presented herein is a case in which an aberrant right hepatic artery ( rha ) passes anterior to the infundibulum and fundus of the gallbladder and courses to an unusually anterior hepatic entry . a 54-year - old female with a history of biliary colic was scheduled for laparoscopic cholecystectomy . laparoscopic dissection revealed an aberrant right hepatic artery ( rha ) anterior to the infundibulum and fundus of the gallbladder . further dissection revealed the cystic artery to branch laterally off this rha over the gallbladder fundus anteriorly . the cystic artery then wrapped postero - laterally on the gallbladder 's surface to its neck . after the gallbladder was removed , the aberrant rha was readily visible traveling across the gallbladder bed and entering the liver at an unusually anterior location . the origins and paths of both the cystic and right hepatic arteries have several documented anomalies . 
 we are unaware of any reports of an rha that transverses the entire neck and fundus of the gallbladder before such an anterior hepatic entry . this case serves as a striking reminder of the variations in extrahepatic biliary and vascular anatomy . ligation of this uniquely located aberrant rha could have led to intraoperative hemorrhage or potential hepatic ischemia . the extrahepatic vascular and biliary anatomy of calot 's triangle is well known to be inconsistent and highly variable . careful dissection of the cystic duct and artery is required with a constant mind on the numerous anatomical possibilities to avoid both conversion requiring hemorrhage and postoperative biliary leak . presented herein is a case in which an aberrant right hepatic artery ( rha ) passes anterior to the infundibulum and fundus of the gallbladder and courses to an unusually anterior hepatic entry . a 54-year - old female presented to her primary care physician with complaints of intermittent epigastric pain accompanied by nausea and vomiting . her symptoms did not last longer than 15 minutes per episode and had been occurring 2 to 4 times per week for 2 months . the patient was given the diagnosis of biliary colic and scheduled for an elective laparoscopic cholecystectomy . at operation , the procedure was initiated with establishment of pneumoperitoneum and the standard two 12-mm and 10-mm trocars in the midline with two 5-mm ports laterally . these adhesions were seen as likely evidence of previous gallbladder inflammation despite no such ultrasound findings . immediately visible upon retraction of the gallbladder was a thick tissue band covered in omental remnants extending from the area of the common bile duct towards the infundibulum . initially thought to be the cystic duct , the size and path of this structure was not compatible . dissection of adhesions revealed the structure to be an aberrant right hepatic artery adherent to the anterior surface of the gallbladder , enveloped in its peri - toneal covering . further dissection revealed the cystic artery to branch laterally off this rha over the gallbladder fundus anteriorly ( figure 1 ) . the cystic artery was clipped and ligated and the rha was completely freed from the gallbladder . the gall - bladder was then able to be retracted superolaterally allowing dissection of the cystic duct . the duct was clipped proximally and left open for insertion of cholangio - catherization ( figure 2 ) . after the gallbladder was removed , the aberrant rha was readily visible traveling across the gallbladder bed and entering the liver at an unusually anterior location ( figure 3 ) . the remainder of the procedure was completed as an uncomplicated laparoscopic cholecystectomy . the aberrant right hepatic artery ( above right angle dissector ) adherent to the anterior surface of the gallbladder . the cystic artery branches off this rha and wraps laterally around the gallbladder towards the infundibulum . with the cystic artery ligated and the right hepatic artery dissected off the gallbladder , the gallbladder was then able to be retracted laterally , allowing for cystic duct identification and ligation for cholangiography . after the gallbladder has been removed , the right hepatic artery is elevated with a probe to illustrate its high site of hepatic entry . superiorly , the artery has adherent remains of omental tissue residual from the preoperative inflammation and adhesions . the origins and paths of both the cystic and right hepatic arteries have several documented anomalies . a single cystic artery with a dominant course originating at the flexure of the right hepatic artery within calot 's triangle passing posteromedially to the cystic duct toward the gallbladder neck is most common ( 70% to 80% ) . in approximately 5% of patients , the cystic artery courses outside of calot 's triangle to the gallbladder . frequently seen cystic artery variants include double artery ( 15% to 20% ) , cystic artery originating from an aberrant right hepatic artery ( 5% to10% ) , left hepatic artery origin ( 1% to 3% ) , and gastroduodenal artery origin ( 3% to 7% ) . studies of hepatic arterial anatomy during liver harvesting for transplantation provide an excellent database documenting anomalies . a replaced rha is seen in 15% to 25% of patients , of which the vast majority reveal the rha branching off the superior mesenteric artery . other aber - rant rha sources are the gastroduodenal artery , right gastric artery , and aorta . while the rha is seen anterior to the junction of the cystic and common bile ducts in a quarter of patients , these pass posteromedially to the gallbladder and cystic duct before entering the liver . while an rha adherent to the cystic duct and gallbladder neck is described amongst the most rare of anomalies , we 
 are unaware of any reports of an rha that transverses the entire neck and fundus of the gallbladder before such an anterior hepatic entry . inadvertent right hepatic artery ligation in cholecystectomy has been associated with liver ischemia , sometimes warranting hepatic lobectomy . an angiographic study would be needed to confirm the origin of this rha and whether it was an accessory rha or a true single aberrant rha  this , however , was not clinically indicated . the size of the vessel ( figures 1 and 2 ) alone is sufficient evidence of its significance . based on historically observed patterns , this rha was most likely of superior mesenteric origin . this case serves as a striking reminder of the variations in extrahepatic biliary and vascular anatomy . ligation of this aberrant rha could have led to intraoperative hemorrhage or potential hepatic ischemia .
introduction : presented herein is a case in which an aberrant right hepatic artery ( rha ) passes anterior to the infundibulum and fundus of the gallbladder and courses to an unusually anterior hepatic entry.case report : a 54-year - old female with a history of biliary colic was scheduled for laparoscopic cholecystectomy . 
 laparoscopic dissection revealed an aberrant right hepatic artery ( rha ) anterior to the infundibulum and fundus of the gallbladder . 
 further dissection revealed the cystic artery to branch laterally off this rha over the gallbladder fundus anteriorly . 
 the cystic artery then wrapped postero - laterally on the gallbladder 's surface to its neck . 
 after the gallbladder was removed , the aberrant rha was readily visible traveling across the gallbladder bed and entering the liver at an unusually anterior location . 
 intraoperative images are included . 
 the procedure was completed laparoscopically without complication.discussion:the origins and paths of both the cystic and right hepatic arteries have several documented anomalies . 
 we are unaware of any reports of an rha that transverses the entire neck and fundus of the gallbladder before such an anterior hepatic entry.conclusion:this case serves as a striking reminder of the variations in extrahepatic biliary and vascular anatomy . 
 ligation of this uniquely located aberrant rha could have led to intraoperative hemorrhage or potential hepatic ischemia .