Right Hepatic Artery: A Cadaver Investigation and Its Clinical Significance

The right hepatic artery is an end artery and contributes sole arterial supply to right lobe of the liver. Misinterpretation of normal anatomy and anatomical variations of the right hepatic artery contribute to the major intraoperative mishaps and complications in hepatobiliary surgery. The frequency of inadvertent or iatrogenic hepatobiliary vascular injury rises with the event of an aberrant anatomy. This descriptive study was carried out to document the normal anatomy and different variations of right hepatic artery to contribute to existing knowledge of right hepatic artery to improve surgical safety. This study conducted on 60 cadavers revealed aberrant replaced right hepatic artery in 18.3% and aberrant accessory right hepatic artery in 3.4%. Considering the course, the right hepatic artery ran outside Calot’s triangle in 5% of cases and caterpillar hump right hepatic artery was seen in 13.3% of cases. The right hepatic artery (normal and aberrant) crossed anteriorly to the common hepatic duct in 8.3% and posteriorly to it in 71.6%. It has posterior relations with the common bile duct in 16.7% while in 3.4% it did not cross the common hepatic duct or common bile duct. The knowledge of such anomalies is important since their awareness will decrease morbidity and help to keep away from a number of surgical complications.

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RIGHT HEPATIC ARTEY: CLINICAL SIGNIFICANCE OF VARIATIONS IN THE ORIGIN AND ITS RELATIONS WITH THE COMMON HEPATIC DUCT

10.36106/ijar/7601815 ◽

2021 ◽

pp. 45-47

Author(s):

Sabeersha. S ◽

K.S. Krishnakumari

Keyword(s):

Hepatic Artery ◽

Hepatic Duct ◽

Celiac Trunk ◽

Anatomical Variations ◽

Middle Part ◽

Common Hepatic Duct ◽

Medical College ◽

Right Hepatic Artery ◽

The Common ◽

The Right

The right hepatic artery is an end artery and contributes sole arterial supply to right lobe of the liver . It also supplies the gall bladder, cystic duct, common hepatic duct and upper and middle part of common bile duct. Normal hepatic arterial anatomy occurs in approximately in 80% of cases, for the remaining 20% multiple variations have been described. Misinterpretation of anatomical variations of the right hepatic artery contribute to the major intraoperative mishaps and complications in hepatobiliary surgery. Materials and Methods: This descriptive study conducted on 50 cadavers in Department of Anatomy,Govt Medical College, Kozhikode to document the normal anatomy and different variations of right hepatic artery regarding its origin and relation with the common hepatic duct. Results : Right hepatic artery had its origin from proper hepatic artery in 47 (94%) cases, in one case the artery came from common hepatic artery, aberrant origin of right hepatic artery was seen in 4% cases, one case from celiac trunk directly and the other from superior mesenteric artery. Relation with common hepatic duct : In 46 cases (92%) the artery (normal and aberrant) passes posterior to common hepatic duct. In 6%, the artery was related anterior to common hepatic duct. In one case the artery was medial to the common hepatic duct. Conclusions : This study highlights the importance of knowledge of such anomalies since their awareness will decrease morbidity and help to keep away from a number of surgical complications.

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IS COMPRESSION OF THE COMMON BILE DUCT BY THE RIGHT HEPATIC ARTERY A POTENTIAL CAUSE OF INTRAHEPATIC STONES?

10.1055/s-0038-1637399 ◽

2018 ◽

Author(s):

V Perri ◽

V Bove ◽

A Tringali ◽

I Boškoski ◽

B Federico ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Hepatic Artery ◽

Intrahepatic Stones ◽

Right Hepatic Artery ◽

The Common ◽

The Right

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Compression of the common hepatic duct by the right hepatic artery

Clinical Imaging ◽

10.1016/j.clinimag.2005.01.023 ◽

2005 ◽

Vol 29 (5) ◽

pp. 342-344 ◽

Cited By ~ 6

Author(s):

Kunihiko Izuishi ◽

Yoshihiro Toyama ◽

Hisao Wakabayashi ◽

Hisashi Usuki ◽

Hajime Maeta

Keyword(s):

Hepatic Artery ◽

Hepatic Duct ◽

Common Hepatic Duct ◽

Right Hepatic Artery ◽

The Common ◽

The Right

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P.08.26 IS COMPRESSION OF THE COMMON BILE DUCT BY THE RIGHT HEPATIC ARTERY A POTENTIAL CAUSE OF INTRAHEPATIC STONES?

Digestive and Liver Disease ◽

10.1016/s1590-8658(18)30603-0 ◽

2018 ◽

Vol 50 (2) ◽

pp. e215

Author(s):

V. Perri ◽

V. Bove ◽

A. Tringali ◽

I. Boškoski ◽

R. Landi ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Hepatic Artery ◽

Intrahepatic Stones ◽

Right Hepatic Artery ◽

The Common ◽

The Right

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Compression of the common hepatic duct by the right hepatic artery in intrahepatic gallstones

World Journal of Surgery ◽

10.1007/bf01655064 ◽

1984 ◽

Vol 8 (3) ◽

pp. 321-326 ◽

Cited By ~ 13

Author(s):

Ryoichi Tsuchiya ◽

Toshifumi Eto ◽

Noboru Harada ◽

Kensuke Yamamoto ◽

Teiji Matsumoto ◽

...

