Sparing a replaced common hepatic artery during pancreaticoduodenectomy

A patient with a replaced common hepatic artery originating from the superior mesenteric artery successfully underwent a pylorus-sparing pancreaticoduodenectomy for chronic pancreatitis. This anomalous vessel was discovered by preoperative angiography but at operation the artery coursed ventral to the head of the pancreas, not, as one would predict, through the substance of the pancreas or dorsal to the pancreatic head and lateral to the portal vein. To our knowledge, this is the first case of a replaced common hepatic artery in this position reported in the English literature. Preservation of the entire blood supply to the liver and biliary tree is important to prevent biliary fistula after a Whipple procedure, and, in some cases, hepatic ischemia. In this case the artery was slightly larger and in the same position as the gastroduodenal artery, predisposing the patient to significant potential morbidity with a standard dissection.