A 57-year-old man with portal hypertension from alcoholic cirrhosis had multiple bleeds from esophageal varices, and multiple endoscopic interventions (sclerosis and banding). The patient was a Child's class A in general medical condition. He was taken to the operating room for a selective, distal splenorenal (Warren) shunt to decompress his varices.
Preoperative angiogram was performed. The celiac injection showed a hepatosplenic trunk with an independent takeoff of the left gastric from the aorta. In addition, a replaced left hepatic artery to segments II and III (see hepatic segmental atlas) was present (see biliary variation). The left hepatic branch to segment IV came off the proper hepatic.
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