Abstract
We experienced a patient with hemorrhage due to ruptured common hepatic artery after pancreatoduodenectomy whose life was saved by ligation of the hepatic artery and arterialization of the portal vein.
A 54-year-old man underwent subtotal stomach preserving pancreatoduodenectomy with a diagnosis of lower bile duct carcinoma. Discharge of pancreatic juice from a drain started 36 hours after the operation, and then 2 hours later the patient went into shock due to abdominal hemorrhage. An emergency laparotomy was performed when the bleeding point was identified to be an opening about 8mm in diameter in the common hepatic artery and the vascular wall became fragile. Suture repair was considered impossible, so that the common hepatic artery was ligated which yielded hemostasis. Ileocolic arteriovenous shunt was performed to compensate for the lack of hepatic arterial blood. After the emergency laparotomy the patient developed jaundice, impairment of the hepatic function, suture failure at the stenosis between the stomach and pancreas which needed intensive care, but gradual symptomatic remission was attained and the patient was discharged very much improved on the 60th hospital day.
Hemorrhage from the common hepatic artery is a life-threatening complication after pancreatoduodenectomy, and thus it is significant to save the patient's life by reoperation like in this case. From this viewpoint we present the case here.
