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case report | DOI: https://doi.org/10.31579/2690-4861/914
1Senior Resident, Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Medical Education and Research, New Delhi, India
2Assistant Professor, Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Medical Education and Research, New Delhi, India
3Professor, Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Medical Education and Research, New Delhi, India
*Corresponding Author: B.G. Vageesh, Room No. 219, Academic Block,2nd floor, Assistant Professor, Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Medical Education and Research, New Delhi, India.
Citation: : Maktum Naik, Theakarajan Rajendran, Devendra Choudhary, B.G. Vageesh, Anil Agarwal, (2025), Proper Hepatic Artery from Superior Mesenteric Artery and Gastroduodenal Artery from Celiac Trunk: A Case Report of Rare Arterial Anatomy, International Journal of Clinical Case Reports and Reviews, 31(1); DOI:10.31579/2690-4861/914
Copyright: © 2025, B.G. Vageesh. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 23 September 2025 | Accepted: 07 October 2025 | Published: 21 October 2025
Keywords: hepatic artery variation; proper hepatic artery; superior mesenteric artery; gastroduodenal artery; celiac trunk; pancreaticoduodenectomy; aberrant vascular anatomy
Background: Variations in hepatic arterial anatomy are well documented; however, the concurrent presence of a proper hepatic artery (PHA) originating from the superior mesenteric artery (SMA) and a gastroduodenal artery (GDA) arising directly from the celiac trunk (CeT) is extremely rare and remains largely unclassified in current anatomical literature.
Case Presentation: We report the case of a 56-year-old male presenting with obstructive jaundice, diagnosed with a periampullary carcinoma. Preoperative contrast-enhanced computed tomography revealed an absent common hepatic artery (CHA), with the PHA originating from the SMA and the GDA from the CeT. Notably, there was no communication between these vessels. Pancreaticoduodenectomy was successfully performed with careful vascular dissection and GDA test clamping, ensuring adequate hepatic perfusion. Postoperative recovery was uneventful. Histopathology confirmed a moderately differentiated adenocarcinoma staged pT2N0.
Conclusion: This case represents a highly unusual arterial configuration, with potential implications for surgical planning and intraoperative safety during hepatopancreatobiliary procedures. Preoperative imaging played a pivotal role in identifying this rare variation, enabling safe surgical management. Only three similar cases have been reported, highlighting the importance of recognizing and documenting such variants.
Common hepatic artery (CHA) is defined as an arterial trunk containing at least one segmental hepatic artery and the gastroduodenal artery (GDA) irrespective of its origin and course.[1] Variations of the hepatic artery are common and thorough knowledge of possible variations in branching, courses, and distribution of the vessels supplying the liver, gallbladder, and gastroduodenal region is essential. To know the anatomy, including abnormal development of the hepatic artery is crucial before doing any major HPB surgeries. Normally after taking origin from the abdominal aorta, celiac trunk (CeT) divides into 3 branches: the left gastric artery (LGA), splenic artery (SA), and common hepatic artery (CHA). Further, CHA gives gastroduodenal artery (GDA) and becomes proper hepatic artery (PHA). PHA is the main source of blood supply to the liver and gallbladder. [2] In literature, there are many variations of hepatic artery reported, among which the most common variation was the Michels Type III in which replaced right hepatic artery (rRHA) originates from superior mesenteric artery (SMA) and accounts for 6-15.5%.[3] Arterial variation with the PHA originating from the SMA and GDA originating from the CeT are extremely rare and no mention of true incidence in the literature. This variation is close to Michels type IX variant, in which the entire CHA trunk originates from SMA and further gives GDA and becomes PHA which accounts for 2-2.5%. To our knowledge, these arterial variations have only been observed in 3 cases, among these 2 cases were discovered during cadaveric dissection and 1 during pancreaticoduodenectomy. [4-5]. We report an extremely rare case in which the origin of the PHA from SMA and the origin of the GDA from CT. Which we identified by preoperative imaging, and pancreaticoduodenectomy (PD) was then successfully performed in a case of periampullary carcinoma.
A 56-year-old man presented with jaundice and generalised weakness of 2 months duration. Ultrasound abdomen shows bilobar dilated intrahepatic radicals, dilated common bile duct (CBD) and main pancreatic duct (MPD), and distended Gall bladder. Laboratory data showed direct hyperbilirubinemia, normal liver enzymes, and raised alkaline phosphatase. Contrast-enhanced computed tomography (CECT) showed a 2x1 cm periampullary lesion with upstream dilatation of both CBD and MPD. Ampullary biopsy shows moderately differentiated adenocarcinoma and we performed pancreaticoduodenectomy and lymphadenectomy. In preoperative CECT (Figure.1)

