SPARING A REPLACED COMMON HEPATIC-ARTERY DURING PANCREATICODUODENECTOMY

A patient with a replaced common hepatic artery originating from the s uperior mesenteric artery successfully underwent a pylorus-sparing pan creaticoduodenectomy for chronic pancreatitis. This anomalous vessel w as 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 he ad 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 th e liver and biliary tree is important to prevent biliary fistula after a Whipple procedure, and, in some cases, hepatic ischemia. In this ca se the artery was slightly larger and in the same position as the gast roduodenal artery, predisposing the patient to significant potential m orbidity with a standard dissection.