A variant common hepatic artery originating from the normal celiac trunk and passing behind the portal vein successfully treated with pancreaticoduodenectomy for middle bile duct cancer: A case Report

Introduction: Pancreaticoduodenectomy (PD) consists of multiple complex surgical procedures, including skeletonization of the hepatic artery for lymph node dissection. Variations in the hepatic artery can be observed in 25-45% of cases, so it is important for surgeons to have knowledge of the hepatic blood supply to avoid injury that may result in biliary fistula or hepatic ischemia after surgery. Case Report: We encountered a 67-year-old male patient with a variant common hepatic artery which originated from the normal celiac trunk and passed behind the portal vein. This patient successfully underwent a subtotal-stomach-preserving PD for middle bile duct cancer. The frequency of this variant common hepatic artery is approximately 0.1%; according to two large-scale retrospective studies on the variations of the hepatic blood supply. Unlike the different branches or number variations, it is difficult to identify the course variations with conventional visceral angiography or three-dimensional computed tomography arteriography (CTA) (3D-CT angiography image in arterial phase). The variant course of the common hepatic artery in this patient was preoperatively identified by fused images from 3D-CTA and venography. Conclusion: Fusing images from 3D-CTA and venography should be recommended as part of the routine preoperative examination for depicting anatomical variations, such as in the variant course of the common hepatic artery in the patients planning to undergo PD.