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Three enormous cystic artery branches: a novel and unusual variant

Year: 2025

Type: article

Abstract: Three enormous cystic artery branches: a novel and unusual variant Gallbladder stones are one common yet significant digestive system ailment. 1 Abdominal pain, fever and jaundice are some of the symptoms that might result from biliary obstruction caused by stone migration into the bile duct, which repeatedly stimulates the biliary system.In severe cases, this may progress to acute obstructive suppurative cholangitis, which could cause infectious shock and endanger the patient's health and life. 2 The most effective treatment for gallbladder stones is surgery, which includes both open and laparoscopic cholecystectomy procedures.Anatomy structure is crucial for gallbladder surgery to be performed successfully and safely.The "Critical View of Safety," first presented by Strasberg et al. in 1995, places a strong emphasis on being able to see the cystic artery and cystic duct in the Calot's triangle.3 Other structures, however, might be found within the triangle of Calot in circumstances of anatomical differences.4 Variations in anatomy may raise the chance of complications during a cholecystectomy.As a result, a comprehensive knowledge of the anatomical structures and their variations is required.A rare type of cystic artery variation was present in a patient being diagnosed with gallbladder stones that were exacerbated by acute cholecystitis.During the emergency surgery, an uncommon variant of the cystic arteries was identified when laparoscopically determining the anatomical Calot's triangle for a Critical View of Safety.Due to extensive abdominal adhesion, laparoscopic procedures were quite challenging.An emergency switch to open surgery was carried out to guarantee precise vascular and duct separation.Each of the three branches of the cystic artery, which had exceptionally coarse diameters, was meticulously dissected (Figs. 1 and 2).The right hepatic artery is the most frequent source of the cystic artery, travelling into the cystohepatic triangle, positioned superomedial to the cystic duct, and posteriorly to the common hepatic duct.5 The cystic artery splits into the smaller posterior deep branch and the bigger anterior superficial branch when it gets closer to the gallbladder.The deep branch extends posteriorly between the gallbladder and the gallbladder bed, while the superficial branch is located beneath the serosa on the left side of the gallbladder.According to earlier research, 8.9% of people had numerous cystic artery branches.6 According to the recently updated classification of cystic artery anatomy, 0.17% of cases exhibit more than two branches of the cystic artery.7 For the variation of three such enormous branches, this was extremely rare.From a surgeon's perspective, a thorough comprehension and identification of cystic artery variations is essential for the safety of cholecystectomy.8 The patient has given informed consent for the publication of images.

Source: ANZ Journal of Surgery

DOI: 10.1111/ans.70120

Authors: Zhetan Ren, Bing Yin, Jiugong Wang, Yuyao Xie, Tao Zhang, Lei Gong

Institutions: Capital Medical University, Beijing Shijitan Hospital, First Hospital of China Medical University, China Medical University, Liaoning University of Traditional Chinese Medicine

Language: English

Topic: Gallbladder and Bile Duct Disorders

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: bronze

OpenAlex ID: W4409215252

FWCI:

Cites: 8

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Related to: 10