Encountering Arc of Bühler during pancreaticoduodenectomy surgery

The Arc of Bühler (AoB) is a rare anatomical variant in gastrointestinal vasculature where there is an aberrant anastomotic vessel between coeliac and superior mesenteric arteries. We present a rare case where AoB was noted intraoperatively to have haemodynamically significant flow in the context of coeliac artery stenosis, supplementing arterial supply to the hepatic artery proper via the gastroduodenal artery (GDA). An interpositional jump graft between the aorta and the GDA stump was created using the long saphenous vein, and flow was restored. The patient recovered well postoperatively. This case highlights the importance of understanding variations in gastrointestinal vasculature and the role of preoperative planning.