A unique case of combined variations of the cystic artery and biliary tree complicating the management of acute cholecystitis

Abstract

Anatomic variations of the biliary tree and/or the vascular supply of the gallbladder pose challenges in the surgical management of diseases and conditions of the liver-biliary tree and the pancreas. A patient with acute cholecystitis underwent imaging investigation preoperatively with computed tomography of the abdomen and magnetic resonance cholangiopancreatography, which revealed a unique combination of variations: the cystic artery originated from the superior mesenteric artery and the right posterior sectoral duct drained at the same point with cystic duct to the common hepatic duct. The patient underwent open cholecystectomy and her postoperative period was uneventful. The surgeon should be aware of these variations in order to avoid intra- or post-operative complications, and the radiologists should report these variations because they could have a significant clinical impact.