifurcación y formación de tronco hepatoesplénico. Hubo un caso (3,8 %) en donde las ramas del T se originaron de manera independiente de la AA. El TC presentó una longitud promedio de 18,6 DE 7,53 mm y un diámetro externo de 7 DE 1,24 mm. De las ramas del TC, la AE presentó un diámetro promedio de 5,89 DE 1,04 mm sin diferencias estadísticamente significativa con relación al diámetro de la AHC, pero si con relación al diámetro de la AGI (P= 0,70; p<0,001 respectivamente). La gran mayoría de la muestra avaluada muestra la presencia de tronco hepatoesplénico seguido de la trifurcación en una verdadera configuración de trípode. El conocimiento de los patrones de ramificación del TC debe ser tomado en cuenta por cirujanos gastroenterólogos, radiólogos intervencionistas y oncólogos para evitar complicaciones durante los procedimientos quirúrgicos abdominales.

SUMMARY: The celiac trunk (CT) is the branch of the abdominal aorta artery (AA) that provides irrigation to the distal portion of the esophagus, the middle part of the duodenum, the stomach, pancreas, spleen and additionally supplies the liver; its different anatomical expressions are reported in the different population groups with variable incidence. The morphological characteristics of the CT and its branches were evaluated in 26 blocks of the supramesocolic floor of unclaimed adult male corpses, of the mestizo population group, who were autopsied at the Institute of Legal Medicine of Bucaramanga - Colombia. Type I CT was observed in 23 specimens (88.4 %), of which 16 samples (61.5 %) corresponded. to subtype Ia with bifurcation and formation of the hepatosplenic trunk. There was one case (3.8 %) in which the branches of the CT originated independently of the AA. The CT had an average length of 18.6 SD 7.53 mm and an external diameter of 7 SD 1.24 mm. Of the CT branches, the splenic artery presented an average diameter of 5.89 SD 1.04 mm without statistically significant differences in relation to the diameter of the AHC, but if in relation to the diameter of the IGA (P = 0.70; p <0.001 respectively). The vast majority of the sample evaluated shows the presence of a hepatosplenic trunk followed by trifurcation in a true tripod configuration. Knowledge of CT branching patterns should be taken into account by gastroenterological surgeons, interventional radiologists, and oncologists to avoid complications during abdominal surgical procedures.

Evaluation of Surgical Anatomy of Common Hepatic Artery: A Cadaveric Study

Background: Anatomical variations of the hepatic artery areimportant in the planning and performance of abdominalsurgical procedures. Hence; the present study was conductedfor assessing the surgical anatomy of common hepatic artery.Materials & Methods: A total of 18 corpses were included anddissected in the department of human anatomy. All thespecimens were then analyzed. A Performa was made andclinical and gender details of all the specimens were recorded.All the cadavers were preserved in 10 percent formaldehydesolution. Age range of all the cadavers was between 25 to 65years. Analysis of origin, position and course of the arterieswas done followed by measurement of their length anddiameter. After analysis, recording of the relations of all thearteries from the celiac trunk was done. All the arteries whichwere studies were marked with colored thread. All the resultswere recorded in Microsoft excel sheet and were analyzed bySPSS software.Results: Anatomic variations were found to be present in27.78 percent of cadavers. Out of 7 females, anatomicvariations were found to be present in 2 females while out of 11males, anatomic variations were found to be presentin 3 males. Among the hepatic artery specimens showingvariations, it originated directly from the superior mesentericartery. The average length among the variation anatomyspecimens of common hepatic artery was 2.81 cm while themean diameter was 0.70 cm.Conclusion: Variations in the hepatic artery are a commonphenomenon and both anatomists and surgeons should bethoroughly aware of the variation patterns.

A Case of Common Hepatic Artery Aneurysm Treated by Abdominal Aorta—Proper Hepatic Artery Bypass and Coil Embolization— / 日本心臓血管外科学会雑誌

A 52-year-old man underwent a medical examination, including abdominal computed tomography (CT). Abdominal CT revealed a common hepatic artery aneurysm (25 mm in diameter) ; a portion of the aneurysm depressed the pancreas. The gastroduodenal artery branched off the common hepatic artery aneurysm. We planned coil embolization for the common hepatic artery aneurysm. However, we could not avoid occluding the proper hepatic artery ; therefore, we performed abdominal aortic-proper hepatic artery bypass with coil embolization. The patient's postoperative course was uneventful.

