2014 Volume 28 Issue 2 Pages 242-248
A 70-year-old man was referred to our hospital for treatment of a tumor in the middle part of the common bile duct and laboratory data revealed abnormal liver function test. Based on the findings of CT and ERC, carcinoma of the common bile duct was suspected. CT showed the replaced common hepatic artery coursing through the pancreatic head parenchyma. A visceral angiography showed that the common hepatic artery originated from the hepatomesenteric trunk. At laparotomy, the pancreas head was transected, and the replaced common hepatic artery was carefully isolated without injury. A pancreaticodudenectomy was carried out. The common hepatic artery arises from the superior mesenteric artery ran between the ventral pancreas and the dorsal pancreas. The preoperative evaluation of the configuration of the hepatic artery is considered to be important. In particular, the replaced common hepatic artery can course behind, within, or along the ventral side of the pancreas. Therefore, the surgeon must be recognized not only vascular anomalies but also the course of the vessels prior to pancreatic resection.
