Novel Presentation of Hepatic and Foregut Vasculature: A Case Study

Background: In the most typical presentation, the foregut (abdominal esophagus, stomach, and first and second parts of the duodenum), pancreas, spleen, and liver are supplied by branches of the celiac trunk. The celiac trunk arises from the superior abdominal aorta and branches into the splenic artery, left gastric artery, and the common hepatic artery. The common hepatic artery further branches into the gastroduodenal artery and the proper hepatic artery, which gives rise to the left and right hepatic arteries near the hilum of the liver. The superior mesenteric artery arises from the abdominal aorta just inferiorly to the celiac trunk and supplies the midgut (third part of the duodenum through the splenic flexure of the colon). While this is the typical “textbook” arrangement, variations in branching patterns are not uncommon. In this case study, we describe a novel case of the hepatic foregut vasculature not matched in the current literature. Case Information: The novel variant in the arterial supply of the liver was encountered during the routine cadaveric dissection of a 63-year-old Caucasian male. The common hepatic artery is absent as per its accepted definition. The gastroduodenal artery is a branch of the celiac trunk, while the proper hepatic artery emerges from the superior mesenteric artery. At the hepatic hilum, the proper hepatic artery gives rise to left and right hepatic arteries. Additionally, an accessory left hepatic artery is present branching from the left gastric artery. Conclusions: Variations in hepatic arterial supply are common, and it is important for surgeons to be aware of these variations when performing surgical procedures such as liver transplants, cholecystectomies, and other abdominal procedures. Patients are at risk of hemorrhage, ischemia, or other surgical complications if these variations are not discovered and precautionary steps taken to avoid damaging or accidentally ligating the vessels. Appropriate imaging techniques, such as contrast-enhanced computed tomography (CE-CT), should be used to document patient-specific vasculature branching patterns from the celiac trunk and superior mesenteric when developing surgical approaches involving the foregut and liver.