Enlarged cystic artery

Abstract

© BMJ Publishing Group Limited 2021. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION A 58yearold woman presented to our clinic on a regular basis for laparoscopic cholecystectomy. The patient was scheduled for surgery as she complained of colicky abdominal pain on the right sight of the upper abdomen for the past 4 months. Her vital signs were unremarkable. On examination, there was no abdominal tenderness or distension, and no evidence of palpable mass. Bowel sounds were audible, and rectal examination was normal. Her routine blood tests, including haemogram, C reactive protein level, liver and renal function test, and serum amylase and lipase, were normal. Chest and abdominal radiography showed no abnormalities. An abdominal ultrasound was performed and revealed cholelithiasis with no other abnormalities. During laparoscopy, the cystic artery was tortuous and significantly enlarged. An abnormal mass of the liver was also present, located at segment IV in continuation of gallbladder fundus (figure 1A–D). Control of the cystic artery was achieved with suture material. Gallbladder was resected en bloc with the hepatic lesion (figure 2). Instantaneous section was not performed. The patient did not have any postoperative complication and was discharged on the first postoperative day. Her final histopathology report was suggestive of inflammatory hepatocellular adenoma, which is the most common subtype and accounts for about 40%–50% of all hepatic adenomas. Hepatocellular adenomas, also called hepatic adenomas, are rare benign lesions of the liver frequently associated with women using oral contraceptives. They are usually asymptomatic and found incidentally on imaging or during surgical operations. Although these tumours are usually benign, they are associated with the risk of malignant transformation to hepatocellular carcinoma, particularly when the diameter of the adenoma is