Murat Çakır, Tevfik Küçükkartallar, Ahmet Tekin, Fatma Betül Tuncer, Adil Kartal

Department of General Surgery, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey

Abstract

A pancreaticoduodenectomy is a surgical procedure with a high morbidity and mortality rate. The injury of the hepatic artery may occasionally lead to intraoperative bleeding. Repair of the injured hepatic artery is of great importance in terms of maintaining the vascular supply of the liver. We report a case with an injury of the hepatic artery that was successfully reconstructed with the gastroduodenal artery and then developed a biliary leak due to bile duct ischemia at an early stage. A 33-year-old women complaining of right upper quadrant pain was found to have a solid pseudopapillary tumor of the pancreas. She underwent an immediate pancreaticoduodenectomy, and her hepatic artery was injured during the operation. The arterial ends were sutured with primary anastomosis, because they could be aligned without any tension. The biliary leak occurred on postoperative day 2. We detected bile duct ischemia and reanastomosed the artery. The patient was discharged on postoperative day 8. Surgeons should be prepared for anomalies of the peripancreatic vascular structures during pancreaticoduodenectomy. Computed tomography (CT) angiography should be considered to reveal these anomalies before the surgery. Insufficiency of the biliodigestive anastomosis due to bile duct ischemia in the postoperative period should be kept in mind, even in cases of successful repair.

Keywords: Bile duct, ischemia, reconstruction


 

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - A.K.; Design - M.Ç.; Supervision - A.T.; Funding - M.Ç.; Materials - T.K.; Data Collection and/or Processing - M.Ç.; Analysis and/or Interpretation - M.Ç.; Literature Review - M.Ç.; Writer - M.Ç.; Critical Review - M.Ç., F.B.T.

Conflict of Interest

No conflict of interest was declared by the authors.

Financial Disclosure

The authors declared that this study has received no financial support.