Replaced Gastroduodenal Artery - A Rare Anomaly and Its Importance in Pancreaticoduodenectomy

Introduction Recent data on borderline resectable pancreatic cancer have resulted in widening horizons of pancreatic surgery in terms of vascular resection. Gastroduodenal artery usually originates from common hepatic artery and traverses anterior to pancreas. It is ligated at its origin from the common hepatic artery during Pancreatoduodenectomy. Case report A middle-aged gentleman presented to us with history of jaundice. On evaluation with contrast enhanced computerised tomography scan was found to have a pancreatic head mass and anomalous GDA. Discussion He was planned for an infracolic superior mesenteric artery first approach and dissection of replaced artery from pancreatic head. A non-artery first approach would result in injury vessel at different parts of procedure and would go unrecognised intra-operatively. Conclusion Detailed study of contrast enhanced CT scan is mandatory to understand vascular anatomy, identify anomalous vessels and comprehend its importance prior to major hepato-pancreatobiliary surgery. Received May 03rd, 2017 Accepted June 20th, 2017