Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 8, 2015; 7(4): 721-724
Published online Apr 8, 2015. doi: 10.4254/wjh.v7.i4.721
First jejunal artery, an alternative graft for right hepatic artery reconstruction
Bibek Aryal, Teruo Komokata, Jun Kadono, Hiroyuki Motodaka, Tetsuya Ueno, Akira Furoi, Yutaka Imoto
Bibek Aryal, Jun Kadono, Hiroyuki Motodaka, Tetsuya Ueno, Yutaka Imoto, Cardiovascular and Gastroenterological Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-shi, Kagoshima 890-8520, Japan
Teruo Komokata, Department of Surgery, Kagoshima Medical Center, National Hospital Organization, Kagoshima-shi, Kagoshima 892-0853, Japan
Akira Furoi, Department of Surgery, Kirishima Medical Center, Kirishima-shi, Kagoshima 899-5112, Japan
Author contributions: Aryal B, Komokata T and Kadono J followed the case and designed the report; Motodaka H involved in in-patient care and collected the patient’s clinical data; Ueno T assisted the vascular reconstruction; Aryal B wrote the paper; Kadono J, Komokata T, Furoi A and Imoto Y reviewed the paper; Imoto Y approved the paper.
Conflict-of-interest: None of the authors in the manuscript has any conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Teruo Komokata, MD, PhD, Department of Surgery, Kagoshima Medical Center, National Hospital Organization, 8-1 Shiroyamacho, Kagoshima-shi, Kagoshima 892-0853, Japan. komokata@kagomc2.hosp.go.jp
Telephone: +81-99-2231151 Fax: +81-99-269246
Received: December 17, 2014
Peer-review started: December 18, 2014
First decision: December 27, 2014
Revised: January 9, 2015
Accepted: February 10, 2015
Article in press: February 12, 2015
Published online: April 8, 2015
Processing time: 118 Days and 4.6 Hours
Abstract

Common bile duct cancer invading right hepatic artery is sometimes diagnosed intraoperatively. Excision and safe reconstruction of the artery with suitable graft is essential. Arterial reconstruction with autologous saphenous vein graft is the preferred method practiced routinely. However the right hepatic artery reconstruction has also been carried out with several other vessels like gastroduodenal artery, right gastroepiploic artery or the splenic artery. We report a case of 63-year-old man presenting with history of progressive jaundice, pruritus and impaired appetite. Following various imaging modalities including computed tomography, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, intraductal ultrasound extrahepatic bile duct cancer was diagnosed; however, none of those detected vessel invasion. Intraoperatively, right hepatic artery invasion was revealed. Right hepatic artery was resected and reconstructed with a graft harvested from the first jejunal artery (JA). Postoperative outcome was satisfactory with a long-term graft patency. First JA can be a reliable graft option for right hepatic artery reconstruction.

Keywords: Common bile duct cancer; Right hepatic artery; Arterial reconstruction; Jejunal artery; Arterial graft

Core tip: Common bile duct (CBD) cancers frequently invade the surrounding vessels like the right hepatic artery (RHA). The arterial excision with tumor free margins followed by the reconstruction remains the mainstay treatment for a better outcome and long-term survival. Various grafts including saphenous vein, splenic artery, right gastroepiploic artery or gastroduodenal artery have been practiced for RHA reconstruction. In our case, the RHA invasion by CBD cancer was detected intra-operatively. We performed the RHA reconstruction using the autologous first jejunal artery (JA) graft. The use of first JA graft during RHA reconstruction seems to be technically feasible leading to an acceptable outcome.