Ischemic Duodenal Ulcers Secondary to Superior Mesenteric Artery Stenosis in a Patient With an Aberrant Common Hepatic Artery: A Case Report and Review of the Literature.

A 77-year-old male patient presented with persistent abdominal pain, nausea, vomiting, and diarrhea. Esophagogastroduodenoscopy (EGD) revealed duodenal ulcers suggestive of ischemia. Vascular imaging demonstrated a replaced common hepatic artery arising from the superior mesenteric artery (SMA), with the gastroduodenal artery originating from this SMA-dependent circulation, consistent with Michels' type IX anatomy. Significant stenosis at the SMA origin was identified. Endovascular stenting of the SMA resulted in symptom resolution and complete endoscopic healing of the ulcers. This case highlights the clinical importance of hepatic arterial variants and demonstrates how single-vessel disease can result in multi-territory ischemia when vascular anatomy is altered.