Pancreatoduodenectomy for Carcinoma of the Ampulla of Vater with Common Hepatic Artery Originated from Hepatomesenteric Trunk, Passing Through the Pancreatic Head: Report of a Case

Masaki Mizumoto, Satoru Nishimura, Gen Honjyo* and Satoru Matsusue

Department of Abdominal Surgery and Department of Pathology*, Tenri Hospital

A 60-years-old man underwent pancreatoduodenectomy for carcinoma in the ampulla of Vater had the common hepatic artery arising from the hepatomesenteric trunk and passing through the parenchyma of the pancreatic head, which was preserved. The groove of the common hepatic artery in the pancreatic head led to a fibrous plate, dividing the pancreatic head into ventral and dorsal portions. Histologically, the tumor was moderately differentiated tubular adenocarcinoma, pT1, pN0, M-, fStageI, R0. Obstructive jaundice occurred due to a tumor of common hepatic duct infiltrating the intrahepatic bile duct 18 months after surgery. The man died 32 months postoperatively of well-differentiated, primary tubular carcinoma of the hilar bile duct confirmed in autopsy, without recurrence of the ampullary carcinoma. In surgery on periampullary carcinoma, surgeons should consider the replaced hepatic artery, which should be preserved in noninvasive carcinoma, but removed and reconstructed in invasive carcinoma.

Key words
periampullary carcinoma, replaced common hepatic artery, pancreatoduodenectomy

Reprint requests
Masaki Mizumoto Department of Surgery, Kyoto City Hospital
1-2 Higashitakada-cho, Mibu, Nakagyo-ku, Kyoto, 604-8845 JAPAN

Accepted
March 25, 2009

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