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. 2019 Nov 19;5(1):180.
doi: 10.1186/s40792-019-0746-y.

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

Takeshi Morinaga  1 , Katsunori Imai  2 , Keisuke Morita  1 , Kenichiro Yamamoto  1 , Satoshi Ikeshima  1 , Kei Horino  1 , Shinya Shimada  1 , Hideo Baba  3
Affiliations

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

Takeshi Morinaga et al. Surg Case Rep. .

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.

Keywords: Arterial reconstruction; Pancreatic cancer; Pancreaticoduodenectomy; Rare anastomosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Contrast-enhanced CT revealed a low-density tumor in the pancreatic head, which was invading the CHA and the root of the GDA. CHA, common hepatic artery; PHA, proper hepatic artery; GDA, gastroduodenal artery
Fig. 2
Fig. 2
Three-dimensional CT angiography showed anastomosis between the root of the CHA and PHA (white arrow). RHA, right hepatic artery; LHA, left hepatic artery; LGA, left gastric artery; SpA, splenic artery; SMA, superior mesenteric artery
Fig. 3
Fig. 3
During the operation, anastomosis between the CHA and PHA was observed (white arrow). The anastomotic site became enlarged after dissection of the CHA. The black arrowhead shows the stump of the CHA. The white arrowhead shows the stump of the PHA. SpV, splenic vein; PV, portal vein; SMV, superior mesenteric vein
Fig. 4
Fig. 4
Follow-up CT angiography at 3 months after surgery demonstrated sufficient hepatic flow through the anastomotic site between the CHA and PHA (white arrow)
See this image and copyright information in PMC

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