A Case of Bile Duct Carcinoma Reconstructed Right Hepatic Artery with Jejunal Artery of the Efferent Limb

Mitsuru Dohke, Hiroyuki Kato, Toshiji Motohara, Shunichi Okushiba, Toshiyuki Takahashi, Takashi Hara*

Second Department of Surgery, Hokkaido University School of Medicine
*Department of Surgery, Kinikyo Central Hospital

A 64-year-old male patient was admitted to our hospital for obstructive jaundice. Due to carcinoma of the middle portion of the bile duct that invaded the right hepatic artery, a pyloric ring-preserving pancreatoduodenectomy was performed, with reconstruction of the right hepatic artery. PTBD was
performed, and cholangiogram revealed an obstruction in the middle portion of the bile duct. A celiac angiogram revealed an encasement on the right hepatic artery. The patient was diagnosed as having bile duct carcinoma with invasion to the right hepatic artery. Pancreatoduodenectomy was planned. During the operation, the tumor could not be stripped from the right hepatic artery, and therefore, we dissected the artery with the tumor. Back flow from the right hepatic artery (from the liver side) was slight. We reconstructed the right hepatic artery with the jejunal artery of the efferent limb, for reconstruction of the biliary tract. The postoperative course was uneventful. Postoperative angiogram indicated that the right hepatic artery was patent. In this case the communication of the right and left hepatic arteries was poor. Thus, reconstruction of the right hepatic artery was considered necessary to prevent hepatic failure. The jejunal artery of the efferent limb is an alternative choice in reconstruction of the hepatic artery in pancreatobiliary surgery.

Key words
reconstruction of the right hepatic artery , jejunal artery of the effernt limb, carcinoma of the biliary tract

Reprint requests
Mitsuru Dohke Second Department of Surgery, Hokkaido University School of Medicine
Kita-15 Nishi-7, Kita-ku, Sapporo, 060 JAPAN

Accepted
June 14, 1995

To read the PDF file you will need Abobe Reader installed on your computer.