Abstract
There are various vascular anomalies in branches from the celiac artery. Careful procedure is necessary for such anomalies in gastrectomy. A 76-year-old woman was referred to our hospital because of anorexia. Upper gastrointestinal endoscopy revealed an ulcerated lesion on the angler region of the lesser curvature side, which was pathologically diagnosed as moderately differentiated tubular adenocarcinoma. Enhanced abdominal CT scan showed the common hepatic artery passed behind the portal vein. We performed laparoscopic distal gastrectomy, which included lymph node dissection around the common hepatic artery. By lifting gently the fat and connective tissue around the common hepatic artery and the portal vein, we could safely dissect lymph nodes around the common hepatic artery, and could easily expose the portal vein, which led to safe resection of the left gastric vein. The portal vein which is surrounded by loose connective tissue could be safely dissected. Therefore, exposing the portal vein seems to be the proper and safe procedure for the anomaly. The patient's postoperative course was uneventful, and no recurrence has been observed. Recognition of vascular anomalies prior to surgery and understanding of surgical procedures for them enable us to perform safe and accurate operation.
