A Resectable Case of Pancreatic Head Cancer with Total Obstruction due to Aneurysm in Common Hepatic Artery

Kazuhiko Yamagami, Tadao Manabe, Nobuo Baba, Takayoshi Tobe, Masanobu Nara*

First Department of Surgery, Faculty of Medicine, Kyoto University
*Department of Surgery, Minami Kyoto National Hospital

We report a case of pancreatic head cancer with total obstruction of the common hepatic artery (CHA) by an aneurysm, in which we were able to perform pancreaticoduodenectomy including partial resection of the portal vein. A 7O-year-old man complaining ofjaundice was admitted and diagnosed as pancreatic head cancer on the basis of clinical findings including those of CT and MRI. Abdominal angiography did not reveal the CHA, but showed that the proper hepatic artery (PHA) was supplied with blood mainly via a pathway extending from the celiac artery to the gastric artery and from the dorsal pancreatic artery to the pancreaticoduodenal artery. An aneurysm of the CHA with total obstruction was detected intraoperatively. When blood flow in the gastroduodenal artery was momentarily interrupted, the PHA blood flow was unaffected and the color of the liver unchanged. We therefore proceeded with pancreaticoduodenectomy including partial resection of the portal vein, without revascularization, while maintaining collateral circulation. Because the patient showed good postoperative recovery and no complications, we concluded that collateral circulation was functioning well.

Key words
aneurysm in common hepatic artery, pancreaticoduodenectomy, collateral circulation

Reprint requests
Kazuhiko Yamagami Department of Surgery, Osaka Saiseikai Noe Hospital
2-2-33 Imafuku, Higashi Jotoku, Osaka City, 536 JAPAN

Accepted
October 9, 1991

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