Preservation of an intra-pancreatic hepatic artery during a duodenopancreatectomy

Abstract

Background: Detailed knowledge of the anatomic variations of the hepatic artery is essential when operating on pancreatic tumours. We present a case report and possible consequences of one of the anatomical variations where the right hepatic artery arises from the superior mesenteric artery (SMA) and travels not behind, but through the head of the pancreas. This is a rarely observed abnormality and there is lack of published literature. Material & Methods: A 62 y-o gentleman presented to our emergency department with jaundice, no abdominal pain. A USS and MRI scan was performed and they showed marked dilatation of the main pancreatic duct and the intra and extra hepatic biliary duct by ampuloma. A left suprarenal mass of 45 x 42mm was also identified. A Cephalic duodenopancreatectomy and left adrenalectomy was performed. During the procedure a left hepatic artery branch of the left gastric artery was found and an aberrant right hepatic artery was identified, it was originated in the SMA and then showed a trajectory through the pancreatic parenchyma. This aberrant artery was easily dissected along its intra-pancreatic path and was successfully preserved. The patient showed an uneventful recovery. Discussion: Only a few cases of an intra-pancreatic hepatic artery with origin in the SMA have been reported . In almost all cases, the aberrant artery was preserved because its intra-pancreatic dissection was found to be favourable. There was an avascular dissection plane surrounding the artery as it traversed the pancreas. Preserving the artery is the preferred option, whereas if injured, the reconstruction is believed to be safe, in this case a simple revascularisation is impossible due to the absence of a gastro-duodenal artery therefore, the recommended published options are: splenic artery transposition and a spleno-hepatic arterial anastomosis or a graft or prosthetic material interposition.