PYLORUS PRESERVING PANCREATICODUODENECTOMY COMBINED WITH RESECTION OF SPLENIC ARTERY ANEURYSMS PRESERVING THE SPLEEN FOR AMPULLARY CARCINOMA -A CASE REPORT-

Abstract

A case of ampullary cancer with splenic artery aneurysms (SAA) performed pylorus preserving pancreaticoduodenectomy (PPPD) is reported.
A 62-year-old woman seen at the hospital because of jaundice and vomiting was diagnosed as having ampullary cancer. After admission she was detected to have SAAs on preoperative CT. Abdominal angiography revealed two aneurysms with the diameter of 1.2 cm and calcification; one at the distal site of the splenic artery, and another one in the hilus of the spleen. In order to preserve the patient's immunoresistance and to insure the blood supply to the remnant pancreas and stomach after pylorus preserving PPPD, splenectomy had to be avoided.
We thus performed resection of the aneurysms, preserving the spleen, and PPPD with lymph nodes dissection. The patient's postoperative course was uneventful and the perfusion from the short gastric artery to the spleen was of excellent quality on MR angiography. Splenectomy can be avoided by determining the blood supply with the use of intraoperative ultrasonography, even if the aneurysms are at the distal site.