Variations in the branching pattern of the celiac trunk and its clinical significance / 대한해부학회지

Celiac trunk is the artery of foregut, arising from the abdominal aorta at the level of T12/L1 vertebral body. It extends approximately 1.5 to 2 cm horizontally forwards before dividing into three branches: left gastric, common hepatic, and splenic arteries. Out of the three ventral branches of abdominal aorta, celiac trunk is more prone to have variations. During routine dissection of abdomen for undergraduate students we found some rare variations in the branching pattern of the celiac trunk. Absence of celiac trunk with hepatomesenteric trunk, quadrifurcation with dorsal pancreatic artery arising from it, quadrifurcation with middle colic artery arising from it, left inferior phrenic artery arising from celiac trunk, highly tortuous splenic artery supplying distal 1/3rd of transverse colon and hepatosplenic trunk. Knowledge of such variations is essential for liver and pancreas transplantations, pancreaticoduodenectomy, radiological abdominal interventions, laproscopic surgeries, and in trauma of the abdomen.

Absence of the celiac trunk and trifurcation of the common hepatic artery: a case report / Ausência de tronco celíaco e trifurcação da artéria hepática comum: relato de caso

Abstract Anatomical variations of the celiac trunk and its branches are particularly important from a surgical perspective due to their relationships with surrounding structures. We report here a particularly rare variant involving absence of the celiac trunk in association with trifurcation of the common hepatic artery. These variations were found in an adult male cadaver. We perform a review of the literature and discuss the clinical and embryological significance of these variations. Recognition of celiac trunk and hepatic artery variations is of utmost importance to surgeons and radiologists because multiple variations can lead to undue complications.

Resumo As variações anatômicas do tronco celíaco e seus ramos são particularmente importantes do ponto de vista cirúrgico devido a sua relação com as estruturas adjacentes. Nós descrevemos aqui uma variante particularmente rara envolvendo ausência do tronco celíaco associada a trifurcação da artéria hepática comum. Essas variações foram observadas no cadáver de um adulto do sexo masculino. Neste artigo revisamos a literatura e discutimos a significância clínica e embriológica dessas variações. O reconhecimento das variações do tronco celíaco e da artéria hepática é extremamente importante para cirurgiões e radiologistas uma vez que variações múltiplas podem levar a complicações inesperadas.

Variations in Origin of Gastroduodenal Artery: A Cadaveric Study.

Background: Gastroduodenal artery (GDA) is usually the first branch of the common hepatic artery from celiac trunk. In patients with chronic pancreatitis visceral artery aneurysms, incidence of up to 10% has been reported. The aneurysms occur most frequently in the splenic artery (10.4%); the common hepatic, gastroduodenal (1.5%), and pancreaticoduodenal arteries are affected. Material and Methods: It was a cross-sectional study conducted in the Department of General Surgery and Forensic Medicine, N.S.C.B. Medical College, Jabalpur during the period from August 2012 to August 2013. Abdomen of the cadaver will be accessed by the standard postmortem midline incision (sternum to pubes). Vascular anatomy of the GDA and vein will be dissected out in-situ using standard surgical instruments. The distance from the pylorus to the GDA will be measured by measuring tape. Results: In our study, out of total 31 cadavers, 19 (61.2%) were of male and 12 (38.8%) were of females. In all the cases, the site of origin of GDA is from the celiac axis of the common hepatic artery. Out of total 19 male cadavers, 17 (89%) showed a distance of 2.5-3 cm between pylorus and GDA and remaining 2 (11%) showed a distance of 3-3.5 cm. Conclusion: In our study, GDA has been seen arising from common hepatic artery from the celiac axis in 100% of cases. Previous studies have also given very less percentage of rare sites of origin but with the advent of newer modalities of investigations such as Doppler studies and computed tomography angiograms this very less percentage of rare variations can be diagnosed if there are knowledge and suspicion. This will help a lot to prevent major catastrophe during surgeries and radiological interventions.

Rare variations in the Origin, Branching Pattern and Course of the Celiac Trunk: Report of Two Cases

Multiple anomalies in the celiac arterial system presents as rare vascular malformations, depicting deviations of the normal vascular developmental pattern. We found a common left gastro-phrenic trunk and a hepato-spleno-mesenteric trunk arising separately from the abdominal aorta in one cadaver. We also found a common hepatic artery and a gastro-splenic trunk arising individually from the abdominal aorta in another cadaver. Even though many variations in the celiac trunk have been described earlier, the complex variations described here are not mentioned and classified by earlier literature. Knowledge of such variations has signifi cance in the surgical and invasive arterial radiological procedures in the upper abdomen.

