Kerrie Lashley

Multiple rare vascular variations were identified in a 97-year-old female donor during the dissection of the gastrointestinal system. An anomalous middle colic artery originated from the celiac trunk alongside the three normal branches. The left hepatic artery, an accessory left hepatic artery, and the right hepatic artery all originated from the proper hepatic artery. The right hepatic artery exhibited a “caterpillar hump” and an abnormal tripod distal branching pattern, consisting of a very short cystic artery and two short right hepatic arteries (one superior and one inferior). Additionally, an accessory cystic artery arose from the inferior pancreaticoduodenal artery, ascending inferiorly to the common bile duct and cystic duct towards the gallbladder to join the cystic artery posteriorly. The right and middle colic arteries originated from a right colic middle colic common arterial trunk. The left colic artery and the sigmoidal arteries also originated from a left colic-sigmoidal common arterial trunk. Surgical and medical procedures in the pancreaticobiliary region are widespread, and cholecystectomy is one of the most common surgeries performed worldwide. A laparoscopic approach is the current ‘gold standard’ surgical approach. Knowledge of these potential gastrointestinal vascular variations is essential to ensure patient safety and avoid iatrogenic complications. The presence of an unidentified caterpillar-type right hepatic artery poses a significant risk of accidental ligation during cholecystectomy. Similarly, the presence of common colic arterial trunks alters the vascular landscape for laparoscopic colectomy. To ensure favorable surgical outcomes, comprehensive preoperative vascular imaging should be performed to identify such rare configurations. In this article, we discussed the frequency, embryology, physiology, and clinical and surgical implications of the anatomical variations present in this donor. To date, there have been no other reports in the literature describing this specific combination of variations.

The azygos lobe (AL), an additional lung lobe most commonly found in the right apical lung region, is a rare anatomical variant present in approximately 1% of the population. It is embryological in origin and may form if the azygos vein fails to migrate medially over the lung. While it is normally clinically silent, it can have surgical and clinical implications. An AL can be the source of infection or disease, such as squamous cell carcinoma, and can also compress the upper lobe and lead to obstruction, infarction, and necrotic tissue. Additionally, it can present as an unforeseen surgical obstacle, specifically during a thoracotomy, and can be mistaken for a thoracic mass on radiographic imaging, potentially leading to unnecessary interventions. In this case report, a 38-year-old male donor with a history of Ogilvie’s syndrome, multiple traumatic brain injuries (TBIs), and chronic respiratory failure presented with an AL during routine donor dissection. The cause of death was listed as prostate cancer, hypertension, atrial fibrillation, and type II diabetes mellitus. The AL, located on the posterior apical surface of the right lung, measured 5 cm in width and 8 cm in length. The left lung showed signs of atrophy and discoloration, possibly the result of pollution exposure or smoking earlier in life. In this article, we describe the incidence, historical classification, embryology, and physiology associated with an AL and its clinical implication for this donor.

The azygos lobe (AL), an additional lung lobe most commonly found in the right apical lung region, is a rare anatomical variant present in approximately 1% of the population. It is embryological in origin and may form if the azygos vein fails to migrate medially over the lung. While it is normally clinically silent, it can have surgical and clinical implications. An AL can be the source of infection or disease, such as squamous cell carcinoma, and can also compress the upper lobe and lead to obstruction, infarction, and necrotic tissue. Additionally, it can present as an unforeseen surgical obstacle, specifically during a thoracotomy, and can be mistaken for a thoracic mass on radiographic imaging, potentially leading to unnecessary interventions.