A Case Report of Cancer in the Head of the Pancreas Associated with Celiac: Occlusive Disease Who Underwent Abdominal Aorta-celiac Bypass before Pancreaticoduodenectomy

We report a patient with cancer in the head of the pancreas associated with celiac occlusive disease who underwent pancreaticoduodenectomy. A 75-year-old woman was admitted to our hospital because of upper abdominal pain, back pain and jaundice. Abdominal CT, percutaneous transhepatic cholangiogram and endoscopic pancreatogram revealed cancer in the head of the pancreas. Superior mesenteric angiogram demonstrated high-grade stenosis of the celiac axis at its origin, and the blood supply to the celiac artery was sustained through the gastroduodenal artery via the pancreaticoduodenal arcades from the superior mesenteric artery. Therefore a diagnosis of cancer in the head of the pancreas associated with high-grade stenosis of the celiac axis was made, and an autograft of saphenous vein was placed between the abdominal aorta and common hepatic artery cranially to the celiac axis before pancreaticoduodenectomy. The postoperative course was uneventful, and angiogram obtained on the 80thpostoperative day demonstrated patency of the graft. Our bypass method is safe because blood supply to the liver is not blocked during the operation. It also maintains curability beca use it does not obstruct the operative procedure or dissection of lymphnodes. Therefore we consider our bypass method to be useful.