Left Gastric Artery Arising From the Superior Mesenteric Artery via a Common Trunk With the Dorsal Pancreatic Artery: A Rare Anatomical Variant Identified Before Laparoscopic Gastrectomy

Preoperative vascular mapping is important for safe laparoscopic gastrectomy because perigastric arterial variants may influence surgical strategy.We report a rare arterial variant in a 45-year-old woman with early gastric cancer, in whom the left gastric artery (LGA) arose from the superior mesenteric artery (SMA) through a shared trunk with the dorsal pancreatic artery (DPA).No conventional LGA arising from the coeliac artery was identified, and an accessory LGA arising from the left hepatic artery was also present.Preoperative CT angiography using multiplanar reformatted, maximum-intensity projection, and volumerendered images clearly demonstrated this branching pattern.These findings informed surgical planning and enabled selective division of the gastric branch distal to the LGA-DPA bifurcation while preserving the DPA and accessory LGA.Laparoscopic distal gastrectomy with D1+ lymphadenectomy was completed without vascular injury or conversion to open surgery.This case highlights the value of CT angiography for detailed recognition of clinically relevant perigastric arterial variants before minimally invasive gastric cancer surgery.