Behavioral Anatomy of the Celiac Trunk Based on Human Embryology.

Anatomical knowledge of the coeliac trunk and its branches is indispensable for surgeons in order to avoid post-surgery complications and malpractice and that’s what inspired us to review this important topic. The coeliac trunk is the first ventral branch of arising from the abdominal aorta below the aortic opening of diaphragm. It is responsible for the blood supply of the not only the foregut but also for accessory organs of gastrointestinal tract (GIT) which include liver, pancreas and biliary apparatus [1]. Anatomic variations are often responsible for a variety of clinical conditions and it’s often occurring in the coeliac trunk branches.

Anomalous branching pattern of common hepatic artery: a case report.

A number of hepatic artery variations exists which is continuously proving a hindrance for the surgeons and radiologists. During routine dissection in the subhepatic region in 50 year old male cadaver for undergraduate teaching, a variation in the branching pattern of common hepatic artery was noticed. We observed an unusual branching of the common hepatic artery into seven terminal branches, of which two were left hepatic arteries, two were right gastric arteries and the remaining three were right hepatic artery, cystic artery and gastroduodenal artery. Hepatic artery proper was absent. Embryological basis of these variations were discussed. The present case is a rarity and will further throw light on the knowledge of the hepatic artery variations, thus assisting surgeons and radiologists in various surgical and diagnostic procedures.

A Rare Case With Multiple Variations Of Liver And Associated Arteries.

Variations of liver, its arterial supply and branching pattern of coeliac trunk are not uncommon as separate entity but this case presents several variations. During routine dissection, a multi-lobular liver, with irregular inferior margin, was observed occupying only right upper quadrant of the abdomen. An extra (accessory) lobe was hanging from its inferior surface. Common hepatic artery was giving eight branches, six on left side and two on right side. Five of the left branches were entering liver but none was passing through porta hepatis. Coeliac trunk showed tetrafurcation; the additional branch was supplying pancreas and transverse colon. Knowledge of these variations or combinations is important in open access surgeries, endoscopic surgeries and diagnostic and interventional radiology of the region.

A study of morphology of coeliac trunk in 100 cadavers.

Background: The coeliac trunk is an integral part of the circulatory system as it delivers blood from the heart to major organs within the abdominal cavity. The blood that it delivers is oxygenated and carries essential nutrients and immune system particles that can aid in life sustaining processes and can also prevent the development of diseases and complications from illnesses. Aims & Objective: (1) To study the anatomy of coeliac trunk, through its diameter, length related to their branches and distance from superior mesenteric artery. (2) To study the clinical implication of coeliac trunk in case of the variations and anomalous formation of coeliac trunk. Material and Methods: Morphology of coeliac trunk was studied in 100 formalin embalmed cadaver, aged between 50 to 80 years. Dissection method was use for this study. Results: Measurement of the length of the coeliac trunk up to the left gastric, Measurement of the length of coeliac trunk up to common hepatic and/or splenic artery, Measurement of coeliac trunk diameter, Distance between coeliac trunk and the superior mesenteric artery were taken. Conclusion: Knowledge of variations concerning the coeliac trunk is of extreme clinical importance in the areas of the laparoscopic surgery, and radiological procedures in the upper abdomen, and should be kept in mind by clinicians to avoid complications.

An accessory right hepatic artery arising from superior mesenteric artery and its clinical significance.

Background: Knowledge of hepatic arterial vascularization and its variations have a significant relevance for the daily practice of hepato-biliary surgeon as well as radiologists and anatomists. The right hepatic artery normally arises from the hepatic artery proper, the continuation of the common hepatic artery which is a branch of celiac trunk. Sometimes the anatomical arterial variations are also very common in human beings especially in hepatic region. During routine dissections for undergraduate medical students at Department of Anatomy, in a 75 -year-old male cadaver, we found the right accessory hepatic artery arises from the superior mesenteric artery which supplied the right lobe of the liver along with normal right hepatic artery. In addition, a direct branch to the left lobe of the liver was seen arising from common hepatic artery. The arterial anomaly can be enlightened by embryonic development. The knowledge of existence of aberrant hepatic arteries, either accessory or replacing, is important because they may influence surgical and interventional radiological procedures.

