{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:57:08Z","timestamp":1790575028823,"version":"4.1.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Portal annular pancreas (PAP) is a rare congenital anatomical variation characterized by pancreatic parenchyma encircling the portal vein (PV) or superior mesenteric vein (SMV). An aberrant common hepatic artery (CHA) originating from the superior mesenteric artery (SMA) represents another uncommon vascular anomaly. The coexistence of these two variations with a distal common bile duct (CBD) malignancy is extremely rare and poses significant technical challenges for pancreaticoduodenectomy (PD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      We report a case of a 55-year-old male with obstructive jaundice caused by distal cholangiocarcinoma, concurrent with PAP (Joseph Type IIIb) and a CHA arising from the SMA (Michels type IX). Preoperative imaging, including multiphasic contrast-enhanced computed tomography (CT) with arterial and portal venous phase protocols and three-dimensional vascular reconstruction, meticulously delineated the complex anatomy\u2014including the complete course of the aberrant CHA, the origin of the gastroduodenal artery (GDA), the relationship of the CHA to the pancreas, PV, and CBD, and the main pancreatic duct (MPD) coursing anterior to the PV. A classical pancreaticoduodenectomy (Whipple procedure) was successfully performed. Key surgical adaptations included a phased pancreatic transection strategy to address the annular pancreas\u2014creating two transection surfaces with\n                      <jats:italic>en bloc<\/jats:italic>\n                      resection of the posterior pancreatic tissue\u2014and careful dissection to preserve the aberrant hepatic artery. The patient recovered uneventfully with only a biochemical leak and without clinically relevant postoperative pancreatic fistula (POPF, Grade B\/C), delayed gastric emptying, post-pancreatectomy hemorrhage, or bile leakage.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case underscores the critical importance of detailed preoperative radiological evaluation in identifying complex anatomical variations. Individualized surgical planning, guided by precise anatomical understanding, is paramount for safe and successful PD in such challenging scenarios. A literature review contextualizes the anatomical features, surgical risks, and management strategies for this rare combination.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1895465","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:44:14Z","timestamp":1790574254000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Distal cholangiocarcinoma in a patient with portal annular pancreas and aberrant common hepatic artery: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Xinglong","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weikang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jirong","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodong","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1332","DOI":"10.1007\/s11605-021-04927-0","article-title":"Portal annular pancreas (PAP): an underestimated devil in pancreatic surgery\u2014systematic review of literature and case report","volume":"25","author":"Pandrowala","year":"2021","journal-title":"J Gastrointest Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"308","DOI":"10.14701\/ahbps.25-027","article-title":"Challenges and outcomes of pancreato-duodenectomy in portal annular pancreas: a single center experience with a systematic review of the literature","volume":"29","author":"Modak","year":"2025","journal-title":"Ann Hepato Biliary Pancreat Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1016\/0002-9610(66)90201-7","article-title":"Newer anatomy of the liver and its variant blood supply and collateral circulation","volume":"112","author":"Michels","year":"1966","journal-title":"Am J Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"247","DOI":"10.5603\/FM.a2019.0090","article-title":"Anatomical variations of hepatic artery using the multidetector computed tomography angiography","volume":"79","author":"Zaki","year":"2020","journal-title":"Folia Morphol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1159\/000538370","article-title":"Two cases of a portal annular pancreas in patients undergoing pancreaticoduodenectomy","volume":"18","author":"Ohta","year":"2024","journal-title":"Case Rep Gastroenterol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.3390\/diagnostics13071233","article-title":"Importance of anatomical variation of the hepatic artery for complicated liver and pancreatic surgeries: a review emphasizing origin and branching","volume":"13","author":"Malviya","year":"2023","journal-title":"Diagnostics"},{"key":"B7","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1016\/j.surg.2016.11.014","article-title":"The 2016 update of the international study group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after","volume":"161","author":"Bassi","year":"2017","journal-title":"Surgery"},{"key":"B8","doi-asserted-by":"publisher","first-page":"93","DOI":"10.3322\/caac.21388","article-title":"The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more \u2018personalized' Approach to cancer staging","volume":"67","author":"Amin","year":"2017","journal-title":"CA Cancer J Clin"},{"key":"B9","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1016\/j.surg.2009.03.018","article-title":"Portal annular pancreas, a notable pancreatic malformation: frequency, morphology, and implications for pancreatic surgery","volume":"146","author":"Karasaki","year":"2009","journal-title":"Surgery"},{"key":"B10","first-page":"453","article-title":"Portal annular pancreas. A rare variant and a new classification","volume":"11","author":"Joseph","year":"2010","journal-title":"JOP J Pancreas"},{"key":"B11","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1097\/MPA.0000000000000186","article-title":"Portal annular pancreas: a systematic review of a clinical challenge","volume":"43","author":"Harnoss","year":"2014","journal-title":"Pancreas"},{"key":"B12","doi-asserted-by":"publisher","first-page":"354","DOI":"10.4103\/jmas.JMAS_235_17","article-title":"Management of portal annular pancreas during laparoscopic pancreaticoduodenectomy","volume":"14","author":"Zimmitti","year":"2018","journal-title":"J Minimal Access Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1593800","DOI":"10.3389\/fsurg.2025.1593800","article-title":"Anatomical variations of hepatic arteries: implications for clinical practice","volume":"12","author":"Samuolyte","year":"2025","journal-title":"Front. Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.3390\/jcm12051965","article-title":"Strategic approach to aberrant hepatic arterial anatomy during laparoscopic pancreaticoduodenectomy: technique with video","volume":"12","author":"Wang","year":"2023","journal-title":"J Clin Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1186\/s12876-025-03761-x","article-title":"Whether preoperative biliary drainage leads to better patient outcomes of pancreaticoduodenectomy: a meta-analysis and systematic review","volume":"25","author":"Zhang","year":"2025","journal-title":"BMC Gastroenterol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"104","DOI":"10.5114\/pjr.2020.93399","article-title":"Computed tomography evaluation of early post-operative complications of the whipple procedure","volume":"85","author":"Emekli","year":"2020","journal-title":"Pol J Radiol"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1895465\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:44:15Z","timestamp":1790574255000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1895465\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":16,"alternative-id":["10.3389\/fsurg.2026.1895465"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1895465","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"article-number":"1895465"}}