A case of missing a. hepatica communis associated with aberrant origin of aa . hepaticae dextra and sinistra

Abstract

A complex variation of truncus celiacus was discovered during routine anatomical dissection of a 65-year old female cadaver. After short course it divides into arteria gastrica sinistra, arteria lienalis and arteria gastroduodenalis. The missing arteria hepatica sinistra is replaced by a branch of arteria gastrica sinistra, and arteria hepatica dextra stems from arteria mesenterica superior. The left hepatic artery passes between the two sheaths of ligamentum hepatogastricum in its upper third and reaches porta hepatis via sulcus ligamenti venosi. The right hepatic is separated from the superior mesenteric artery just under the incisura pancreatica and crosses behind vena mesenterica superior. It continues in the free margin of ligamentum hepatoduodenale posteriorly to the ductus choledochus and to the right of vena portae. Uppon entrance in the hepatoduodenal ligament the artery separates arteria pancreaticoduodenalis superior posterior. Arteria gastroduodenalis has a similar anatomical course to the course of the `normal` arteria hepatica communis in the base of ligamentum hepatoduodenale. It separates arteria gastrica dextra, arteria pancreaticoduodenalis superior anterior and continues as expected into arteria gastroomentalis dextra. The incidence of the individual described variations (according literature data) is 10% - 19% for the left hepatic artery starting from the left gastric artery and 5% - 9% for the right hepatic artery starting from the superior mesenteric artery. The variations of the celiac trunk and the hepatic arteries are of greatest importance for the classical and minimum invasive surgical approach to the liver, gall bladder and hepatoduodenal ligament (e.g. cholecystectomy, tumor resection of liver, pancreas head or duodenum, aquisition of donor material for liver transplantation). The knowledge of the possible deviations in the hepatic arterial tree has also a significant impact on the interpretation of hepatic anatomy based on imaging data received by means of hepatic angiography, 3d computed tomography, CT angiography etc.