A case of Right Hepatic Artery anterior to the common hepatic duct: A not so rare variation.

INTRODUCTION AND IMPORTANCE

The hepatic arteries may be subject to anatomical variations that can cause operating difficulties with a risk of iatrogenic vascular injuries. A perfect knowledge of anatomy is an essential prerequisite for both surgeons and interventional radiologists.

CASE PRESENTATION

During a duodenopancreatectomy for a pancreatic head tumor in a 46-year-old man, we observed an anatomical variation regarding the course of the right hepatic artery (RHA). Indeed, RHA arose from the proper hepatic artery (PHA) at the left edge of the hepatoduodenal ligament and instead of crossing the common hepatic duct (CHD) posteriorly which is the usual course, it passed overhead before ascending and finishing its course in the liver hilum.

CLINICAL DISCUSSION

Anatomical variations of the hepatic arteries can be explained by the partial or complete persistence of the fetal model. Variations in the RHA may concern its number, origin or route. A prebiliary course of the RHA has been described with a prevalence ranging from 15 to 25% depending on series. The high sensitivity of Multidetector Computed Tomographic Angiography (MCTA) allows performing a complete vascular mapping, which remains essential before any Hepato-Pancreato-Biliary (HPB) surgery.

CONCLUSION

This case confirms once again the frequency of anatomical variations of the hepatic arteries, and underlines the value of CT Angiography to detect them in order to best plan any HPB surgery, where RHA remains an essential anatomical landmark that all surgeons must keep in mind in order to avoid any unfortunate incidents.