A Case of Carcinoma of the Papilla of Vater Accompanied with a Stricture of the Celiac Artery by the Median Arcuate Ligament

Celiac artery root stricture causes an inherent risk of ischemic liver damage due to insufficient blood flow after pancreatoduodenectomy (PD). We report a case of carcinoma of papilla of vater accompanied by such a stricture that was safely resected using ultrasonic blood flowmetry. Preoperative examination showed the stricture to be due to constriction by the median arcuate ligament. Before cutting the ligament, the blood flow of the proper hepatic artery (PHA) was entered from the gastroduodenal artery (GDA) and that in the common hepatic artery (CHA) was also from the GDA. Clamping the GDA reduced the blood flow to the PHA. After clamping the GDA and cutting the median arcuate ligament, we corrected the direction of blood flow entering from the CHA into the PHA, and returning the blood flow volume in the PHA to initial values. After confirming sufficient blood flow in the PHA, we cut the GDA and conducted PD. Intraoperative blood flow volume measurement was effectively avoided liver damage due to ischemia.