Unique Hepatic Arterial Pattern Associated With the Presence of Accessory Proper Hepatic Artery and Middle Hepatic Artery.

Vascular variations of the coeliac trunk are relatively common, with documented occurrences including trifurcation of the common hepatic artery (CHA) and the presence of accessory and replaced hepatic arteries. This case report describes a novel variation wherein the CHA trifurcates into the proper hepatic artery (PHA), gastroduodenal artery, and accessory PHA (APHA). This particular trifurcation pattern has not been previously recorded. The APHA further branches into two arteries that supply the right lobe of the liver. Additionally, a middle hepatic artery (MHA), originating from the PHA, was identified alongside the right and left hepatic arteries. The MHA serves as a hilar artery that drains segment IV of the liver. This anatomical variant does not conform to any existing coeliac trunk classifications. Understanding this unique arterial pattern is crucial for liver transplantation, as well as procedures involving the pancreas, duodenum, and gallbladder, and for interventional techniques such as transcatheter arterial chemoembolization and transarterial radionuclide therapy.

The Dual Innervation of the Gluteus Maximus Associated with Other Anatomical Variations of the Gluteal Region.

The gluteus maximus (GM) is a big quadrilateral musculature that lines the rear portion of the pelvis. It is innervated by the inferior gluteal nerve. The sciatic nerve, inferior gluteal nerve, and posterior cutaneous nerve of the thigh are branches of the sacral plexus. The superior and inferior gluteal arteries are the chief arterial supply to the gluteal region. In the present case, there was a dual innervation of the GM. The superior gluteal artery and the superior gluteal nerve was piercing the piriformis and the inferior gluteal artery was running between the posterior cutaneous nerve of the thigh and the inferior gluteal nerve. According to our literature review, anatomical studies in which this cadaveric procedure has been performed have not been previously reported. The anatomical variations of the gluteal region are important to surgeons, physicians, anatomists, and nurses.

A Rare Variation of High Division of the Sciatic Nerve and Associated Neuromuscular Variations in the Gluteal Region.

Variations in the anatomical division of the sciatic nerve are not uncommon. In this case report, we are presenting a rare variation of the sciatic nerve in relation to the superior gemellus and the presence of anomalous muscle. To the best of our knowledge, the anomalous communicating branches of the posterior cutaneous femoral nerve with tibial and common peroneal nerve and the presence of an anomalous muscle originating from the greater sciatic notch and inserting at ischial tuberosity have not been reported yet in the literature. This anomalous muscle found can be named as 'Sciaticotuberosus' after its origin and insertion. Such variations hold clinical significance as they may contribute to piriformis syndrome, coccydynia, non-discogenic sciatica, and popliteal fossa block failure leading to local anesthesia toxicity and blood vessel traumatization. The current classifications of division of the sciatic nerve are based on its relation to the piriformis muscle. In our case report, the variation of the sciatic nerve in relation to the superior gemellus suggests the need for the revision of current classification systems. Category-like division of the sciatic nerve in relation to the superior gemellus muscle can be added.