2020 Volume 34 Issue 4 Pages 741-747
We herein report a case of pancreatoduodenectomy (PD) for carcinoma of the bile duct with a replaced common hepatic artery (CHA) arisen from the hepatomesenteric trunk running through the pancreatic parenchyma. A 76-year-old man was diagnosed as carcinoma of the bile duct in clinical stage IIA.
CT showed the replaced CHA coursing through the pancreatic head parenchyma. Since the location of the tumor was distant from the CHA, we determined that the conservation of the CHA could afford to perform a radical operation. SSPPD was performed preserving the CHA after the pancreas parenchyma was transected. There were abundant fragile vessels around CHA. The operation time was 483min, and the intraoperative blood loss was 1386g. Pathologically, the exfoliation margin was negative. The anatomy that the replaced CHA is running through the pancreatic parenchyma is very rare. To perform safe and radical PD, preoperative precise investigation of the anatomy and simulation of the operation are necessary.
