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

Unusual development of the celiac trunk and its clinical significance / Desenvolvimento incomum do tronco celíaco e sua importância clínica

Abstract We describe a case of unusual development of the celiac trunk observed in the cadaver of 1-year old male child. The celiac trunk branched into five vessels: the splenic, common hepatic and left gastric arteries, the left inferior diaphragmatic artery, and a short trunk that branched into the right inferior diaphragmatic artery and right accessory hepatic artery. Additionally, the manner of branching of the vessel was unusual: it was possible to distinguish two branching points that corresponded to its s-shaped trajectory. There were also other variations of vascular supply, such as the presence of a left accessory hepatic artery, an additional superior pancreatoduodenal artery, and others. It should be noted that multiple developmental variations can be common in clinical practice and clinicians should be aware of them during diagnostic and interventional procedures.

Resumo Apresentamos um relato de caso de desenvolvimento incomum do tronco celíaco em um cadáver do sexo masculino de 1 ano de idade. O tronco celíaco ramificou-se para cinco vasos: as artérias esplênica, hepática comum e gástrica esquerda, a artéria diafragmática inferior esquerda e um tronco pequeno que se ramificou para a artéria diafragmática inferior direita e para a artéria hepática direita acessória. Além disso, a forma como o vaso se ramificou foi incomum: é possível distinguir dois pontos de ramificação que correspondem à trajetória em formato de S. Também houve outras variações do suprimento vascular, como a presença da artéria hepática esquerda acessória, da artéria pancreaticoduodenal superior acessória e outras. Cabe observar que a variação de desenvolvimento múltipla pode ser comum na prática clínica, e os médicos devem estar cientes dela durante os procedimentos de diagnóstico e intervenção.

Intrahepatic cholangiocarcinoma with aberrant hepatic artery presenting as hepatic abscess: a case report

Intrahepatic cholangiocarcinoma (ICC) is a primary hepatic malignancy that originates from epithelial cells of bile duct. Lack of diagnostic measures and therapies leads to an increasing number of deaths from ICC worldwide. Here we described a case of 61-year-old Chinese female, who initially presented with right upper quadrant pain, combined with the results that a low density mass accompanied by multiple nodules occupied the right liver lobe by CT-scan, which also showed an aberrant right hepatic artery that participated in the right liver lobe and origining from the superior mesenteric artery, this patient was clinically considered as hepatic abscess (HA). The patient’s right upper quadrant pain was alleviated after been treated with the infusion chemotherapy of the aberrant right hepatic artery (ARHA) via percutaneous femoral arterial catheterization by Seldinger technique (Meropenem 7 days) following the failure of the liver-puncture drainage.  However, the right upper quadrant pain occurred again 6 days later, serum CA19-9>1000.0 U/ml, which indicated the possibility of hepatic malignancy, so we performed laparotomy. The histopathological result of intraoperative frozen section demonstrated cholangiocarcinoma, unfortunately, it was unresectable. Finally, right lower lung pneumonia and pleural empyema happened to her and she succumbed to respiratory failure 22 days following surgery. In this report, we will discuss the case with reference to the literature.

A Study On Variations In Origin And Course Of Right Hepatic Artery

Background: With ever increasing load of liver disease on population of developed as well as developingcountries, it has become mandatory to have a detailed knowledge about hepatic arteries. Since adequate literatureregarding hepatic arteries and its variation e in people living in and around Eluru is not available, a study ofhepatic arteries ad its variation is carried out in our ASRAM medical college, Andhra Pradesh, India.Aims and objectives: To study the variations in the origin, course of right hepatic arteryMaterials and methods: This study was conducted in 60 embalmed adult cadavers of both sexes of age groupbetween 50 to 80 years. The common hepatic artery and its branch gastroduodenal artery were identified. Properhepatic artery in the hepatoduodenal ligament was traced and the relation of the common hepatic artery and theproper hepatic artery were noted. Origin of the RHA was traced and the presence of aberrant right hepaticarteries: (i) Replaced; (ii) Accessory were noted. To identify the presence of aberrant right hepatic arteries,abdominal aorta was exposed from the level of origin of the coeliac trunk to the level of origin of the inferiormesenteric artery.Results: In this study, the right hepatic artery originates from the proper hepatic artery in 24 (60%) specimens.Theaberrant, accessory and replaced right hepatic artery were found to be 20%, 12.5%, and 7.5% respectively. 5% ofspecimen showed caterpillar hump in right hepatic artery.Conclusion: Right hepatic artery is subject to anatomical variation in its origin and course. Because of anatomicvariations in the RHA, surgical injuries in the liver can occur even by the most experienced surgeon. A thoroughknowledge of the RHA anatomy is necessary while performing hepatic surgery and hepatic arteriography

