Abstract
A 69-year-old man was introduced to our hospital because of an abdominal aortic aneurysm (AAA) and obstructive jaundice. Computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) showed the dilatation of the common bile duct due to an obstruction which had been caused by distal bile duct cancer, an AAA, which measured 77 mm in diameter, and stenosis of the coronary artery.
At first endoscopic retrograde biliary drainage was carried out, next a coronary artery bypass graft (CABG) and replacement of the AAA with a synthetic graft were simultaneously performed. At 38 days after the operation, pylorus preserving pancreatoduodenectomy (PPPD) was performed. He was discharged 19 days after the last surgical procedure without any major complications. At 6 months after the 2nd operation, an infection of the blood vessel prosthesis occurred, but we were able to successfully treat it using conservative management.
Carcinomas of the digestive system and AAAs are often detected simultaneously, but no optimal treatment strategy for this combination has yet been established. In this case, we were able to successfully carry out a double stage operation for distal bile duct cancer concomitant with an AAA and ischemic heart disease.
