Rare arterial variations associated with dorsal pancreatic agenesis

The purpose of the current case is to describe a very rare coexistence of a replaced common hepatic artery (rCHA) and dorsal pancreatic agenesis with notable surgical implications. Preoperative computed tomography angiography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography were performed in a 53-year-old female with cholangiocarcinoma. Imaging revealed an rCHA arising from the superior mesenteric artery (SMA) and coursing anterior to the pancreatic head, supplying the right and left hepatic arteries, right gastroepiploic artery, and both the superior and inferior pancreaticoduodenal arteries. The gastroduodenal artery was absent. Dorsal pancreatic agenesis was confirmed, with the absence of the pancreatic body and tail. This configuration places the rCHA at high intraoperative risk and eliminates a major coeliac-SMA collateral route. Detailed preoperative vascular mapping and tailored surgical strategies are essential to prevent catastrophic ischemia during pancreatic or hepatic surgery and to guide appropriative operative approach.