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      Hepatolithiasis caused by right hepatic artery branches forming an arterial ring compressing the common hepatic duct

      case-report

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          Abstract

          Anatomic variations of the hepatic artery do not usually cause biliary obstruction. We present a 51-year-old male who developed biliary obstruction and hepatolithiasis due to extrinsic compression of the common hepatic duct (CHD) by an arterial ring formed by the anterior and posterior branches of the right hepatic artery. We performed a surgical bile duct exploration and used intraoperative direct cholangioscopy to guide clearance of hepatolithiasis. Herein, we review the existing literature on CHD compression caused by topographical variants of the hepatic artery and discuss diagnostic and treatment strategies.

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          Most cited references11

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          Surgical anatomy of the hepatic arteries in 1000 cases.

          J Gabbay, R Busuttil, Michael J. Hiatt (1994)
          Anatomic variations in the hepatic arteries were studied in donor livers that were used for orthotopic transplantation. Variations have occurred in 25% to 75% of cases. Donor livers represent an appropriate model for study because extrahepatic arterial anatomy must be defined precisely to ensure complete arterialization of the graft at time of transplantation. Records of 1000 patients who underwent liver harvesting for orthotopic transplantation between 1984 and 1993 were reviewed. Arterial patterns in order of frequency included the normal Type 1 anatomy (n = 757), with the common hepatic artery arising from the celiac axis to form the gastroduodenal and proper hepatic arteries and the proper hepatic dividing distally into right and left branches; Type 3 (n = 106), with a replaced or accessory right hepatic artery originating from the superior mesenteric artery; Type 2 (n = 97), with a replaced or accessory left hepatic artery arising from the left gastric artery; Type 4 (n = 23), with both right and left hepatic arteries arising from the superior mesenteric and left gastric arteries, respectively; Type 5 (n = 15), with the entire common hepatic artery arising as a branch of the superior mesenteric; and Type 6 (n = 2), with the common hepatic artery originating directly from the aorta. These data are useful for the planning and conduct of surgical and radiological procedures of the upper abdomen, including laparoscopic operations of the biliary tract.
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            Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies.

            A Koops, B Wojciechowski, D C Broering … (2004)
            In modern surgical and transplantation procedures the recognition of anatomic vascular abnormalities of the hepatic arteries is of greater importance than ever. The purpose of this study was to evaluate and classify these variations with respect to their impact on visceral surgery. A total of 604 selective celiac and superior mesenteric angiographies performed on patients with known or suspected liver cirrhosis or hepatic or pancreatic malignancies and on donors of partial liver grafts were analyzed retrospectively. The vascular anatomy of the liver was classified according to different established systems and with particular attention to rare variations. Hepatic arterial anatomy as considered normal in textbook descriptions was found in 79.1%, an aberrant or accessory left hepatic artery (LHA) arising from the left gastric artery in 3.0% and an aberrant or accessory right hepatic artery (RHA) branching off the superior mesenteric artery in 11.9% of the cases. In 1.4% of the cases there was a combination of anomalies of both the LHA and RHA. Variants of the celiac trunk, double hepatic arteries branching at the celiac trunk or hepatic arteries arising directly from the aorta, occurred in 4.1% of the cases. Further atypical branches of the LHA and RHA were found in 0.5% of the cases. Since the incidence and pattern of different types of hepatic arterial anatomy can require specialized preoperative diagnostic as well as intraoperative strategies, knowledge of these abnormalities and their frequency is of major importance for the surgeon as well as the radiologist.
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              Compression of the common hepatic duct by the right hepatic artery in intrahepatic gallstones.

              K. Yamamoto, T Tsunoda, R Tsuchiya … (1984)
              Article 0 comments Cited 7 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Yifan Wang:
                ORCID: https://orcid.org/0000-0003-2821-1953
                Benjamin M Motz
                Matthew S Strand
                John B Martinie
                Dionisios Vrochides
                Erin Baker
                David A Iannitti
                Journal
                Journal ID (nlm-ta): J Surg Case Rep
                Journal ID (iso-abbrev): J Surg Case Rep
                Journal ID (publisher-id): jscr
                Title: Journal of Surgical Case Reports
                Publisher: Oxford University Press
                ISSN (Electronic): 2042-8812
                Publication date Collection: October 2022
                Publication date (Electronic): 31 October 2022
                Publication date PMC-release: 31 October 2022
                Volume: 2022
                Issue: 10
                Electronic Location Identifier: rjac492
                Affiliations
                Division of Hepato-Pancreato-Biliary Surgery , Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
                Division of Hepato-Pancreato-Biliary Surgery , Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
                Division of Hepato-Pancreato-Biliary Surgery , Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
                Division of Hepato-Pancreato-Biliary Surgery , Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
                Division of Hepato-Pancreato-Biliary Surgery , Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
                Division of Hepato-Pancreato-Biliary Surgery , Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
                Division of Hepato-Pancreato-Biliary Surgery , Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
                Author notes
                Correspondence address. Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA. Tel: (704) 355-4062; Fax: (704) 355-4965; E-mail: David.Iannitti@ 123456atriumhealth.org
                Author information
                https://orcid.org/0000-0003-2821-1953
                Article
                Publisher ID: rjac492
                DOI: 10.1093/jscr/rjac492
                PMC ID: 9624198
                PubMed ID: 36329778
                SO-VID: 19dbcbb7-af2c-42f2-ba5f-c99c945f2f2b
                Copyright © Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2022.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 29 August 2022
                Date accepted : 5 October 2022
                Page count
                Pages: 0
                Categories
                Subject: Case Report
                Subject: AcademicSubjects/MED00910
                Subject: jscrep/080

                Data availability:

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