Aberrant left hepatic artery originating from the left gastric artery identified during gastrectomy: a case report.

BACKGROUND

Variations in hepatic arterial anatomy are clinically significant in upper abdominal surgery. A left hepatic artery (LHA) arising from the left gastric artery (LGA) is a recognized variant occurring in 6-21% of cases, but a large-caliber, dominant LHA is rare and has important implications during gastrectomy.

CASE PRESENTATION: A 58-year-old man of Azerbaijani ethnicity with gastric cancer, after four cycles of chemotherapy, underwent gastrectomy with D2 + lymph node dissection. During mobilization of the gastrohepatic ligament, a large aberrant LHA was discovered intraoperatively. The vessel originated from the LGA, coursed parallel to the superior margin of the left hepatic lobe and entered the hepatic hilum as an independent trunk. Preoperative contrast-enhanced computed tomography (CT) had demonstrated this anomalous artery. The vessel measured approximately 15 mm in diameter, indicating dominant arterial supply. The artery was preserved, and the procedure was completed uneventfully.

CONCLUSION

A dominant aberrant LHA originating from the LGA is uncommon but clinically significant. Recognition of such variants-preferably through preoperative imaging-helps avoid inadvertent injury during gastrectomy.