Compression of the Main Pancreatic Duct by the Intrapancreatic-Replaced Common Hepatic Artery

We describe a unique case of a patient who presented with a linear, transverse, and incidentally-detected main pancreatic duct dilatation that was caused by the intrapancreatic-replaced common hepatic artery, detected on the MDCT, MRCP and endoscopic retrograde cholangiopancreatography. We believe this case to be the first of its kind reported in the literature.

Discussion on the strategies of common hepatic artery lymph node dissection for thoracic esophageal squamous cell carcinoma / 中华消化外科杂志

Objective To analyze the metastatic rule of common hepatic artery lymph node of thoracic esophageal squamous cell carcinoma,and to investigate the strategies of common hepatic artery lymph node dissection.Methods The clinical data of 682 patients with esophageal squamous cell carcinoma who were admitted to the Cancer Hospital of Fudan University from May 2005 to December 2010 were retrospectively analyzed.The locoregional lymph node metastasis of thoracic esophageal squamous cell carcinoma,relationship between metastatic rates of common hepatic artery lymph node and clinicopathological factors and the postoperative complications were analyzed.The enumeration data were analyzed using the chi-square test.Results A total of 18 277 lymph nodes were dissected (27 lymph nodes per patient).The lymph node metastatic rate was 55.87％ (381/682),and the metastatic lymph node ratio was 7.87％ (1438/18 277).Lymph nodes adjacent to the cardia of stomach,laryngeal nerve,lesser curvature of stomach,cervical esophagus,left gastric artery had a higher metastatic rate,while common hepatic artery lymph node had a lower metastatic rate.All the common hepatic artery lymph node metastasis was accompanied with locoregional metastasis.A total of 1480 common hepatic artery lymph nodes were dissected (2 common hepatic artery lymph nodes per patient).Twenty-four patients had common hepatic artery lymph node metastasis,with the metastatic rate of 3.52％ (24/682) and the lymph node ratio of 2.16％ (32/1480).The common hepatic artery lymph node metastatic rates of upper,middle and lower esophageal squamous cell carcinoma were 2.33％ (1/43),3.76％ (16/425) and 3.27％ (7/217),with no significant difference (x2 =0.295,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients in T1,T2 and T3 stages were 2.35％ (2/85),5.46％ (10/183) and 2.90％ (12/414),with no significant difference (x2 =2.850,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients with high,moderate and poor differentiated esophageal squamous cell carcinoma were 0(0/63),3.50％ (16/457) and 4.94％ (8/162),with no significant difference (x2=3.259,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients with diameter of tumor under 3 cm,3-5 cm and above 5 cm were 2.59％ (6/232),3.02％ (11/364) and 8.14％ (7/86),with significant difference (x2 =6.267,P ＜ 0.05).The common hepatic artery lymph node metastatic rates of patients in N0,N1,N2,N3 stages were 0(0/301),2.53％ (5/198),5.65％ (7/124) and 20.34％ (12/56),with significant difference (x2 =62.368,P ＜ 0.05).The common hepatic artery lymph node metastatic rates of patients in stage Ⅰ,Ⅱ,Ⅲ and Ⅳ were 0(0/62),1.78％ (6/337),5.06％ (13/257) and 19.23％ (5/26),with significant difference (x2=25.959,P ＜0.05).Two hundred and twenty-eight patients had postoperative complications with the complication rate of 33.43％ (228/682).The incidence of anastomotic fistula was the highest,which was 11.58％(79/682).Conclusions The metastatic rates of common hepatic artery lymph node in thoracic esophageal squamous cell carcinoma is the lowest.For patients suffered from esophageal cancer in stage I or the tumor diameter under 5 cm,the dissection of common hepatic lymph node can be ommitted in surgery.

A spontaneous pseudoaneurysm of the common hepatic artery / 대한내과학회지

Hepatic pseudoaneurysms were once relatively uncommon and often associated with hepatic trauma. Currently, the main etiology of pseudoaneurysms is iatrogenic injuries with the increased use of percutaneous procedures and laparoscopic surgery. However, a spontaneous hepatic pseudoaneurysm is very rare. The clinical manifestations can include pain, swelling, thrombosis, bleeding, and rupture. Early detection is critical for the proper treatment, because ruptured pseudoaneurysms have high morbidity and mortality. We present a case of spontaneous pseudoaneurysm in the common hepatic artery that was treated successfully with transarterial coil embolization.