VCOM Research Day Program Book 2023

Medical Student Research Educational

08 Cadaveric Structural Variants Relevant to Cholecystectomy: Examples of Moynihan's (Caterpillar) Hump and Atypical Cystic Artery Origins

Michael Wheeler, OMS III; Tiffany Carpenetti, PhD Corresponding author: mwheeler@vcom.edu

Edward Via College of Osteopathic Medicine-Virginia Campus

Blood supply to the gallbladder is provided by the cystic artery, a branch of the right hepatic artery. The cystic artery typically courses through the hepatocystic (Calot's) triangle, defined laterally by the cystic duct, medially by the hepatic duct, and superiorly by the inferior margin of the liver. Many variants exist in the arterial supply of the gallbladder with the typical origin from the RHA only occurring 79.3% of patients. In individuals where the cystic artery is displaced from the RHA, the origin is from atypical RHA in 12.1%, hepatic artery proper in 3.7%,

middle hepatic artery in 1.2%, and the left hepatic artery in 1.2%. The cystic artery originates in the hepatocystic triangle in 80-96% of individuals. The RHA can present with abnormal looping, switching back on itself and protruding within the hepatocystic triangle; this is called a Moynihan's or caterpillar hump. When Moynihan's hump is present, there is typically a short cystic artery.

With laparoscopic cholecystectomy being the most performed intra-abdominal procedure in the Western civilization, anatomic variants are frequently encountered and require thorough study.

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