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Aberrant Anterior Portal Vein within the Extra Hepatic Portal Triad with Variation in the course of a Replaced Common Hepatic Artery

Bedia Castellanos, Salman Ahmad, Naveen Kandavalli, Sushama Rich, Ramona Baez, Carlos Quinteros, Myra Ahmad

The Hepatoduodenal ligament is a part of the lesser omentum that carries portal triad structures such as portal vein, common bile duct and proper hepatic artery to the liver. Following routine dissection of a 96-year-old female, a rare variation in location of the portal vein within the hepatoduodenal ligament was found. The portal vein is lying anterior to the common hepatic artery and common bile duct. The common hepatic artery was unusual in that it arises from the superior mesenteric artery bifurcating posterior to the portal vein on the right side into a gastroduodenal artery and an uncharacteristically short proper hepatic artery (PHA). The PHA quickly gave off the right and left hepatic arteries that coursed anterior to the portal vein before entering the liver. This is an aberrant type IX branching pattern from Michel’s classification of variant arterial hepatic anatomy, with significant difference in its anatomical position in relation to hepatoduodenal ligament and its arterial course in relation to the head and neck of the pancreas. This finding makes our case report very unique and clinically relevant in upper gastrointestinal surgeries and procedures.

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