Rare combined variations of the coeliac trunk, accessory hepatic and gastric arteries with co-occurrence of double cystic arteries

Many variations of the coeliac trunk and hepatic or gallbladder arterial supply have been reported before in many cadaveric and radiologic studies. In this case we present combined anomalies observed in dissected cadaver of a 73-year-old female. The left gastric artery arises directly from the abdominal aorta and gives two branches: the right inferior phrenic artery in the proximal part and the accessory left hepatic artery in the distal part. The coeliac trunk is bifurcated into the common hepatic artery and the splenic artery. The right gastric artery emerges from the left hepatic artery. The right hepatic artery gives two cystic arteries and the accessory right hepatic artery is noticed arising from the posterior superior pancreaticoduodenal artery. The deep cystic artery and the right inferior phrenic artery give hepatic branches. Also, we noticed small accessory biliary duct going to the cystic duct. This complexity of the arterial supply with anomaly of the biliary ducts has many surgical implications which will be herein discussed.