Publication

Abstract : The right hepatic artery crossing the common hepatic duct anteriorly is one of the frequent abnormalities. This aberrant right hepatic artery interferes with the dissection of the common bile duct and can cause postoperative hepaticojejunostomy stenosis. So repositioning of the right hepatic artery posterior to hepaticojejunostomy should be done. We had a 28-year-old female who presented with upper abdominal pain and on evaluation was diagnosed with a choledochal cyst and pancreatico- biliary maljunction. Abdominal MRI showed an aberrant right hepatic artery running anteriorly to the common hepatic duct. Open choledochal cyst resection and hepaticojejunostomy were planned. Intraoperative findings showed the aberrant right hepatic artery crossing the choledochal cyst anteriorly. We performed open hepaticojejunostomy by replacing the aber- rant right hepatic artery posteriorly to facilitate suturing and prevent postoperative anastomotic stenosis. The postoperative course was uneventful, with no findings suggestive of anastomotic leak, stenosis, strictures, bleed, liver dysfunction, or ab- scess. The abnormality of the right hepatic artery is reported to be one of the primary causes of anastomotic stenosis after he- paticojejunostomy. Once anastomotic stenosis or stricture develops, it is often difficult to treat. In a choledochal cyst with an aberrant right hepatic artery, posterior repositioning is effective for preventing postoperative anastomotic stenosis and cholestasis.