A resected case of advanced duodenal carcinoma with occlusion of the celiac artery.

A 75-year-old woman with vomiting, admitted on March 7 2002, was diagnosed with advanced duodenal carcinoma based on ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance cholangio-ancreatography (MRCP), percutaneus transhepatic cholangiography. Angiography showed the celiac artery to be occluded. The common hepatic artery was demonstrated via the gastroduodenal artery (GDA). We conducted a probe laparotomy and resected connective tissue with the celiac ganglion and lymph nodes surrounding the celiac artery. The frozen specimen showed no malignancy. Then the celiac artery was exposed and celiac axis compression syndrome was not seen. A portion of the greater saphenous vein was taken from the patient's right thigh and grafted between the common hepatic artery and the supraceliac portion of the aorta. One end of the saphenous vein was anastomosed to the side of the common hepatic artery. The other end of the saphenous vein was anstomosed to the aorta in an end to side fashion. After the reconstruction of celiac circulation, we performed radical pancreaticoduodenectomy. The postoperative course was not eventful and the patient was discharged from the hospital 5 weeks after surgery.

A resected case of multiple intraductal papillary mucinous tumors of the pancreas with US-guided ductal branch-oriented partial pancreatectomy.

A 69-year-old man with epigastralgia was admitted on August 26, 2002 and diagnosed with multiple intraductal papillary mucinous tumors by various imagings. The cystic tumor of pancreas head had a diameter of 2 cm, and the mural nodule of the cystic tumor measured only 3 mm. In the pancreas body the cystic tumor was measured at 1.5 cm with the mural nodule of the cystic tumor measuring 3 mm. It was believed that the tumors were benign. However, a mural nodule of the cystic lesion was recognized, thus, the possibility of malignancy could not be completely ruled out. The reduction operation for preservation of pancreatic parenchyma should be selected for these circumstances. Ductal branch-oriented partial pancreatectomy was performed on September 6, 2002 with intraoperative ultrasonography and a Cavitron Ultrasonic Aspirator, preserving the main pancreatic duct and normal pancreatic parenchyma. The operation was successful, and the histopathological diagnosis of the tumors was intraductal papillary adenoma of the pancreas.