Right hepatic artery ‘caterpillar hump’ and dual cystic arteries: relevance of critical view of safety in a ‘straightforward’ cholecystectomy

Zefelippo, Arianna; Fornoni, G.

doi:10.1136/bcr-2017-221534

Cited by 5 publications

(6 citation statements)

References 3 publications

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“…Taylor et al hypothesized that the architecture of the Moynihan’s hump or caterpillar configuration of the RHA could be the consequence of cirrhosis, which leads to a distortion of the intrahepatic branches of the hepatic artery [ 32 ]. However, neither our patient nor the ones presented in various case reports were affected by cirrhosis [ 5 , 33 , 34 ]. Miyaki et al suggested that the RHA variation could be the result of a partial or complete persistence of the foetal arterial blood supply [ 35 ].…”

Section: Discussionmentioning

confidence: 67%

A 56-Year-Old Woman with Acute Cholecystitis and a Moynihan’s Hump, or Caterpillar Configuration, of the Right Hepatic Artery Identified During Laparoscopic Cholecystectomy

et al. 2022

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Patient: Female, 56-year-old Final Diagnosis: Cholecystitis and caterpillar configuration Symptoms: Abdominal pain in the right upper quadrant • nausea • vomiting and abnormal warm and cold sensation Medication: — Clinical Procedure: — Specialty: Surgery Objective: Rare disease Background: When performing a cholecystectomy, several variations can be encountered by the surgeon. The “Moynihan’s hump” or “caterpillar configuration” of the right hepatic artery are the terms used to describe a tortuous right hepatic artery running proximal or parallel to the cystic duct, resulting in a small or short cystic artery and occupying most of Calot’s triangle. This report is of a 56-year-old woman with acute cholecystitis and a Moynihan’s hump or caterpillar configuration identified at laparoscopic cholecystectomy. Case Report: A 56-year-old woman presented herself to the Emergency Department with abdominal pain in the right upper quadrant for a week, associated with nausea, vomiting, and abnormal warm and cold sensation. Acute cholecystitis was diagnosed with ultrasound, and a laparoscopic cholecystectomy using a 4-port technique was performed. During the dissection of Calot’s triangle, a large pulsatile vessel forming a loop was found, which turned out to be the right hepatic artery. The anatomic variation that was observed during the procedure is called Moynihan’s hump or caterpillar configuration of the right hepatic artery. The surgery was uneventful, and the patient was discharged the next day. Conclusions: The Moynihan’s hump or caterpillar configuration of the right hepatic artery is a rare anomaly, with an incidence reported to be between 1.3% and 13.3%. This report has shown that although a Moynihan’s hump or caterpillar configuration of the right hepatic artery is rare, the surgeon should be aware of this anatomic anomaly when performing gallbladder surgery to prevent arterial damage and operative complications.

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Section: Discussionmentioning

confidence: 67%

A 56-Year-Old Woman with Acute Cholecystitis and a Moynihan’s Hump, or Caterpillar Configuration, of the Right Hepatic Artery Identified During Laparoscopic Cholecystectomy

et al. 2022

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“…The CA, when arising from the proximal loop, is long and crosses the tortuous RHA to reach the gallbladder. When the CA arises from a distal loop, it is very short, this variant being the most common [2] , [6] , [10] , [11] , [15] , [16] , [17] . In our case, the hump had a single loop with a short CA arising from its convexity.…”

Section: Discussionmentioning

confidence: 99%

Moynihan's Lump as an unusual variant of right hepatic artery during a laparoscopic cholecystectomy approach. A case report

Martín-Pérez

Rodríguez

Cruz

et al. 2021

International Journal of Surgery Case Reports

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Introduction and importance One of the most important measures during the cholecystectomy procedure is based on a “Culture for Safe Cholecystectomy (CSC)”. Vascular injury reports an open surgery conversion rate of 0 to 1.9% and a mortality of less than 0.02%. The caterpillar or Moynihan's hump configuration is characterized by a tortuous right hepatic artery (RHA) running proximal and/or parallel to the cystic duct and predisposes to a small and/or short cystic artery (CA). Case presentation A 65-year-old woman with no relevant clinical history underwent a laparoscopic cholecystectomy (LC) for cholelithiasis; during the procedure a caterpillar or Moynihan's hump was identified. Clinical discussion Anatomical variations represent 20-50% of all cases; therefore, CVS is required. The incidence of caterpillar or Moynihan's hump varies between 1% and 13% of all cases. To date, the scientific literature on this topic is limited. The most accepted etiology is related to embryological formation. Conclusion Biliary and arterial variations are more frequent than we think, so an anatomical knowledge, CSC and CVS represent a fundamental rule, increasing the safety of the surgical procedure.

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“…Interestingly, the reported incidence rate of conversion to open surgery due to vascular lesions is ~0%–1.9% with a mortality rate of about 0.02% 4 . According to literature data, mainly case reports in elective LC and cadaveric studies, 4,7–10 the tortuous RHA can be found anteriorly or posteriorly to the common hepatic duct. The hump may have a single or double loop and it can be proximal or distal.…”

Section: Figmentioning

confidence: 99%

“…In others studies, the origin of two short cystic arteries from the caterpillar hump reaching the gallbladder or accessory cystic artery in double RHA hump (proximal and distal) have been described. 7,8 Therefore, the recognition of possible variations of biliary and vascular anatomy in everyday laparoscopic cholecystectomies, especially in emergency settings such in this case presentation, is of utmost importance to avoid intra-and post-operative complications.…”

mentioning

confidence: 97%

Moynihan's hump of the right hepatic artery: the surgeon's eye cannot recognize what mind doesn't know

Pesce

Fabbri

Labriola

et al. 2022

ANZ Journal of Surgery

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We describe a rare vascular anomaly found during emergent laparoscopic cholecystectomy for acute cholecystitis in an 81-year-old female patient. During the careful dissection of hepatocystic triangle in compliance with the critical view of safety (CVS) rules, an important arterial anomaly was found and correctly identified. Indeed, in search for the cystic artery, a kinking of the right hepatic artery (RHA) was detected, also known as 'caterpillar or Moynihan's hump' (Fig. 1) and a hidden cystic artery within fat and inflammatory tissue was captured after careful traction of gallbladder infundibulum. The cystic artery, thin and short, was subsequently clipped very close to its origin from the convexity of the RHA, by respecting the uncommon hump of the artery over the gallbladder and the right liver's vascularisation without any injury (Fig. 2). Moreover, indocyanine green (ICG) fluorescent cholangiography was used to confirm biliary structures during dissection.

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Right hepatic artery ‘caterpillar hump’ and dual cystic arteries: relevance of critical view of safety in a ‘straightforward’ cholecystectomy

Cited by 5 publications

References 3 publications

A 56-Year-Old Woman with Acute Cholecystitis and a Moynihan’s Hump, or Caterpillar Configuration, of the Right Hepatic Artery Identified During Laparoscopic Cholecystectomy

A 56-Year-Old Woman with Acute Cholecystitis and a Moynihan’s Hump, or Caterpillar Configuration, of the Right Hepatic Artery Identified During Laparoscopic Cholecystectomy

Moynihan's Lump as an unusual variant of right hepatic artery during a laparoscopic cholecystectomy approach. A case report

Moynihan's hump of the right hepatic artery: the surgeon's eye cannot recognize what mind doesn't know

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