Pancreatoduodenectomy in a patient with celiac axis stenosis and a replaced common hepatic artery: A case report.

Autor:	Komatsubara T; Department of Surgery, Shinko Hospital, 1-4-47 Wakihama-cho, Chuo-ku, Kobe City, Hyogo 651-0072, Japan. Electronic address: komatsubara.takashi@shinkohp.or.jp., Fujimoto K; Department of Surgery, Shinko Hospital, 1-4-47 Wakihama-cho, Chuo-ku, Kobe City, Hyogo 651-0072, Japan., Tanigawa Y; Department of Surgery, Shinko Hospital, 1-4-47 Wakihama-cho, Chuo-ku, Kobe City, Hyogo 651-0072, Japan., Mitsuoka E; Department of Surgery, Shinko Hospital, 1-4-47 Wakihama-cho, Chuo-ku, Kobe City, Hyogo 651-0072, Japan., Isii M; Department of Surgery, Shinko Hospital, 1-4-47 Wakihama-cho, Chuo-ku, Kobe City, Hyogo 651-0072, Japan.
Jazyk:	angličtina
Zdroj:	International journal of surgery case reports [Int J Surg Case Rep] 2022 May; Vol. 94, pp. 107088. Date of Electronic Publication: 2022 Apr 18.
DOI:	10.1016/j.ijscr.2022.107088
Abstrakt:	Introduction: Evaluation of anatomical variations is important in pancreatoduodenectomy (PD) because an arterial anomaly is a risk factor for morbidity. Herein, we report a rare case of PD for lower bile duct cancer in which celiac axis stenosis and a replaced common hepatic artery (rCHA) coexisted. Presentation of Case: An 84-year-old woman presented with epigastric pain. She was diagnosed with a lower bile duct cancer and underwent PD. Preoperative computed tomography showed celiac axis stenosis, and the deformed celiac artery had a "hooked appearance," suggesting compression by the median arcuate ligament (MAL). The rCHA branched from the superior mesenteric artery. The gastroduodenal artery (GDA) diverged from the rCHA, forming a developed arterial arcade of the pancreatic head. There was an oncological safety margin between the rCHA and common bile duct; however, a part of the collateral artery was close to the common bile duct. Therefore, we planned to preserve the rCHA and resect the GDA to form collateral circulation. The MAL was divided and we evaluated the blood flow of the left upper abdominal organs using indocyanine green fluorescence imaging with a near-infrared camera system. We considered that perfusion of organs was preserved, and PD was performed without vessel reconstruction. No ischemic complication occurred in the postoperative course. Discussion: The coexistence of these arterial anomalies made the procedure of PD more complicated. Conclusion: Precise preoperative diagnosis of arterial anomalies is necessary to avoid postoperative complications that may be induced by intraoperative arterial injury and organ ischemia. (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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