Angiotomografía de las variantes anatómicas de la arteria cística: estudio en el preoperatorio de colelitiasis / Angiotomography of the anatomical variants of the cystic artery: pre-operative study of cholelithiasis

La colecistectomía laparoscópica es el tratamiento indicado en la colelitiasis, sin embargo el procedimiento no está exento de complicaciones o morbilidad concomitante. Es posible que, debido a lesiones ductales colaterales, ocurra sangrado con posibilidad de conversión de la cirugía e indeseables resultados. Para un correcto abordaje de la región se hace fundamental la identificación del trígono cistohepático (TCH) y sus componentes, a su vez de la ligadura y sección de la arteria cística (AC). Conociendo la elevada variabilidad de la AC, el objetivo de este trabajo consistió en identificar el número, origen, trayecto y relación de la AC con el TCH y sus variaciones, utilizando angiotomografía por medio de un tomógrafo detector de 64 cortes, en el preoperatorio de 30 pacientes de sexo femenino, entre 24 y 54 años de edad, con colelitiasis diagnosticadas clínicamente y por ecosonografía. La AC en el 76,67 % era única y se encontraba dentro del TCH, en el 16,67 % era única y se observó fuera del TCH. En el 6,67 % se observaron dos AC, una dentro y otra fuera del TCH. En el 66,67 % de los casos la AC se originaba de manera normal de la arteria hepática derecha. La trazabilidad de la AC fue en el 53,3 % medianamente visible y en el 46,7 % de trazabilidad excelente. En conclusión, la identificación de la AC y sus variaciones anatómicas se puede determinar en el preoperatorio y puede ser útil para mejorar el plan quirúrgico en pacientes con colelitiasis, brindando información al procedimiento, optimizarlo y disminuir los riesgos de eventuales complicaciones relacionados con sangrado.

Laparoscopic cholecystectomy is the treatment indicated for cholelithiasis, however the procedure is not free of complications or concomitant morbidity. It is possible that, due to collateral ductal lesions, bleeding occurs with the possibility of surgery conversion and undesirable results. For a correct approach to the region it is essential to identify the cystohepatic trigone (CHT) and its components, as well as the ligation and section of the cystic artery (AC). Knowing the high variability of CA, the aim of this work was to identify the number, origin, path and relationship of CA with the CHT and its variations using angiotomography by means of a 64-slice detector tomograph in the preoperative period of 30 female patients, between 24 and 54 years old, with clinically diagnosed cholelithiasis and by echo sonography. The AC in 76.67 % was unique and was within the CHT, in 16.67 % it was unique and was observed outside the CHT. In 6.67 %, two ACs were observed, one inside and one outside the TCH. In 66.67 % of cases, CA originated normally from the right hepatic artery. The traceability of AC was 53.3 % moderately visible and 46.7 % excellent traceability. In conclusion, the identification of AC and its anatomical variations can be determined in the preoperative period and can be useful to improve the surgical plan in patients with cholelithiasis, providing information on the procedure, optimizing it and reducing the risks of possible bleeding related complications.

Hemobilia pós-trauma: forma não usual de hemorragia digestiva alta - relato de caso / Hemobilia post-trauma: unusual form of upper gastrointestinal bleeding - case report

A hemobilia é definida como o sangramento no trato biliar e representa uma causa rara de hemorragia digestiva alta. Sua etiologia é variada, sendo majoritariamente devido a trauma acidental e iatrogenia, e o seu tratamento padrão ouro consiste na embolização seletiva da artéria hepática. Os autores relatam o caso de um paciente de 19 anos, do sexo masculino, vítima de uma queda de 5 metros de altura. Após tomografia computadorizada de abdome, foi evidenciada lesão hepática e optado por tratamento conservador. Paciente recebeu alta hospitalar com ultrassonografia de abdome, evidenciando estabilidade da lesão e retornou após 43 dias do trauma apresentando dor epigástrica e hematêmese. Tomografia computadorizada contrastada de abdome evidenciou a presença de pseudoaneurisma de artéria hepática direita, sendo optado pela embolização. Desse modo, apesar de não ser frequente, hemobilia é uma hipótese a qual deve sempre ser considerada em pacientes com hemorragia digestiva alta que sofreram trauma acidental ou foram submetidos a algum tipo de procedimento envolvendo a árvore biliar.

