2010 Volume 43 Issue 1 Pages 72-76
A 67-year-old woman whose laboratory data showed obstructive jaundice during ambulatory treatment for rheumatoid arthritis was found in abdominal dynamic computed tomography (CT) to have a low-density area at the pancreatic head and severe stenosis from the root of the superior mesenteric artery (SMA) up to the root of the inferior pancreaticoduodenal artery (IPDA). SMA-oriented pancreaticoduodenectomy was conducted in which major arteries such as the IPDA or first jejunal artery is transected early in surgery from the dorsal side of the pancreatic head Ultrasonic flowmetry monitoring after major vessels were test-clamped showed no suppression of peripheral SMA blood flow. After resection, retrograde blood supply was observed from the middle colic artery. The postoperative course was uneventful and the woman was discharged on postoperative day 20. This SMA-oriented procedure enables us to conduct pancreaticoduodenectomy safely without intestinal ischemia despite severe SMA root stenosis.
