DOUBLE, VERY SHORT CYSTIC ARTERY: ANATOMIC VARIATION REVEALED DURING LAPAROSCOPIC CHOLECYSTECTOMY: A CASE REPORT

Abstract

Introduction. The cystic artery (CA) is the key struc-ture sought to be clipped or ligated during laparoscopicor conventional cholecystectomy.In up to 25% of sub-jects, the superficial and deep branches of the CA have separate origins and Michels called them double CA. Case report. We are presenting a 38-year-old female with one-year history of chronic gallbladder inflamma-tion. During the laparoscopy dissection in the region of the Calot’striangle, we revealed an anatomic va-riation of the cystic artery-a double cystic artery. The more important thing was that both branches were ex-tremely short, or at the lower limit of the publishedlengths of this blood vessel-approximately 3mm each. Bydoing so, the surgicalcourse further took the standardcourse-laparoscopic clips were placed on both branches. Conclusion. The incidence of double CA ranges from 15 to 25%. Such arteries usually arise from RHA and frequently replace the deep branch of the CA. Anatomicvariations in and around Calot’s triangle are frequent. Therefore, careful dissection of Calot’s triangle is ne-cessary for both conventional and laparoscopic chole-cystectomy. Hemorrhage could be a problem during search of the CA if these variations are overlooked and that increases the rate of conversion to open surgery. It also hasto be kept in mind that during laparoscopic visualization anatomical relations are seen differently compared to conventional cholecystectomy