Keyword(s):

Hepatic Artery ◽

Hepatic Duct ◽

Common Hepatic Duct ◽

Right Hepatic Artery ◽

The Common ◽

The Right

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Left hepatic trisectionectomy combined with pancreatoduodenectomy for wide-spread bile duct cancer with right hepatic artery running in front of the common bile duct

HPB ◽

10.1016/j.hpb.2016.01.338 ◽

2016 ◽

Vol 18 ◽

pp. e804

Author(s):

N. Kokudo ◽

Y. Miyata ◽

Y. Sakamoto

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Hepatic Artery ◽

Bile Duct Cancer ◽

Wide Spread ◽

Right Hepatic Artery ◽

Left Hepatic Trisectionectomy ◽

Duct Cancer ◽

The Common

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Aberrant Right Hepatic Duct Originating from the Right Posterior Duct with Low Insertion into the Common Bile Duct

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2006.04.007 ◽

2006 ◽

Vol 203 (6) ◽

pp. 972 ◽

Cited By ~ 1

Author(s):

Gonzalo Pérez ◽

Ricardo O. Escárcega ◽

Julio Gargantua ◽

Salvador Fuentes-Alexandro

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Hepatic Duct ◽

The Common ◽

The Right

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Photodynamic therapy of extrahepatic cholangiocarcinoma using digital cholangioscopy

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020190001e1490 ◽

2020 ◽

Vol 33 (1) ◽

Author(s):

Vítor Ottoboni BRUNALDI ◽

José Eduardo BRUNALDI ◽

José Dirceu VOLLET-FILHO ◽

Mariangela Ottoboni BRUNALDI ◽

José Celso ARDENGH ◽

...

Keyword(s):

Photodynamic Therapy ◽

Bile Duct ◽

Common Bile Duct ◽

Laser Light ◽

Hepatic Duct ◽

Common Hepatic Duct ◽

Direct Visualization ◽

Extrahepatic Cholangiocarcinoma ◽

Adjunct Treatment ◽

The Common

ABSTRACT Background: Cholangiocarcinoma is an aggressive neoplasm that usually requires palliative biliary drainage. Photodynamic therapy (PDT) has been described as a successful adjunct treatment to malignant biliary obstruction. Aim: To describe the use of digital cholangioscope to help provide laser light during biliary PDT session using locally developed light source. Method: Patient receives intravenous photosensitizer 24 h before the procedure. It starts with a regular duodenoscopy. After identification of the major papilla and retrograde cannulation, the digital cholangioscope is introduced into the common bile duct. Then, the cholangioscopic examination helps to identify the neoplastic stricture. Under direct visualization lighting catheter is advanced through the cholangioscope. Repositioning is recommended every centimeter to cover all strictured area. At the end of the procedure, a final cholangioscopy assesses the bile duct for the immediate result and adverse events. Result: This procedure was applied in one 82-year-old male due to obstructive jaundice in the last two months. EUS and ERCP revealed a severe dilation of the common bile duct associated with choledocholithiasis. Besides, was revealed dilation of hepatic duct up to a well-circumscribed hypoechoic solid mass measuring 1.8x2 cm compressing the common hepatic duct. The mass was deemed unresectable and the patient was referred for palliative treatment with PDT. He remained asymptomatic for three months. He perished due to complications 15 months after the PDT session. Conclusion: Digital cholangioscopy-guided biliary PDT is feasible and seems safe and effective as an adjunct modality in the palliation of extrahepatic cholangiocarcinoma.

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Mirizzi Syndrome with Cholecystobiliary Fistula: Observation of Development from Asymptomatic Cholecystolithiasis to Surgery

Case Reports in Radiology ◽

10.1155/2020/2049525 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Hiroyuki Sugo ◽

Yuuki Sekine ◽

Naoki Iwanaga ◽

Shigefumi Neshime ◽

Michio Machida

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Hepatic Duct ◽

Filling Defect ◽

Mirizzi Syndrome ◽

Common Hepatic Duct ◽

Gallbladder Stone ◽

Quadrant Pain ◽

Abdominal Ct ◽

The Common

Despite a considerable number of reports of Mirizzi syndrome, none have described the process of its development from simple cholecystolithiasis. We report an extremely rare case of Mirizzi syndrome in which it was possible to observe the process of development of cholecystobiliary fistula from asymptomatic cholecystolithiasis until unavoidable surgical intervention 4 years later. A 68-year-old woman presented at our hospital with right upper quadrant pain. She had been diagnosed as having asymptomatic cholecystolithiasis 4 years previously. Diagnostic abdominal computed tomography (CT) had revealed a 1.9 cm radiopaque stone, and thereafter, the patient had been monitored by imaging alone. CT conducted 6 months before the present admission revealed that the gallbladder stone was compressing the common hepatic duct, although the patient remained asymptomatic. On admission, abdominal CT showed that the gallbladder stone was obstructing the common bile duct with dilatation of the intrahepatic duct. Endoscopic retrograde cholangiopancreatography revealed a round filling defect at the confluence of the common bile duct and the image of the cystic duct; therefore, the patient was categorized as having Mirizzi syndrome type III, according to the Csendes classification. Intraoperative findings revealed a cholecystobiliary fistula involving up to two-thirds of the circumference of the common bile duct.

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