A Case of Safely Resected Pancreatic head Cancer Associated with Atherosclerotic Stenosis of Superior Mesenteric Artery

Koichi Taniguchi, Itaru Endo, Keiichi Yazawa, Ryusei Matsuyama, Kenichi Matsuo, Hirokazu Suwa, Kuniya Tanaka, Hirotoshi Akiyama, Toshio Imada and Hiroshi Shimada

Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine

A 67-year-old woman whose laboratory data showed obstructive jaundice during ambulatory treatment for rheumatoid arthritis was found in abdominal dynamic computed tomography (CT) to have a low-density area at the pancreatic head and severe stenosis from the root of the superior mesenteric artery (SMA) up to the root of the inferior pancreaticoduodenal artery (IPDA). SMA-oriented pancreaticoduodenectomy was conducted in which major arteries such as the IPDA or first jejunal artery is transected early in surgery from the dorsal side of the pancreatic head Ultrasonic flowmetry monitoring after major vessels were test-clamped showed no suppression of peripheral SMA blood flow. After resection, retrograde blood supply was observed from the middle colic artery. The postoperative course was uneventful and the woman was discharged on postoperative day 20. This SMA-oriented procedure enables us to conduct pancreaticoduodenectomy safely without intestinal ischemia despite severe SMA root stenosis.

Key words
pancreatic cancer, SMA stenosis, SMA oriented PD

Reprint requests
Koichi Taniguchi Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine
3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 JAPAN

Accepted
June 18, 2009

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