A Case of Duodenal Cancer Developed after Common Hepatic Artery Occlusion Undergoing Pancreaticoduodenectomy with Preservation of Hepatic Arterial Flow from the Gastric Arteries

Abstract

When the common hepatic artery is occluded for some reason, the hepatic arterial blood flow is often maintained by various forms of collateral circulation. When pancreaticoduodenectomy (PD) is performed in such a case, how the collateral hepatic arterial blood flow is preserved is important. While a common collateral circulation depends on a route from the superior mesenteric artery (SMA) through the arcade around the pancreas to the gastroduodenal artery, a route from the left gastric artery through the gastric wall to the right gastric artery may develop in some cases. We describe a patient with a left-to-right gastric artery collateral circulation who required PD for early duodenal cancer. In this case, we were able to safely perform PD without arterial reconstruction by preserving this collateral circulation. In a case with such unusual hemodynamics, it is important to plan surgery based on computed tomographic arteriography and to monitor intraoperative blood flow.