Reconstruction of the hepatic artery with the middle colic artery is feasible in distal pancreatectomy with celiac axis resection: A case report

Figure 1 Computed tomography scan demonstrating the dilatation of the main pancreatic duct (A) and a tumor of the pancreatic body which invaded the celiac artery after the abdominal aortic aneurysm operation (B). MPD: Main pancreatic duct.

Figure 2 Endoscopic retrograde cholangiopancreatography showing a stricture of the main pancreatic duct in the body of the pancreas. MPD: Main pancreatic duct.

Figure 3 Abdominal angiography showing splenic and celiac arteries involved with a solid tumor in the pancreatic body and the gastroduodenal artery arising from the area close to the celiac. SA: Splenic CA: Celiac axis; CHA: Common hepatic artery; GDA: Gastroduodenal artery.

Figure 4 Operative photograph showing that reconstruction was completed. End-to-end anastomosis was performed between the proper hepatic artery (PHA) and the middle colic artery (MCA) (yellow circle). A: Before anastomosis; B: After anastomosis.

Figure 5 In the pathological findings, there was a prominent formation of mucinous nodules and mucinous carcinoma including large quantities of mucus. Final histolopathological diagnosis of the resected specimen shows mucinous carcinoma (with an intraductal papillary-mucinous tumor, Hematoxylin eosin staining, ×100).

Figure 6 Postoperative evaluation of the proper hepatic artery by 3D-computer tomography angiography. The arrows indicate the anastomosis between the proper hepatic artery (PHA) and the middle colic artery (MCA).