Double cystic artery originating from the superior mesenteric and right hepatic artery: A case report

Abstract Purpose: The cystic artery serves as an essential anatomical reference in both laparoscopic and open cholecystectomy. In this report, we present a unique case featuring two rare anatomical variations: double cystic arteries, along with a superficial branch originating from the superior mesenteric artery (SMA) a previously undescribed combination that has significant clinical and surgical implications, necessitating a surgeon’s awareness of its anatomical and embryological basis. Methods: The cadaver examined in this study was donated to Griffith School of Medicine for medical education and research purposes. A macroscopic examination was conducted to identify anatomical variations and elucidate the relationships between the atypical cystic artery and surrounding abdominal structures. Results: The typical cystic artery originated from the right hepatic artery, passing posterior to the common hepatic duct within Calot’s triangle, to supply the superomedial (dorsal/deep) surface of the gallbladder. The wider calibre, 100mm long accessory cystic artery originated 35 mm distal to the SMA origin, with a retro-pancreatic and sub-calot course, bifurcating to supply the cystic duct and inferolateral (superficial) surface of the gallbladder, respectively; almost resembling the calibre and positioning of an aberrant right hepatic artery. This configuration necessitates increased care by a surgeon, as it can lead to an increased risk of bleeding and injury during laparoscopic hepatoduodenal ligament dissection, Kocherisation/duodenal mobilisation, and pancreatic inflammatory/neoplastic processes. Conclusion: We believe accumulating knowledge of such variations will significantly enhance the safety and efficacy of cholecystectomy and pancreatic procedures.