title: Anomalous middle hepatic artery in laparoscopic cholecystectomy: Wolf in sheep's clothing.
abstract: Laparoscopic cholecystectomy is a simple but dangerous operation. The complex anatomy and frequent anomalies of the hepatic arterial and biliary system are often a shocking surprise to the laparoscopic surgeon. When these vital structures cannot be identified correctly, potentially crippling serious vascular and biliary injury can occur. A very rare case of middle hepatic artery encountered in the Calot's coursing over the gall bladder and travelling extraparenchymal into segment IV is reported. Identification and preservation of the middle hepatic artery is essential to prevent the possibility of hepatic artery thrombosis and to avoid ischemic cholangiopathy of segment IV duct. A comprehensive understanding of the hepatic arterial and biliary anatomy of the liver will empower laparoscopic surgeons to avoid crippling vascular and biliary injury.
authors.affiliation: Institute of Surgical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India.
authors.forename: Johnrose John
authors.initials: JJ
authors.lastname: Grifson
authors.affiliation: Institute of Surgical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India.
authors.forename: Thirumaraichelvan
authors.initials: T
authors.lastname: Perungo
authors.affiliation: Institute of Surgical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India.
authors.forename: Durairaj
authors.initials: D
authors.lastname: Sengamalai
authors.affiliation: Institute of Surgical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India.
authors.forename: Bennet
authors.initials: B
authors.lastname: Duraisamy
authors.affiliation: Institute of Surgical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India.
authors.forename: Amudhan
authors.initials: A
authors.lastname: Anbalagan
authors.affiliation: Institute of Surgical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India.
authors.forename: Prabhakaran
authors.initials: P
authors.lastname: Raju
authors.affiliation: Institute of Surgical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India.
authors.forename: Devy Gounder
authors.initials: DG
authors.lastname: Kannan