A case of cholangiocarcinoma with hepatomesenteric trunk and intestinal malrotation treated with pancreaticoduodenectomy

: The patient was a 61-year-old man. He was underwent pancreaticoduodenectomy for common bile duct cancer. The preoperative dynamic CT revealed that hepatic artery was branched from the superior mesenteric artery, run through pancreatic surface caudal to cranial and flowed into liver. And this vessel had several branches into pancreas. In operation, to ensure blood flow to the liver, hepatic artery was detached from pancreas by cutting off branches into pancreas. In addition, intestinal malrotation was also confirmed (Treitz ligament was not formed and small intestine was present in the right side of abdominal space, while colon was present in the other side). Performing a pancreatoduodenectomy for malignant tumors, it is very important to recognize the variation of hepatic artery, because of the necessity for the consideration of blood flow to the liver. In this case, we indicated a preservation of hepatic artery with adequate lymph node dissection.