Right hepatic artery syndrome: report of three cases and literature review

Laparoscopic Kasai Procedure of Treating Biliary Atresia with an Aberrant Right Hepatic Artery

Background: An aberrant vascular anatomy might present a technical pitfall for biliary atresia (BA) surgery. The purpose of this study was to report the rare cases and discuss the significance and management strategy for BA with an aberrant right hepatic artery (ARHA) by laparoscopic Kasai procedure in children. Methods: The subjects for this study were 10 consecutive type III BA patients with an ARHA who had laparoscopic Kasai procedure at our institute between January 2012 and August 2021. The common bile duct was mobilized between the right hepatic artery and the right branch of portal vein, and then lifted to the liver hilum. The fibrous cord was transected and then the laparoscopic Kasai was carried out. Results: All patients survived the laparoscopic Kasai without any intraoperative complications. The mean operative time was 235 minutes for each laparoscopic Kasai. The mean follow-up time was 32.6 months. The total and direct bilirubin dropped to normal within 4 months of surgery in 7 patients. One patient died of repeated cholangitis and liver failure 1 year after surgery. In the additional 2 patients the bilirubin levels dropped significantly after the surgery but elevated again because of repeated cholangitis and requiring ongoing observation and intermittent treatment. Conclusions: With the perfect laparoscopic skills, the common bile duct could be safely mobilized between the right hepatic artery and right branch of portal vein for the infants with type III BA associated with an ARHA, and laparoscopic Kasai could be carried out safely and successfully.

Right Hepatic Artery Syndrome With Mirizzi Syndrome: A Case Report

Anatomical diversity is rather typical in the biliary region. However, it has only sometimes been documented that the arteries of a hepatobiliary origin compressed the extrahepatic bile duct. Biliary obstruction may be caused by a myriad of benign and malignant diseases. Right hepatic artery syndrome (RHAS) is described as the consequence of right hepatic artery compression of the extrahepatic bile duct. We report a case of a 22-year-old male who presented with a complaint of abdominal pain and was later admitted as a case of acute calculous cholecystitis with obstructive jaundice. Abdominal ultrasound showed a picture of the so-called Mirizzi. However, A magnetic resonance cholangiopancreatography showed a picture of RHAS, so the patient needed endoscopic retrograde cholangiopancreatography to decompress the biliary system which was later performed successfully followed by cholecystectomy. The diagnosis of RHAS is well established in the literature, and it depends on the facility of the institute, cholecystectomy versus hepaticojejunostomy or endoscopic treatment alone are the management options that have been utilized to manage such cases.

Rare Relationship Between the Right Hepatic Artery and Common Hepatic Duct in Living Donor Right Hepatectomy

In living donor liver transplant, it is vital to perceive the hepatic artery anatomy and its variants. In the normal hepatic artery pattern, the common hepatic artery originates from the celiac artery to form the proper hepatic artery and gastroduodenal artery. The proper hepatic artery divides into right and left branches that supply the right and left lobes of the liver, respectively. Here, we report a rare variation of the right hepatic artery that was detected during a living liver right lobe hepatectomy. A 59-year-old man with alcoholic liver cirrhosis underwent living donor liver transplant. The patient's niece (a 47-year-old woman) volunteered to be a living donor. During the hilar dissection, we noticed that the anterior and posterior branches of the right hepatic artery passed through points anterior and posterior to the common hepatic duct, respectively. The right anterior hepatic artery and the right hepatic artery were divided separately. Although previously defined classifications have described anatomical variations of origin, branching, and course of hepatic artery, the topographical relationship of the anterior right hepatic artery and the posterior right hepatic artery versus the common hepatic duct has not been a matter of concern. Awareness must be maintained of this rare anatomical course of the right hepatic artery, especially in living liver right lobe donors. In the event of donors with rare variations, living donor liver transplant should be performed by an experienced team.

Hepatolithiasis caused by right hepatic artery branches forming an arterial ring compressing the common hepatic duct

Anatomic variations of the hepatic artery do not usually cause biliary obstruction. We present a 51-year-old male who developed biliary obstruction and hepatolithiasis due to extrinsic compression of the common hepatic duct (CHD) by an arterial ring formed by the anterior and posterior branches of the right hepatic artery. We performed a surgical bile duct exploration and used intraoperative direct cholangioscopy to guide clearance of hepatolithiasis. Herein, we review the existing literature on CHD compression caused by topographical variants of the hepatic artery and discuss diagnostic and treatment strategies.

Compression of the Distal Common Bile Duct by Enlarged Inferior Pancreaticoduodenal Artery Branches in a Patient with Celiac Trunk Stenosis: A Case Report

Various benign and malignant pathologies/conditions can cause compression of the extrahepatic biliary system. Anatomical and/or topographic variations of the hepatic artery have long been recognized as a possible cause of the EBS compression. However, anatomical and/or topographic variations, other than the hepatic artery's, should also be considered during the evaluation of the EBS compression. We, herein, report a unique case of the distal common bile duct compression by tortuous and enlarged inferior pancreaticoduodenal artery branches due to severe stenosis of the celiac trunk orifice.

Dynamic Intraductal Endoscopic Visualization of Right Hepatic Artery Pulsation Underlying Minor Vascular Impression of the Proximal Bile Duct

Right hepatic artery (RHA) syndrome is a well-recognized, though an uncommon cause of benign bile duct stricture, potentially simulating malignancy. Albeit the latter was not the case in this unique clinical report after cholangitis resolution and clearance of biliary sludge and debris, high-quality direct cholangioscopy (DC) illustration of the RHA overriding the proximal common bile duct with well visible arterial pulsation has not yet been reported before. Beyond its potential visual informativeness, this uncommon cholangioscopic documentation may provide key didactic advances in terms of intraductal visualization of the anatomy of the biliary tree.

How to cite this article: Zimmer V. Dynamic Intraductal Endoscopic Visualization of Right Hepatic Artery Pulsation Underlying Minor Vascular Impression of the Proximal Bile Duct. Euroasian J Hepato-Gastroenterol 2021;11(1):41–42.