Laparoscopic repositioning of an aberrant right hepatic artery and hepaticojejunostomy for pediatric choledochal cyst: A case report
| Autor: | Kina Miyoshi, Kazuhiko Nakame, Satoshi Ieiri, Ryuta Masuya, Atsushi Nanashima |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Common bile duct business.industry Aberrant right hepatic artery Choledochal cyst Repositioning Hepaticojejunostomy Case Report Dissection (medical) Anastomosis medicine.disease Surgery Stenosis medicine.anatomical_structure Cholestasis Pancreaticobiliary maljunction Common hepatic duct medicine Choledochal cysts business |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Introduction The right hepatic artery crossing the ventral side of the common hepatic duct is a relatively frequent abnormality. This aberrant right hepatic artery not only interferes with dissection of the common bile duct and hepaticojejunostomy for choledochal cyst but can also cause postoperative anastomotic stenosis. Case presentation A 14-year-old patient presented with upper abdominal pain and was diagnosed with a choledochal cyst (Type IVA in Todani Classification) and pancreaticobiliary maljunction. Abdominal enhanced computed tomography showed aberrant right hepatic artery located at the ventral side of the common hepatic duct. Laparoscopic choledochal cyst resection and hepaticojejunostomy were planned. Intraoperative findings also showed the aberrant right hepatic artery crossing the common hepatic duct ventrally as detected on preoperative computed tomography. Laparoscopic dorsal side repositioning of the aberrant right hepatic artery was performed because it appeared to compress the common hepatic duct and risked causing postoperative anastomotic stenosis. We performed laparoscopic hepaticojejunostomy by replacing the aberrant right hepatic artery dorsally to facilitate suturing and prevent postoperative anastomotic stenosis. The postoperative course was uneventful, with no findings suggestive of anastomotic stenosis. Discussion The abnormality of the right hepatic artery is reported to be a primary cause of anastomotic stenosis after hepaticojejunostomy. Once anastomotic stenosis or stricture develops, it is often difficult to treat. The prevention of the stenosis is important. Conclusions In choledochal cyst with aberrant right hepatic artery, dorsal repositioning is effective for preventing postoperative anastomotic stenosis and cholestasis. Highlights • The right hepatic artery crossing the anterior aspect of the common hepatic duct is a relatively frequent abnormality. • The aberrant right hepatic artery can cause the postoperative anastomotic stenosis. • We performed laparoscopic hepaticojejunostomy by replacing the aberrant right hepatic artery dorsally. |
| Databáze: | OpenAIRE |
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