A case of pylorus preserving pancreatoduodenectomy for ampullary cancer with right-sided round ligament and replaced common hepatic artery replaced from superior mesenteric artery, running through the pancreatic head

Abstract

A 60-year-old man presented with dark urine and had a diagnosis of distal bile duct cancer and was referred to our hospital. Preoperative abdominal CT findings were an anomaly of the hepatomesenteric trunk as the common hepatic artery (CHA) replaced from the superior mesenteric artery, CHA running through the parenchyma of the pancreatic head and right-sided round ligament. As the location of the tumor was distant from the CHA, we performed a pylorus preserving pancreatoduodenectomy while carefully preserving this artery. The histopathological diagnosis was ampullary cancer. In surgery on pancreatic head area, we must consider to maintain the hepatic blood flow and to keep the radical curability. Detailed understanding of the hepatic arterial anatomy and accurate recognition of anatomy are important to perform safe and curative surgery.