Anatomical Study of Variations of Cystic Artery and Contents of Calot’s Triangle in South Kerala - A Cross Sectional Study

Abstract

BACKGROUND Cystic artery originates from right hepatic artery which is a branch of hepatic artery proper of coeliac trunk from abdominal aorta. Variations in the origin and course of cystic artery were observed in this study. Contents of Calot’s triangle were also studied. Knowledge of normal anatomy, variations of the biliary apparatus and the arterial supply to the gallbladder is important for surgeon. METHODS Descriptive cross-sectional study was done from April 2008 to January 2010 in 180 adult specimens and 50 foetal specimens in the Departments of Anatomy, Forensic Medicine and Pathology in Government Medical College, Thiruvananthapuram. The abdominal wall was incised and hepatobiliary region was identified and dissected. The gallbladder and coeliac trunk were identified. Cystic artery and Calot’s triangle were studied. RESULTS More than 90 percent of the cystic artery originates from the right hepatic artery in both sexes. Cystic artery originated from left hepatic artery in 4 cases, common hepatic artery in 5 cases and from middle hepatic artery in 1 case. The cystic artery within Calot’s triangle was observed in 41 %. Right hepatic artery was content in 29.9 %. Both the arteries were content in 19 %. Cystic artery and accessory hepatic duct were content of Calot’s triangle in 2.2 %. Double cystic artery was content of the triangle in 1 cadaver. Artery or duct was seen outside the Calot’s triangle in 16 cadavers. CONCLUSIONS It is important for surgeons to know the variations of cystic artery and Calot’s triangle during surgical interventions of the hepato biliary region. “Cystic artery syndrome” is a condition where cystic artery is seen winding around cystic duct although it originates from right hepatic artery. Knowledge of these variations is important for surgeons and helps in better surgical outcome. KEYWORDS Cystic Artery, Calot’s Triangle, Right Hepatic, Gall Bladder, Coeliac Trunk