The Absence of a Proper Hepatic Artery: A Case Report

Patient: Female, 80-year-old Final Diagnosis: Lung adenocarcinoma Symptoms: Death Medication:— Clinical Procedure: — Specialty: Anatomy • Surgery OBJECTIVE: Unusual clinical course 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.