Successful pancreaticoduodenectomy for pancreatic cancer with an aberrant hepatic artery following hepatic arterial alteration by selective embolization: A case report

Transcatheter arterial embolization (TAE) is the standard of care for haemodynamically-stable patients with blunt hepatic injury but it is sometimes impossible due to unfavourable vascular anatomies. This case report describes a 43-year-old male patient with abdominal pain following a motorcycle accident. Based on computed tomography (CT) findings, he was diagnosed with high-grade hepatic injury with coeliac axis stenosis (CAS) due to compression by the median arcuate ligament, and an aberrant right hepatic artery. Contrast-enhanced ultrasonography (CEUS) demonstrated multiple high echogenic tubular and ovoid structures suggestive of active bleeding within the injured liver area. Angiography revealed unique interlobar and intrahepatic collateral vessels between the right and left hepatic arteries. Liver haemorrhages were also identified. Catheterization of the feeding arteries through the collateral pathway was unsuccessful, so a decision was made to cannulate the stenotic portion of the coeliac trunk with a 5-Fr Yashiro catheter. After several attempts, the microcatheter was successfully advanced coaxially into the common hepatic artery. Embolization was performed with a 1:2 mixture of N-butyl cyanoacrylate and iodized oil. Successful haemostasis was confirmed following TAE. CEUS helped clinicians identify active bleeding following traumatic solid organ injury. TAE was a safe and effective treatment strategy. Before performing TAE, attention should be given to the presence of CAS associated with compression by the median arcuate ligament.

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A rare anastomosis between the root of common hepatic artery and proper hepatic artery: implications for pancreaticoduodenectomy

Surgical Case Reports ◽

10.1186/s40792-019-0746-y ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 1

Author(s):

Takeshi Morinaga ◽

Katsunori Imai ◽

Keisuke Morita ◽

Kenichiro Yamamoto ◽

Satoshi Ikeshima ◽

...

Keyword(s):

Pancreatic Cancer ◽

Hepatic Artery ◽

Pancreatic Head ◽

Common Hepatic Artery ◽

Arterial Flow ◽

Anastomotic Site ◽

Proper Hepatic Artery ◽

Arterial Reconstruction ◽

Hepatic Arterial Flow ◽

The Common

Abstract Background Hepatic artery anomalies are often observed, and the variations are wide-ranging. We herein report a case of pancreatic cancer involving the common hepatic artery (CHA) that was successfully treated with pancreaticoduodenectomy (PD) without arterial reconstruction, thanks to anastomosis between the root of CHA and proper hepatic artery (PHA), which is a very rare anastomotic site. Case presentation A 78-year-old woman was referred to our department for the examination of a tumor in the pancreatic head. Contrast-enhanced computed tomography (CT) revealed a low-density tumor of 40 mm in diameter located in the pancreatic head. The involvement of the common hepatic artery (CHA), the root of the gastroduodenal artery (GDA), and portal vein was noted. Although such cases would usually require PD with arterial reconstruction of the CHA, it was thought that the hepatic arterial flow would be preserved by the anastomotic site between the root of the CHA and the PHA, even if the CHA was dissected without arterial reconstruction. PD with dissection of the CHA and PHA was safely completed without arterial reconstruction, and sufficient hepatic arterial flow was preserved through the anastomotic site between the CHA and PHA. Conclusion We presented an extremely rare case of an anastomosis between the CHA and PHA in a patient with pancreatic cancer involving the CHA. Thanks to this anastomosis, surgical resection was successfully performed with sufficient hepatic arterial flow without arterial reconstruction.

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Pimozide and pancreatic cancer in diabetic chorea: a case report

International Journal of Neuroscience ◽

10.1080/00207454.2021.1879063 ◽

2021 ◽

pp. 1-4

Author(s):

Carmelo Tiberio Currò ◽

Giulia Nicocia ◽

Vanessa Ziccone ◽

Antonio Ciacciarelli ◽

Giuseppina Russo ◽

...

Keyword(s):

Pancreatic Cancer ◽

Case Report

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Combined resection of the hepatic artery without reconstruction in pancreaticoduodenectomy: a case report of pancreatic cancer with an aberrant hepatic artery

Surgical Case Reports ◽

10.1186/s40792-020-00997-5 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Tadao Kuribara ◽

Tatsuo Ichikawa ◽

Kiyoshi Osa ◽

Takeshi Inoue ◽

Satoshi Ono ◽

...

Keyword(s):

Pancreatic Cancer ◽

Hepatic Artery ◽

Locally Advanced ◽

Pancreatic Head ◽

Arterial Embolization ◽

Arterial Blood Flow ◽

Temporary Increase ◽

Combined Resection ◽

Arterial Blood ◽

Arterial Resection

Abstract Background Pancreaticoduodenectomy (PD) is rarely performed for pancreatic cancer with hepatic arterial invasion owing to its poor prognosis and high surgical risks. Although there has been a recent increase in the reports of PD combined with hepatic arterial resection due to improvements in disease prognosis and operative safety, PD with major arterial resection and reconstruction is still considered a challenging treatment. Case presentation A 61-year-old man with back pain was diagnosed with pancreatic head and body cancer. Although distant metastasis was not confirmed, the tumor had extensively invaded the hepatic artery; therefore, we diagnosed the patient with locally advanced unresectable pancreatic cancer. After gemcitabine plus nab-paclitaxel (GnP) therapy, the tumor considerably decreased in size from 35 to 20 mm. Magnetic resonance imaging revealed a gap between the tumor and the hepatic artery. Tumor marker levels returned to their normal range, and we decided to perform conversion surgery. In this case, an artery of liver segment 2 (A2) had branched from the left gastric artery; therefore, we decided to preserve A2 and perform PD combined with hepatic arterial resection without reconstruction. After four cycles of GnP therapy, we performed hepatic arterial embolization to prevent postoperative ischemic complications prior to surgery. Immediately after embolization, collateral arterial blood flow to the liver was observed. Operation was performed 19 days after embolization. Although there was a temporary increase in liver enzyme levels and an ischemic region was found near the surface of segment 8 of the liver after surgery, no liver abscess developed. The postoperative course was uneventful, and S-1 was administered for a year as adjuvant chemotherapy. The patient is currently alive without any ischemic liver events and cholangitis and has not experienced recurrence in the past 4 years since the surgery. Conclusions In PD for pancreatic cancer with hepatic arterial invasion, if a part of the hepatic artery is aberrant and can be preserved, combined resection of the common and proper hepatic artery without reconstruction might be feasible for both curability and safety.

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