Total Pancreatomy for Carcinoma of the Ampulla of Vater with Aplasia of the Pancreas and Common Hepatic Artery Originating from the Hepatomesenteric Trunk and Running through the Pancreatic Head

Abstract

A 79-year-old woman was referred to our hospital with carcinoma of the ampulla of Vater．CT showed a hepatic artery branching from the superior mesenteric artery and passing through the pancreatic head. Aplasia of the pancreas was also revealed. Gastrointestinal fiberscopy revealed a tumor spreading from the ampulla of Vater towards the anus. Adenocarcinoma was confirmed by biopsy and total pancreatomy was undertaken. Intraoperatively, the hepatic artery in the pancreatic parenchyma and the spleen were preserved. Histologically, the tumor was a moderately differentiated tubular adenocarcinoma, pT1, N0, M0, fStage I, R0. Aberrant hepatic arteries are often encountered and must be carefully handled in surgery of the pancreas head area, to preserve hepatic blood flow and achieve surgical objectives.