A Case of Early-stage Gastric Cancer in which Left Portal Vein, Left Accessory Hepatic Artery, and Celiac Axis Occlusion was Identified on Preoperative Computed Tomography

Abstract

A 77-year-old man presented to our hospital complaining of neck discomfort. Upper gastrointestinal endoscopy showed early-stage gastric cancer in the greater curvature of the inferior gastric corpus, and endoscopic submucosal dissection was performed, but since the endoscopic curability was C2, additional resection was performed. Preoperative abdominal contrast-enhanced computed tomography (CT) showed that the left gastric vein was flowing into the umbilical portion of the portal vein, and the presence of a left portal vein was diagnosed. A left accessory hepatic artery branching off the left gastric artery was also observed, as was abnormal development of the collateral circurations of the head of the pancreas as a result of celiac axis occlusion. Laparoscopic distal gastrectomy and D1+ lymph node dissection were performed. In this operation, care was taken to avoid damaging the anterior superior pancreaticoduodenal artery, and the left accessory hepatic artery was preserved to prevent reduced hepatic perfusion postoperatively. The left gastric vein ran alongside the left accessory hepatic artery within the hepatogastric ligament, and it was divided near the left accessory hepatic artery bifurcation. Although liver enzymes were mildly elevated postoperatively, the patient's course was otherwise uneventful. This surgical patient who showed noteworthy vascular branching and morphological abnormalities, in addition to an extremely rare left portal vein, is presented.