Clinical Image
A 63-year-old man presented with advanced gastric cancer. Chemotherapy followed by distal gastrectomy with D2 lymph node dissection was planned. Multiplanar reconstruction in computed tomography (CT) findings showed a vascular anomaly of the celiac axis (CA): the common hepatic artery (CHA) and the proper hepatic artery were absent around the portal vein and, moreover, an aberrant CHA originated from the left gastric artery (LGA) (Fig. 1). Three-dimensional CT angiography revealed that there was no perfusion of the liver from the gastroduodenal artery (GDA) (Fig. 2). Intraoperative findings also showed an aberrant CHA originating from the LGA (Fig. 3). The aberrant CHA was preserved, and the distal side of the LGA was resected to prevent hepatic arterial ischemia. Song’s and Adachi’s studies of the classifications of CA variations demonstrated that CHA, which was absent in the suprapancreatic area, was in 2% of cases ( 1 ,2 ) . In addition, an aberrant CHA originating from the LGA was demonstrated in 0.16% of cases (2 ). However, there were no cases of aberrant CHA originating from the LGA without connecting the GDA. Observation of the vascular anatomy around the stomach using a CT reconstruction system may be useful to avoid complications related to vascular anomaly.