Common hepatic artery quadrifurcation associated with right hepatic artery from superior mesenteric artery during laparoscopic total splenopancreasectomy

Abstract

Hepatobiliopancreatic surgery is challenging becouse of the complexity of resections and reconstructions and variability of vascular anatomy. The arterial vascularization of the liver is susteined by the common hepatic artery (CHA) that originates from the celiac trunk (CT). The CHA bifurcates into the gastroduodenal artery (GDA) and proper hepatic artery (PHA) 0.5-1 cm medial to the common bile duct (CBD), and the PHA bifurcates into a right and a left branch at hepatic hilum. The most frequent variants are the right hepatic artery (RHA) from the superior mesenteric artery (SMA), the left hepatic artery (LHA) from the left gastric artery (LGA) or a combination of these two variants. Herein, we describe the case of a 70 years old woman affected by IPMN of the pancreas with a quadrifurcation of CHA, associated with a RHA off the SMA.