Figure 1: CT angiography showing Replaced PHA from SMA and GDA from Celiac trunk
CHA was absent and PHA originating from SMA and GDA originated from CeT. The GDA branched into the right gastroepiploic artery (RGEA) and superior pancreaticoduodenal artery (SPDA), and there is no communicating branch between the PHA and GDA. Left gastric artery (LGA) and Splenic artery (SA) originate from CeT normally and CHA was absent. The PHA course between the common bile duct and portal vein branched into the right and left hepatic arteries. (Figure.2)

Figure 2: Intraoperative pictures (a)GDA originate from Celiac trunk and PHA from SMA (b)After dissection, no communicating vessel between PAH and GDA and GDA test clamping done (c)Post pancreaticoduodenectomy resection
Intraoperative findings and preoperative CECT pictures were matched. The GDA branched into the RGEA and SPDA, without any communication to PHA. PHA is traced from its origin (SMA) till it divided into RHA and LHA. GDA ligated after test clamping and the procedure was completed. The operative time was 430 minutes, and the blood loss was 300ml. (Fig.3)

Figure 3: Schematic illustration showing arterial variation as in this case illustrates the arterial variations in this case.
The patient’s postoperative course was uneventful. Histopathological report revealed moderately differentiated adenocarcinoma with stage of pT2N0.
Haller first described celiac axis variations in 1756. Michel described the classification for anatomic variation in the hepatic arterial blood supply based on the results of dissecting 200 cadavers in 1955.[3] After that many classifications for HA variations were proposed. Normally during embryologic development, four ventral vessels (LGA, SA, CHA, and SMA) stem from the abdominal aorta and these splanchnic arteries are paired vessels that are interconnected by longitudinal anastomoses. Normally longitudinal anastomosis between the SA and SMA roots is interrupted, leading to anatomic separation of the CeT from the SMA. Any changes in this process lead to several variations in the CeT and SMA. [6]
Very few reports have found PHA from SMA, and GDA to be a branch of the CeT, as was seen in this case. Michels classified anatomic variations of hepatic arteries into 10 types. Frequency of the entire hepatic trunk being derived from the SMA (type IX) was 2.5%, However, in this variation, GDA also originates from hepatic artery. Huang et al. described 6 variations in the absence of the CHA; however, the kind in which the PHA originates from the SMA, and GDA from CeT as seen in this case, remains unclassified.[7]
Covey et al. described the classification of anatomic variations of HA based on the results of digital subtraction angiography (DSA) performed in 600 patients. The variation wherein the PHA originated from the SMA and the GDA originated as a separate branch of the aorta was found in 2 patients (0.3%) [8]. Song et al. described the classification of celiac trunk (CeT) and CHA variations based on the results of spiral CT and DSA performed in 5002 patients. They defined the type of GDA originating
separately without any hepatic arterial component as the absence of CHA (1.10%).[1]
There were only 3 case reports with the same arterial variants as seen in this case; out of these 2 cases were discovered during cadaveric dissection, and one case report in which this variant was diagnosed by
preoperative diagnostic imaging and pancreaticoduodenectomy was done.[5] Ours is the second report in which these arterial variants were diagnosed by preoperative diagnostic imaging, and pancreaticoduodenectomy was successfully performed.
In HPB surgery such as Pancreaticoduodenectomy, an in-depth knowledge of HA anomalies is of great importance to surgeons, and can help avoid iatrogenic injuries and postoperative complications. We did careful dissection and test clamping of GDA and looked for any communication with PHA.After confirming this GDA was ligated. Advancements in imaging such as multidetector CT technology have facilitated preoperative imaging evaluation of the hepatic vasculature [9]. Which facilitates diagnosing the rare arterial variants preoperatively, and helps in performing safe surgery.
We report an extremely rare case of an aberrant PHA (originating from the SMA) and an aberrant GDA (originating from the CeT) that were diagnosed by CECT preoperatively and did pancreaticoduodenectomy safely without any vascular compromise. In HPB surgery, understanding variations in the hepatic artery before planning for surgery is crucial to ensure optimum surgical outcomes.
Acknowledgement: Nil
Conflict of Interest: No conflict of interest.
Funding: This research did not receive a specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Ethical Board: Institutional Ethics Committee/MAMC/2025: F. No.17/IEC/MAMC/2025/07: Our institute doesn’t require ethical clearance for case reports.
Informed consent: Informed consent was obtained from the patient and guardian* to publish the case report and accompanying images.
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Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.