The hepatic arterial anatomy is aberrant in almost 50 per cent of all
individuals. The most common anomalies include the right hepatic arter
y arising from the superior mesenteric artery (25%) and the left hepat
ic artery arising from the left gastric artery (25%). Anomalies of the
common hepatic artery, usually a branch of the celiac artery, are rar
e. A replaced common hepatic artery originating from the superior mese
nteric artery occurs in 2.5% of the entire population. Injury to hepat
ic blood supply is more common in the presence of aberrant arterial an
atomy. Knowledge of aberrant arterial anatomy in patients about to und
ergo pancreaticoduodenectomy can lead to measures to preserve the vess
els, and avoid fatal hepatic injury. We present a patient with a repla
ced common hepatic artery originating from the superior mesenteric art
ery successfully treated with a standard pancreaticoduodenectomy for p
ancreatic adenocarcinoma. The anomalous vessel was identified on visce
ral angiography, performed as part of the initial preoperative evaluat
ion. At the time of laparotomy, the artery followed a course atypical
for replaced hepatic arteries, lying medial to the common bile duct, a
nd closely mimicking the gastroduodenal artery that would normally be
divided during a Whipple procedure. This case emphasizes the importanc
e of preoperative visceral angiography and the margin of safety it can
provide when that knowledge is used in the operative strategy. Viscer
al angiography should be considered routine before pancreaticoduodenec
tomy, particularly in surgical residency training programs.