Distal bile duct cancer treated with preoperative arterial embolization for celiac axis obstruction and pancreaticoduodenectomy

Abstract

We treated an 81-year-old man with distal bile duct cancer with pancreaticoduodenectomy following preoperative arterial modification for celiac axis (CA) obstruction. Contrast-enhanced CT revealed increased wall thickness of the distal bile duct, indicating the cancer and CA obstruction. The arterial arcade at the pancreatic head and dorsal pancreatic artery (DPA) were well developed and were the main blood supply to the hepatic artery. Angiographic balloon occlusion of the inferior pancreaticoduodenal artery (IPDA) revealed good blood flow to the hepatic artery via the DPA, so the IPDA was embolized with coils to modify arterial blood flow. Nine days thereafter, pylorus-preserving pancreaticoduodenectomy with D2 lymph node dissection was performed, and curative resection with cancer-free surgical margin was obtained histologically. The DPA was preserved, and hepatic arterial flow observed intraoperatively was maintained. No events related to poor blood flow occurred perioperatively. The many varieties of CA and superior mesenteric arteries must be kept in mind.