Replaced Common Hepatic Artery from Superior Mesenteric Artery and Low Insertion of Right Posterior Sectoral Duct: Dealing with Two Rare Anomalies During Pancreaticoduodenectomy for Ampullary Cancer

Hepatic arterial anomalies are relatively commonly encountered during surgery. Of these, the replaced common hepatic artery (RCHA) is a very rare entity having serious clinical implications, especially while performing pancreaticoduodenectomy (PD) as any inadvertent injury can have serious consequences, e.g., intraoperative torrential bleeding, hepatic infarction or necrosis, and biliary-enteric anastomotic leak. This becomes much tricky when the arterial anomalies are associated with bile duct anomalies warranting complex billio-enteric anastomosis. Here, we describe one patient of ampullary cancer with RCHA from superior mesenteric artery (SMA) and low insertion of right posterior sectoral duct (RPSD) into common bile duct (CBD). He underwent PD after careful dissection of the RCHA and two hepaticojejunostomy (HJ) without any postoperative complications.