A case of adenoendocrine cell caecinoma of the bile duct in which the common hepatic artery arisen from the hepatomesenteric trunk was running through the pancreas

Abstract

An 85-year-old man presented with obstructive jaundice and diagnosed as having lower bile duct carcinoma was referred to the hospital for the purpose of operation. On preoperative abdominal CT findings, we saw an anomaly in the hepatomesenteric trunk as the common hepatic artery had arisen from the superior mesenteric artery, and resultantly the common hepatic artery was running through the parenchyma of the pancreas head. Since the location of the tumor was distant from the common hepatic artery, we determined that the conservation of the common hepatic artery could afford to perform a radical operation. Pancreaticoduodenectomy was thus performed conserving the common hepatic artery after it was dissected from the pancreas parenchyma. The histopathological diagnosis was adenoendocrine cell carcinoma.
Quite often aberrant hepatic arteries appear and, in these circumferences, we must consider to maintain the hepatic blood flow as well as to keep the radicality of surgeries for the pancreas head area. In order to perform surgery safely and to prevent postoperative complications, detailed understanding of the hepatic arterial anatomy by preoperative imaging methods is important.