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.