A Case of Carcinoma of the Papilla Vater with Celiac Axis Obstruction which Conducted Pancreatoduodenectomy

Hiroki Moriyama, Michihiro Kurose, Takemasa Watanabe, Yasuyuki Nonaka, Doufu Hayashi, Naohiko Tokuda, Tohru Kojima* and Shinichi Takada**

Department of Surgery, Department of Cardiovascular Surgery* and Department of Pathology**, Tsuyama Central Hospital

When pancreatoduodenectomy is conducted in a patient with celiac axis obstruction, the blood flow to the liver becomes an important consideration. We report a case of carcinoma of the papilla of Vater with celiac axis obstruction, for which pancreatoduodenectomy was done safely without reconstruction of blood circulation. A 75-year-old woman admitted for general fatigue and right hypochondralgia was found in endoscopic examination to have carcinoma of the papilla of Vater. Visceral angiography showed extensive collateral blood flow to the hepatic artery and splenic artery via dilated pancreatic arcades and the dorsal pancreatic artery from the superior mesenteric artery. A lateral view of 3D reformation of enhancement abdominal CT showed celiac axis obstruction necessitating surgery. We found a stricture at the celiac axis and we detached it, but pulsations of the common hepatic artery were not visible. Monitoring with ultrasonic flowmetry showed that the common hepatic artery had an efferent blood flow after test-clamping gastroduodenal artery, which is supposed to be from the dorsal pancreatic artery. We conducted pancreatoduodenectomy safely without reconstruction of blood circulation.

Key words
celiac axis obstruction, pancreatoduodenectomy

Reprint requests
Hiroki Moriyama Department of Surgery, Ibaraki Iseikai Hospital
11-25 Hatakedacho, Ibaraki, 567-0028 JAPAN

Accepted
December 17, 2004

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