Double Cystic Artery Originating in a Right and a Segment IV Hepatic Artery: A Case Report

Anatomical variation of the cystic artery (CA) is frequently observed. However, a CA originating in a segment IV hepatic artery (HA) has been rarely reported. We report double CA originating in a right segment IV HA detected during laparoscopic cholecystectomy (LC). A 67-year-old man underwent LC for symptomatic gallstones. We ligated and divided the cystic duct initially, and performed a procedure similar to the management of CA in the hepatobiliary triangle. In contrast to the other cases, the falciform ligament was attached to gallbladder. Severe arterial bleeding was observed during the dissection. We dissected the bleeding site and found another CA for ligation. A preoperative abdominal computed tomography (CT) scan confirmed a CA originating from a segment IV HA. The patient was discharged without any events the next day. In conclusion, we report a CA originating in segment IV HA. A falciform ligament attached to gallbladder suggests the unusual CA.