A case of resected pancreatic head cancer associated with hepatomesenteric type hepatic artery variation and superior mesenteric artery occlusion

Abstract

The patient was a male in his 60s who was referred to our hospital for further evaluation after dilatation of the main pancreatic duct and a high value of CA19-9. ERP revealed that the main pancreatic duct was disrupted in the pancreatic head, and the patient was diagnosed with adenocarcinoma by exfoliative cytology. The observation of vascular anatomy by abdominal CT showed hepatomesenteric type hepatic artery variation and occlusion at the root of the superior mesenteric artery. After further evaluation by angiography and 3D image analysis, we performed pancreaticoduodenectomy. By conserving collateral blood circulation as much as possible to secure vascular flow of the superior mesenteric artery and the hepatic perfusion, surgical resection was safely performed without reconstruction of the hepatic and mesenteric arteries. There are some reports on cases of resected pancreatic head tumors with stenosis or obstruction of the superior mesenteric artery. In the present case, however, hepatomesenteric type hepatic artery variation was involved. We found it essential to fully comprehend the hemodynamic status in order to ensure hepatic perfusion at the time of resection, and to maintain careful surgical maneuvers.