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

Figure 1

Preoperative image findings. (a) Three-dimensional computed tomography scan of the abdomen reveals the replaced common hepatic artery arising from the superior mesenteric artery. (b) Magnetic resonance cholangiopancreatogram shows the annular duct, but no relevant tumor or dilation of the common bile duct and the pancreatic duct. (c) Esophagogastroduodenoscopy shows an ulcer at the ampulla of Vater, and the biopsy results of the ulcer indicate adenocarcinoma. Cannulation of the papilla region could not be performed because of direct invasion of the tumor.

(a)

(b)

(c)