Abstract
We report a case of pancreaticoduodenectomy after coronary artery bypass grafting using a right gastroepiploic artery. The case involved a 67-year-old man who had been performed coronary artery bypass operations at the ages of 66 years. Abdominal CT scan revealed intrahepatic bile duct dilatation and the tumor in lower bile duct. Based on the diagnosis of the lower bile duct cancer, we performed subtotal stomach-preserving pancreaticoduodenectomy with the gastroduodenal artery intact. During surgery, we confirmed that vascular treatment had been done at the greater curvature aspect of the gastric pylorus. The right gastroepiploic artery graft which was the periphery of the gastroduodenal artery showed favorable pulsation and run toward the cranial direction to the mediastinum on the ventral aspect of the lateral area of the liver. We evaluated the flow of artery graft by ultrasonic Doppler method. At surgery, dissection of the stomach was performed first, and the gastroduodenal artery-right gastroepiploic artery graft was treated from the widely exposed anterior surface of the pancreas head. At reconstruction, gastrojejunostomy was performed at the posterior area of artery graft avoiding the tension to artery graft. Postoperative pancreatic fistula occurred and treated conservatively. No noteworthy perioperative cardiovascular complications occurred.
