Double Cystic Artery Originating From the Superior Mesenteric Artery and Right Hepatic Artery: A Case Report

The cystic artery is a critical anatomical landmark in both laparoscopic and open cholecystectomy. This report presents a unique case involving two rare anatomical variations: double cystic arteries, along with a superficial branch originating from the superior mesenteric artery (SMA) - a previously unreported combination with significant clinical and surgical implications. Unlike earlier studies, this research provides detailed anatomical and embryological insights supported by high-quality imaging and illustrations to guide surgeons in recognizing and managing this novel variation. The cadaver examined in this study was donated to the Griffith University School of Medicine for medical education and research. A macroscopic examination was conducted to identify anatomical variations and elucidate the relationships between the atypical cystic artery and surrounding abdominal structures. The typical cystic artery originated from the right hepatic artery, passing posterior to the common hepatic duct within the hepatocystic triangle to supply the superomedial (dorsal/deep) surface of the gallbladder. An accessory cystic artery (100 mm long, 2.5 mm in diameter) originated 35 mm distal to the SMA origin, with a retro-pancreatic and sub-hepatocystic course, bifurcating to supply the cystic duct and the inferolateral (superficial) surface of the gallbladder. This configuration, resembling an aberrant right hepatic artery in size and position, poses heightened risks of bleeding and injury during laparoscopic hepatoduodenal ligament dissection, duodenal mobilization, and in the presence of pancreatic inflammatory or neoplastic processes. By addressing a significant gap in the literature, this study advances both anatomical knowledge and surgical safety. Understanding such variations can significantly improve the safety and efficacy of cholecystectomies and other hepatobiliary, duodenal, and pancreatic surgical procedures. In select cases, preoperative imaging such as computed tomography angiography and collaboration with radiologists can aid in detecting vascular anomalies and guiding surgical planning.