Published online Apr 8, 2015. doi: 10.4254/wjh.v7.i4.721
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
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.
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.