Replaced right hepatic artery arising directly from the celiac trunk in a difficult pancreaticoduodenectomy for intraductal papillary mucinous neoplasm after cholangitis and biliary stenting: a case report and literature review.

Hepatic arterial variations are frequently encountered during hepatopancreatobiliary surgery; however, the majority conforms to established patterns described in classical classification systems. A replaced right hepatic artery most commonly arises from the superior mesenteric artery, while origin directly from the celiac trunk is exceptionally rare and not represented in standard classifications. We report a case of a replaced right hepatic artery arising directly from the celiac trunk encountered during pancreaticoduodenectomy in a patient with mixed-type intraductal papillary mucinous neoplasm complicated by acute cholangitis and prior endoscopic biliary stenting. Despite comprehensive preoperative cross-sectional imaging, the arterial anomaly was not identified and was recognized only during meticulous intraoperative dissection. A review of patient-based clinical literature identified four published case reports describing a total of five patients with a right hepatic artery arising directly from the celiac trunk. The present case represents an additional clinical example, further expanding the limited patient-based evidence.