Anomalous hepatic arterial anatomy discovered during pancreaticoduodenectomy.

Introduction: A number of variations in hepatic arterial anatomy have been described. Anomalous arterial supply is of particular relevance to the hepatobiliary, pancreatic or liver transplant surgeon.

Case Report: We describe the case of a 57-year-old gentleman who presented with painless obstructive jaundice and was found to have a mass in the head of the pancreas. At pylorus-preserving pancreaticoduodenectomy a distal quadrifurcation of the hepatic artery was discovered. It gave rise to the right hepatic artery, left hepatic artery, intermediate branch and a right accessory hepatic artery. The right accessory hepatic artery gave rise to the gastroduodenal artery.

Conclusion: The surgeon and interventional radiologist need to be aware of the potential for such aberrant anatomy in order to avoid potentially disastrous complications.