Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 27, 2025; 17(8): 110413
Published online Aug 27, 2025. doi: 10.4254/wjh.v17.i8.110413
Rare complete replacement-type left hepatic artery originating from the left gastric artery: A case report
Xiao-Xin Gao, Xin-Xin Xu, Peng Chen, Tian-Xiao He, Cheng-Zhou Du, Qian Zhou, Guang-Fu Zhou, Xiao-Wei Guo, Jun-Rui Peng, Hong-Tao Li
Xiao-Xin Gao, Xin-Xin Xu, Peng Chen, Tian-Xiao He, Cheng-Zhou Du, Qian Zhou, Guang-Fu Zhou, Xiao-Wei Guo, Jun-Rui Peng, Hong-Tao Li, Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese PLA, Lanzhou 730050, Gansu Province, China
Co-first authors: Xiao-Xin Gao and Xin-Xin Xu.
Co-corresponding authors: Jun-Rui Peng and Hong-Tao Li.
Author contributions: Gao XX, Xu XX, Peng JR, and Li HT made substantial contributions to the conception and design of the study; Gao XX ,Xu XX, and Chen P were primarily responsible for writing the manuscript; Du CZ, Zhou Q, Zhou GF, and Guo XW were responsible for collecting the patient’s clinical data and data analysis; Gao XX, Xu XX, and Du CZ were responsible for patient management, data collection, and clinical analysis; Chen P and He TX contributed to imaging evaluation; Du CZ, Zhou Q, Zhou GF, and Guo XW provided critical clinical insights and validation; Li HT and Peng JR confirmed the authenticity of all the raw data. All authors have read and approved the final manuscript. Gao XX and Xu XX made equal contributions to the work as the co-first authors; As co-corresponding authors, Li HT and Peng JR played indispensable and crucial roles in case report design, logical framework development, and manuscript writing. Li HT applied for and secured the funding for this research project. Li HT conceived, designed, and guided the case report. Furthermore, he revised deficiencies in the early manuscript drafts. Peng JR assisted and was primarily responsible for the re-analysis and reinterpretation of previous literature, figure creation, and manuscript preparation and submission. The collaboration between Li HT and Peng JR was crucial for the publication of this manuscript and others still in preparation.
Supported by Lanzhou Science and Technology Project, No. 2024-9-139.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Tao Li, Professor, Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese PLA, No. 333 South River Road, Lanzhou 730050, Gansu Province, China. lihongtao528@163.com
Received: June 7, 2025
Revised: June 19, 2025
Accepted: July 22, 2025
Published online: August 27, 2025
Processing time: 82 Days and 18.9 Hours
Abstract
BACKGROUND

A complete replacement left hepatic artery (LHA) solely originating from the left gastric artery (LGA), with no supply from the hepatic artery proper, is exceptionally rare. This variant places entire left lobe perfusion on the LGA. Literature review confirms no prior reports of such an isolated LHA replacement pattern in surgical/radiological publications. Unrecognized, this anatomy carries significant intraoperative injury risk during hepatobiliary/ upper gastrointestinal surgery.

CASE SUMMARY

A 62-year-old man underwent laparoscopic radical gastrectomy with D2 Lymphadenectomy for gastric cancer. During dissection of the hepatogastric ligament, an unexpected vascular anatomy was encountered: The LHA originated exclusively from the LGA, with no conventional branch from the hepatic artery proper. Recognizing this variant artery was essential for left liver perfusion, the LGA was ligated proximally near its celiac origin while meticulously preserving blood flow through the anomalous LHA. The gastrectomy and reconstruction were completed without complication. Postoperative recovery was smooth, with serial liver function tests remaining normal, confirming preserved hepatic arterial supply.

CONCLUSION

Preoperative mapping detected a critical aberrant left hepatic artery; its preservation prevented liver ischemia, ensured safety.

Keywords: Gastric cancer; Left hepatic artery; Left gastric artery; Vascularvariation; Case report

Core Tip: This case report underscores the critical importance of preoperatively clarifying hepatic vascular variations for surgical management. Preoperative imaging allows for confirmation of the specific type of variation and facilitates the development of personalized implementation strategies. These strategies ensure both radical tumor eradication and effective preservation of liver function. This approach provides a new perspective for managing such rare vascular anomalies. Complete details are available in the published article.