Ashwin Rammohan, Jeswanth Sathyanesan, Ravichandran Palaniappan, Manoharan Govindan
Context Standard celiac and hepatic arterial anatomy occur in approximately 60% of the patients; for the remaining,multiple variations have been described. A thorough knowledge of these anomalies is important in order to avoidunnecessary complications. In this report we describe one of the rarest arterial anomalies, a hepatomesenteric trunksupplying the liver. We attempt to elucidate its implications pertaining to the safe performance of apancreaticoduodenectomy. Case report A 45-year-old male with a one-month duration painless progressive jaundice wasevaluated and diagnosed as having a periampullary growth. Preoperative imaging did not suggest any arterial anomalies.Intraoperatively, the common hepatic artery was found to originate from the superior mesenteric artery. He underwent apylorus preserving pancreaticoduodenectomy with a meticulous dissection and preservation of the aberranthepatomesenteric trunk. His postoperative period was uneventful and is doing well on follow up. Conclusion Variations inhepatic and celiac arterial anatomy are common, and may not get picked up on preoperative imaging. A high index ofsuspicion in every patient along with a precise knowledge of the normal anatomy and awareness of the aberrant anatomy isa sine qua non to the performance of a safe pancreaticoduodenectomy.
