Answer to Cowboys will be Cowboys
Correct answer is D, the hepatic artery proper. The arrow is pointing to the hepatoduodenal ligament portion of the lesser omentum. Within this area three structures are located, the bile duct, the hepatic artery proper and the portal vein. All three head towards the porta hepatis of the liver. While all three structures can be inadvertently injured if the hepatoduodenal ligament is cut, if blood squirts out it is the common hepatic artery that was injured. Indeed, this was a complication of the open gall bladder removal, although the literature reports that it is actually the right hepatic artery (not an answer option) that is most at risk during a cholecystectomy. Note, this question was further complicated because images A and B are not of the same patient. The location of the hepatic artery proper in B is a variation. The portal vein is coursing between the origin of the hepatic artery proper and the gastroduodenal artery, where the two arise from the common hepatic artery. Note also that the superior mesenteric artery and the celiac trunk in image B appear to have a common origin.
= Gastroduodenal a.
= Bile duct
= Portal vein
= Hepatic artery proper
= Splenic a.
Answer to this question is based on material presented in lectures 7 of the Abdomen Lecture Series.
