Abstract
Anatomical variations of hepatic arteries may be problematic in pancreaticoduodenectomy (PD). We experienced pancreatic head cancer in a patient with rare variation of hepatic artery and performed PD successfully with the resection of this artery. A 75-year-old woman showed pancreatic head tumor on CT. Preoperative CT detected rare variation of hepatic artery; posterior segmental branch of right hepatic artery (RHA-PB) originating from posterior inferior pancreaticoduodenal artery. The image also demonstrated that there was a junction between RHA-PB and anterior branch of right hepatic artery (RHA-AB). We performed PD for suspected pancreatic head cancer. We divided RHA-PB for complete resection of cancer because we preoperatively knew that there was the junction between RHA-PB and RHA-AB. She was discharged uneventfully, and there was no evidence of local recurrence throughout the whole course. Careful preoperative assessment of hepatic blood supply is the key to perform successful PD even in this troublesome situation.
Highlights
Anatomical variations of hepatic arteries are of great importance for abdominal surgery and interventional radiology
Aberrant right hepatic artery (RHA) may be problematic in pancreaticoduodenectomy (PD) [1]. Resection of this aberrant artery is sometimes necessary to achieve R0 resection of cancer, it can lead to possible bile duct and liver ischemia
We experienced pancreatic head cancer in a patient with rare variation of hepatic artery; RHA-Posterior branch (PB) originating from posterior inferior pancreaticoduodenal artery (PIPDA)
Summary
Anatomical variations of hepatic arteries are of great importance for abdominal surgery and interventional radiology. Aberrant right hepatic artery (RHA) may be problematic in pancreaticoduodenectomy (PD) [1] Resection of this aberrant artery is sometimes necessary to achieve R0 resection of cancer, it can lead to possible bile duct and liver ischemia. Preoperative enhanced high-resolution CT detected pancreatic head tumor and major posterior segmental branch of RHA (RHA-PB) which originated from posterior inferior pancreaticoduodenal artery (PIPDA) and run through the tumor (Fig. 1). The image demonstrated that there was a junction between RHA-PB and minor anterior segmental branch of RHA (RHA-AB) at the hilar portion (Fig. 2). We performed the operation without any complication and achieved R0 resection macroscopically (duration of surgery, 355 min; blood loss, 220 mL) Her postoperative course was uneventful, and she was discharged on POD15 without hepatic or biliary ischemia. She died from chronic heart failure 13 months after the operation, local recurrence had not be seen throughout the whole course
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