Hemobilia is defined as bleeding in the biliary tract, and is a very rare cause of upper gastrointestinal bleeding. Its etiology is varied (mostly due to accidental trauma and iatrogenic) and its gold standard treatment is selective hepatic artery embolization. The authors report a case of a 19 year old patient, male, victim of a fall of 5 meters high. After computed tomography of the abdomen, liver damage was observed and opted for conservative treatment. Patient was discharge with abdominal ultrasonography demonstrating stability of the injury and returned after 43 days of trauma presenting epigastric pain and hematemesis. Contrasted computed tomography of the abdomen showed the presence of pseudoaneurysm of right hepatic artery and opted for embolization. Thus, although it is unusual, it is a hypothesis that must always be considered in patients with upper gastrointestinal bleeding who have suffered accidental trauma or underwent some kind of procedure involving the biliary tree.

Multiple variations in the branches of the coeliac trunk / 대한해부학회지

Here we present a unique case of variation in the branching pattern of the coeliac trunk. In the present case, the coeliac trunk was replaced by two separate arterial trunks. The first arterial trunk bifurcated into the left gastric and the left hepatic arteries. The second arterial trunk bifurcated into a splenic artery and a hepato-gastroduodenal trunk. The hepato-gastroduodenal trunk presented an unusual course and termination. The right hepatic artery arising from the hepato-gastroduodenal trunk also showed a variant course. Such rare variations are important for gastroenterological surgeons and interventional radiologists due to increase in number of transplantation surgeries and live donor liver transplantations.

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.

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.

Variante anatómica: origen de la arteria hepática derecha de la arteria mesentérica superior / Anatomical variant: origin of right hepatic artery from the superior mesenteric artery

Este trabajo describe la presencia de la variante anatómica que presenta la arteria hepática derecha como rama de la arteria mesentérica superior en un caso incidental de disección en la Escuela de Medicina de la Universidad de Costa Rica, dicha variante se presenta desde 6,4 por ciento hasta un 18 por ciento por lo que debe siempre tenerse en cuenta durante cualquier cirugía hepatobiliar y más aún si se trata de cirugía de transplante hepático. Así mismo se revisa el tema y su importancia clínica...

Obstructive Jaundice due to Compression of the Common Bile Duct by Right Hepatic Artery Originated from Gastroduodenal Artery / 대한소화기학회지

Obstructive jaundice by vascular compression is rare. The causative arteries were identified as the right hepatic artery, gastroduodenal artery, cystic artery, proper hepatic artery, and an unspecified branch of the common hepatic artery. Also the venous system, such as enlarging collateral veins in cases of portal hypertension was a causative vessel. Herein, we describe a case of a proximal choledocholithiasis due to compression of the common bile duct by right hepatic artery originated from gastroduodenal artery. Final diagnosis and treatment were achieved through an operation.

Hepatocholelithiasis due to compression of common hepatic duct by right hepatic artery / 한국간담췌외과학회지

We present two cases of compression of the common hepatic duct by overriding of the right hepatic artery. One case is gall bladder, common hepatic duct stone and one case is right intrahepatic duct stone. We observed the compression of the common hepatic duct caused by overriding of the right hepatic artery in the both cases. The final diagnosis was made at operative fields. These patient were successfully treated by dissection of adhesion, suture, fixation between gall bladder bed and right hepatic artery.

Obstructive jaundice due to compression of the common hepatic duct by right hepatic artery: a case associated with the absence of the lateral segment of the left hepatic lobe

Various benign and malignant conditions can cause biliary obstruction. We present a rare case of obstructive jaundice due to the compression of the common hepatic duct by the anteriorly overriding right hepatic artery. This case was also associated with the absence of the lateral segment of the left hepatic lobe. The patient was a 39 year-old housewife with a 4-day history of jaundice and occasional febrile sensation. An abdominal computed tomography showed absence of the lateral segment of the left hepatic lobe and a percutaneous transhepatic cholangiography showed a band-like filling defect of 2 mm width at the level of the upper common hepatic duct. The anteriorly overriding right hepatic artery compressing the common hepatic duct and the absence of the lateral segment of the left hepatic lobe were confirmed by operation.

Undescended caecum and right-sided sigmoid colon with aberrant right hepatic artery: A case report.

Malrotation of the intestines in the third stage of intestinal rotation can be found in many studies and reports, but the incidence is variable. Aberrant right hepatic artery variations have been reported frequently in many series, but no report has described aberrant right hepatic arteries coming from the posterior branches of the superior and inferior pancreaticduodenal arteries. We report a case of undescended caecum and right-sided sigmoid colon with aberrant right hepatic artery in the cadaver of a 53-year-old male since it is important in some surgical arpects.