Multiple rare vascular variations were identified in a 97-year-old female donor during the dissection of the gastrointestinal system. An anomalous middle colic artery originated from the celiac trunk alongside the three normal branches. The left hepatic artery, an accessory left hepatic artery, and the right hepatic artery all originated from the proper hepatic artery. The right hepatic artery exhibited a “caterpillar hump” and an abnormal tripod distal branching pattern, consisting of a very short cystic artery and two short right hepatic arteries (one superior and one inferior). Additionally, an accessory cystic artery arose from the inferior pancreaticoduodenal artery, ascending inferiorly to the common bile duct and cystic duct towards the gallbladder to join the cystic artery posteriorly. The right and middle colic arteries originated from a right colic middle colic common arterial trunk. The left colic artery and the sigmoidal arteries also originated from a left colic-sigmoidal common arterial trunk. Surgical and medical procedures in the pancreaticobiliary region are widespread, and cholecystectomy is one of the most common surgeries performed worldwide. A laparoscopic approach is the current ‘gold standard’ surgical approach. Knowledge of these potential gastrointestinal vascular variations is essential to ensure patient safety and avoid iatrogenic complications. The presence of an unidentified caterpillar-type right hepatic artery poses a significant risk of accidental ligation during cholecystectomy. Similarly, the presence of common colic arterial trunks alters the vascular landscape for laparoscopic colectomy. To ensure favorable surgical outcomes, comprehensive preoperative vascular imaging should be performed to identify such rare configurations. In this article, we discussed the frequency, embryology, physiology, and clinical and surgical implications of the anatomical variations present in this donor. To date, there have been no other reports in the literature describing this specific combination of variations.
Chen et al. (Tue,) studied this question.