TY - JOUR
T1 - A case of carcinoma of the ampulla of vater with anomaly of the portal venous system
T2 - Prepancreatic postduodenal portal vein
AU - Shimizu, Dai
AU - Fujii, Tsutomu
AU - Suenaga, Masaya
AU - Niwa, Yukiko
AU - Okumura, Norio
AU - Kanda, Mitsuro
AU - Yamada, Suguru
AU - Takeda, Shin
AU - Kodera, Yasuhiro
PY - 2014
Y1 - 2014
N2 - Prepancreatic postduodenal portal vein is a very rare anomaly, having only 10 reported cases including our case. We report a surgical case of carcinoma of the ampulla of Vater with a prepancreatic postduodenal portal vein. An 85- year-old woman was admitted for treatment of carcinoma of the ampulla of Vater. Preoperative enhanced CT showed the portal vein passing to the ventral pancreas and to the dorsal duodenum, and three-dimensional reconstruction of the portal vein showed an L-shaped curve. Subtotal stomach-preserving pancreatoduodenectomy was performed. It was difficult to exfoliate the portal vein from the pancreas and bile duct because the portal vein wall was fragile and thin, and its adhesion to the surrounding tissue was extremely strong. As a result, portal vein thrombosis occurred and resection of the portal vein was performed despite the absence of cancer invasion. We resected and reconstructed the portal vein repeatedly, but portal vein thrombosis occurred again. Fortunately, bowel necrosis was avoided and the patient recovered, although strict postoperative management was required. It was suggested that prepancreatic postduodenal portal vein might result in complications such as hemorrhage and thrombosis during surgical procedures for treating the hepatoduodenal ligament, because of fragility, thinness and strong adhesion of the portal vein wall. Prepancreatic postduodenal portal vein is easy to diagnose by preoperative enhanced CT, however, it is necessary to carefully consider the surgical procedure and the indications.
AB - Prepancreatic postduodenal portal vein is a very rare anomaly, having only 10 reported cases including our case. We report a surgical case of carcinoma of the ampulla of Vater with a prepancreatic postduodenal portal vein. An 85- year-old woman was admitted for treatment of carcinoma of the ampulla of Vater. Preoperative enhanced CT showed the portal vein passing to the ventral pancreas and to the dorsal duodenum, and three-dimensional reconstruction of the portal vein showed an L-shaped curve. Subtotal stomach-preserving pancreatoduodenectomy was performed. It was difficult to exfoliate the portal vein from the pancreas and bile duct because the portal vein wall was fragile and thin, and its adhesion to the surrounding tissue was extremely strong. As a result, portal vein thrombosis occurred and resection of the portal vein was performed despite the absence of cancer invasion. We resected and reconstructed the portal vein repeatedly, but portal vein thrombosis occurred again. Fortunately, bowel necrosis was avoided and the patient recovered, although strict postoperative management was required. It was suggested that prepancreatic postduodenal portal vein might result in complications such as hemorrhage and thrombosis during surgical procedures for treating the hepatoduodenal ligament, because of fragility, thinness and strong adhesion of the portal vein wall. Prepancreatic postduodenal portal vein is easy to diagnose by preoperative enhanced CT, however, it is necessary to carefully consider the surgical procedure and the indications.
KW - Anomaly of the portal vein
KW - Pancreatoduodenectomy
KW - Prepancreatic postduodenal portal vein
UR - http://www.scopus.com/inward/record.url?scp=84901241399&partnerID=8YFLogxK
U2 - 10.5833/jjgs.2013.0229
DO - 10.5833/jjgs.2013.0229
M3 - 学術論文
AN - SCOPUS:84901241399
SN - 0386-9768
VL - 47
SP - 275
EP - 280
JO - the japanese journal of gastroenterological surgery
JF - the japanese journal of gastroenterological surgery
IS - 5
ER -