Cadaveric study on variations of the cystic artery in a Zambian population

*Isaac Sing`ombe, Vivienne Nambule, Fridah Mutalife, Sikhanyiso Mutemwa, Elliot Kafumukache, Krikor Erzingastian

Abstract

The main source of blood supply to the gall bladder is the cystic artery which is a branch of the right hepatic artery. Anatomical variations of the cystic artery are frequent. Thus, careful dissection of the Calot`s triangle is necessary for conventional and laparoscopic cholecystectomy. The knowledge of variations of the origin, course, and length of the cystic artery is important for the surgeon as bleeding from the cystic artery during cholecystectomy can lead to death. Forty-three post-mortem human cadavers at the University Teaching Hospitals, Pathology Department, Lusaka were dissected and examined over a period of five weeks, to establish the origin, length and course of the cystic artery. And to establish the relationship of the cystic artery to the cystic duct. Out of the 43 human cadavers, the cystic artery was found to be originating from the right hepatic artery in 37 cases (86%), from hepatic artery proper in four cases (9.3%), from the left hepatic artery in one case (2.3%) and liver parenchyma in one case (2.3%). In the forty (93%) cadavers dissected, only one cystic artery was identified and in three (7%) others there were two arteries detected. The cystic artery length ranged from 2 – 6 cm (mean 3.53± 0.962 cm). The cystic artery was found to be inside Calot`s triangle in 37 cases (86%) while in four cases (9.3%) it was outside the Calot`s triangle. The cystic artery was found to be passing supero-medial to the cystic duct in 40 cases (93%) while in two cases (4.7%) the cystic artery was passing anterior to the cystic duct and one (2.3%) was unrelated (from the gall bladder bed) to the cystic duct. Demographic characteristic (gender and age) had no statistically significant association to variations of cystic artery (p>0.005). Six (16.2%) of males had variants of cystic artery and no females had variants of the cystic artery. Variations of the cystic artery origin, length, its course through the Calot`s triangle and its relation to the cystic duct are common. Knowledge of these variations is important and helpful in preventing and controlling haemorrhage or avoiding other complications during conventional and laparoscopic cholecystectomy.

Keywords: Cystic artery, Cholecystectomy, Calot`s triangle

 


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