A Case of Lower Bile Duct Carcinoma Associated with Celiac Axis Compression Syndrome

Hiroki Akamatsu, Masaaki Nakahara, Shigeru Imabun, Nobutaka Hatanaka, Kazushi Kurozumi, Masayuki Tori, Shigeyuki Ueshima, Kazuyasu Nakao and Masahiko Tsujimoto^*

Department of Surgery and Department of Pathology^*, Osaka Police Hospital

We report a case of lower bile duct carcinoma associated with celiac axis compression syndrome (CACS). Pancreaticoduodenectomy was safely done monitoring hepatic arterial flow with electromagnetic flowmetry. A 77-year-old woman admitted for epigastralgia and jaundice was found in visceral arteriography to have extensive collateral blood flow to the hepatic artery via the dilated pancreatic arcade from the superior mesenteric artery. A lateral view of aortography showed compression of the celiac axis. A diagnosis of lower bile duct carcinoma associated with CACS was made. The median arcuate ligament was divided and pancreaticoduodenectomy done. After ligament division, clamping of the gastroduodenal artery did not decrease the hepatic arterial blood flow measured with electromagnetic flowmetry. The patient's postoperative course was uneventful. When pancreaticoduodenectomy is done on patients with CACS, monitoring and securing the hepatic arterial blood flow is important for preventing postoperative complications. Doppler ultrasonography was useful in diagnosis and postoperative follow-up.

Key words
pancreaticoduodenectomy, celiac axis compression syndrome, median arcuate ligament

Reprint requests
Hiroki Akamatsu Department of surgery, Osaka Police Hospital 10-31 Kitayama-cho, Tennoji-ku, Osaka, 543-0035 JAPAN

Accepted
February 26, 2003

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