Clinical Images Left gastric and right hepatic artery anomalies in a patient with gastric cancer: images for surgeons Atilla Celik, M.D. a, *, Aysun Simsek Celik, M.D. c , Ediz Altinli, M.D. a , Omer Beykal, M.D. b , Kasim Caglayan, M.D. d , Neset Koksal, M.D. a a 2nd Department of General Surgery, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey; b Sonomed Medical Imaging Center, Istanbul, Turkey; c 2nd Department of General Surgery, Vakif Gureba Education and Research Hospital, Istanbul, Turkey; d Bozok University, Medical Faculty, Department of General Surgery, Yozgat, Turkey Abstract BACKGROUND: Surgical resection remains the principal treatment for advanced gastric cancer, but one of the difficulties in a curative or extended gastrectomy is the identification of the vascular supply of the stomach. METHODS: A patient had gastric cancer hospitalized for planning and performing his surgical therapy. A multidetector-row computed tomography scan showed us a large tumor mass and numerous lymph nodes invading perigastric and second tiers of stomach and revealed a left gastric artery and right hepatic artery in which branched directly from aorta. A 3-dimensional construction showed a demon- strative vascular anomaly as well during operation. RESULT: We were able to perform total gastrectomy and D2 lymph node dissection as surgical therapy for patient. The patient’s postoperative clinical course was uneventful, and after postoperative 36 months, there was no evidence of recurrence. CONCLUSION: We recommend that a multidetector-row computed tomography scan is very useful for the preoperative staging in gastric cancer patients because of its diagnostic value for showing any vascular anomaly and aiding in decision making on the appropriate surgical strategy. © 2011 Elsevier Inc. All rights reserved. KEYWORDS: Gastric cancer; Multidetector-row computed tomography scan; Preoperative staging; Vascular anomaly Surgical resection with lymph node (LN) dissection re- mains the principal treatment for advanced gastric cancer but is not always possible. 1 One of the difficulties in a curative or extended gastrectomy is the identification of the vascular sup- ply of the stomach. Therefore, the recognition of vascular abnormalities of the celiac trunk (CT) is of great importance. 2 Recently, preoperative multidetector-row computed tomogra- phy (MDCT) studies, combined with angiography, for gastric cancer staging has enabled the noninvasive visualization of arteries surrounding the stomach. A 50-year old man was diagnosed with gastric cancer after presenting with weight loss, epigastric pain, and post- prandial nausea. His upper gastrointestinal endoscopy re- vealed a large tumor in the proximal stomach. Biopsies revealed a poorly differentiated adenocarcinoma. An ab- dominal MDCT scan showed pathological gastric wall thickening involving the fundus and corpus. Multiple met- astatic LNs were also seen in the perigastric area around the celiac artery with conglomerated lymphadenopathy at the splenic hilus (Fig. 1A). However, the para-aortic LNs were not identified by the MDCT scan, and there was no evidence of distant metastasis. * Corresponding author. Tel: +90 216 4728184; fax: +90 216 3475144. E-mail address: dratillacelik@yahoo.com Manuscript received January 22, 2010; revised manuscript April 28, 2010 0002-9610/$ - see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.amjsurg.2010.04.028 The American Journal of Surgery (2011) 202, e13– e16