Sawa Yui, Inoue Yosuke, Kobayashi Kosuke, Oba Atsushi, Ono Yoshihiro, Ito Hiromichi, Takahashi Yu
Division of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.24-0184. Epub 2025 Mar 21.
Anatomical anomalies, such as branches of the celiac artery and superior mesenteric artery (SMA), and pancreatic malformations, including the annular pancreas, are important during pancreaticoduodenectomy (PD). Here, we report a case of an anomaly of the artery and main pancreatic duct (MPD) in which the pancreatic parenchyma surrounded the replaced common hepatic artery (rCHA), and the meandering main pancreatic duct (MMPD) ran behind the rCHA.
A 71-year-old woman was diagnosed with intraductal papillary mucinous neoplasm (IPMN) of pancreatic body and the dilation of MPD to 13 mm, which was a factor of high-risk stigmata. Preoperative computed tomography (CT) showed that the rCHA branched from the superior mesenteric artery (SMA) and the pancreatic parenchyma surrounded the rCHA. Moreover, the MPD meandered and ran behind the rCHA. PD was performed. At the time of dissection between the rCHA and pancreatic parenchyma, we had to divide not only the cranial part of the pancreatic parenchyma along the rCHA but also the MPD. The postoperative course was uneventful.
This is the first report of the rCHA surrounded by pancreatic parenchyma and MMPD running behind the rCHA and in front of the portal vein.
解剖学异常，如腹腔干动脉和肠系膜上动脉（SMA）的分支，以及胰腺畸形，包括环状胰腺，在胰十二指肠切除术（PD）中很重要。在此，我们报告一例动脉和主胰管（MPD）异常的病例，其中胰腺实质包绕替代肝总动脉（rCHA），迂曲的主胰管（MMPD）走行于rCHA后方。
一名71岁女性被诊断为胰体部导管内乳头状黏液性肿瘤（IPMN），主胰管扩张至13mm，这是高危征象之一。术前计算机断层扫描（CT）显示rCHA发自肠系膜上动脉（SMA），胰腺实质包绕rCHA。此外，主胰管迂曲并走行于rCHA后方。实施了胰十二指肠切除术。在分离rCHA与胰腺实质时，我们不仅要沿rCHA切开胰腺实质的头侧部分，还要切开主胰管。术后病程顺利。
这是首例关于rCHA被胰腺实质包绕且MMPD走行于rCHA后方和门静脉前方的报道。
