Hepatomesenteric type anomaly with a replaced right hepatic artery

Abstract

A 64-year-old male with jaundice was admitted. A contrast enhanced abdominal computed tomography (CT) scan revealed a low-density mass in the pancreatic head. The right and left hepatic artery (LHA) originated independently from the superior mesenteric artery. In addition, the gastroduodenal artery (GDA) originated from the LHA superior to the pancreas. The patient underwent pancreatoduodenectomy (PD) for pancreatic cancer. The GDA was correctly identified and the LHA was preserved without injury. Variations in the anatomy of the hepatic arteries have been classified by Michels and Hiatt. However, this anomaly was not defined in these traditional classifications, and is considered to be extremely rare. When performing a PD associated with hepatic artery and/or GDA variations, detailed preoperative evaluation of the relationship between the aberrant arteries and pancreas by three-dimensional CT scan visualization is essential.