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Case Reports in Medicine
Volume 2018, Article ID 3258141, 5 pages
Case Report

Pancreaticoduodenectomy for an Ampullary Region Carcinoma Occurred in Annular Pancreas Coexistent with Replaced Common Hepatic Artery

1Department of General and Gastrointestinal Surgery, Mitsui Memorial Hospital, 1 Kanda Izumicho, Chiyoda-Ku, Tokyo 101-8643, Japan
2Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda Izumicho, Chiyoda-ku, Tokyo 101-8643, Japan
3Department of Pathology, Mitsui Memorial Hospital, 1 Kanda Izumicho, Chiyoda-ku, Tokyo 101-8643, Japan

Correspondence should be addressed to Ryuji Komine; moc.liamg@kr.dem.arod

Received 14 December 2017; Accepted 23 January 2018; Published 20 February 2018

Academic Editor: William B. Silverman

Copyright © 2018 Ryuji Komine et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. Annular pancreas is a rare congenital abnormality characterized by a ring of pancreatic tissue surrounding the descending portion of the duodenum. Annular pancreas coexisting with replaced common hepatic artery which is also a rare anatomical variation has not been reported previously. Case Presentation. A 53-year-old man visited our hospital complaining of epigastric pain. Based on radiological examinations, he was diagnosed as having pancreatitis, annular pancreas, and hepatomesenteric trunk. One month later, obstructive jaundice developed. Endoscopic examination revealed ampullary region carcinoma. We performed pancreaticoduodenectomy using the “artery-first” approach. Discussion. Both annular pancreas and common hepatic artery anomaly are rare. High-quality preoperative imaging and awareness of such rare conditions are necessary for operative safety. Although the embryological relationship between these anomalies is uncertain, the present case may suggest some relevance between the two. Conclusion. The “artery-first” approach may be a useful method for pancreaticoduodenectomy in patients who have an anatomical abnormality.