Successfully performed pylorus preserving pancreatoduodenectomy for ampullary carcinoma associated with celiac axis occlusion

Blood flow to the liver, spleen, stomach and pancreas must be preserved during and after pylorus preserving pancreatoduodenectomy (PPPD) in patients with celiac axis (CeA) occlusion. We report a patient with ampullary carcinoma and CeA occlusion in whom PPPD was successfully performed. Preoperative angiography demonstrated complete obstruction of the CeA. The territorial blood flow to the celiac organs was supplied by the superior mesenteric artery via the gastroduodenal artery (GDA). This required a bypass from the aorta to the GDA using a saphenous vein graft (SVG). A PPPD was performed after the bypass was created. The postoperative course was uneventful. Follow-up angiography showed patency of the SVG. In patients with CeA occlusion who requre PPPD, a bypass from the aorta to the GDA using SVG may be performed safely and easily.