Connaître et reconnaître un piège en chirurgie : la bifurcation précoce de l'artère hépatique commune

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Résumé

Summary Early bifurcation of the common hepatic artery (EBCHA) is a rare anatomical variation (1%), that is often overlooked but can lead to accidental ligation of the right branch of the
hepatic artery with consequent arterial ischemia of the right liver and potentially very serious
complications during pancreaticoduodenectomy, partial hepatectomy, or liver harvesting for
transplantation. It may be difficult to diagnose EBCHA using transverse imaging sections. However, on standard CT sections with intravenous contrast injection, three warning signs should
allow the image reader to suspect it: presence of two hepatic arteries to the right of the celiac
trunk, presence of a retro-portal hepatic artery, and absence of a right hepatic artery arising
from the superior mesenteric artery. Analysis of the CT with reconstruction then allows for
definitive diagnosis and limits the risk of accidental arterial injury or ligation.
© 2024 Les Auteurs. Publie´ par Elsevier Masson SAS. Cet article est publie´ en Open Access sous
licence CC BY (http://creativecommons.org/licenses/by/4.0/).

Mots-clés

KEYWORDS Anatomy ; Hepatic artery ; CT scan ; Three-dimensional reconstruction ; Liver harvesting ; Cephalic pancreatoduodenectom