Pancreaticoduodenectomy assisted by 3-D visualization reconstruction and portal vein arterialization: A case report (a CARE-compliant article)

• Published in: Medicine (Baltimore) Vol. 95; no. 36; p. e4697
• Main Authors: Su, Zhao-jie, Li, Wen-gang, Huang, Jun-li, Xiao, Lin-feng, Chen, Fu-zhen, Wang, Bo-liang
• Format: Journal Article
• Language: English
• Published: United States The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved 01.09.2016; Wolters Kluwer Health
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Adult; Clinical Case Report; Duodenal Neoplasms - diagnostic imaging; Duodenal Neoplasms - pathology; Duodenal Neoplasms - surgery; Female; Humans; Imaging, Three-Dimensional; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - secondary; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy; Portal Vein - diagnostic imaging; Portal Vein - surgery
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000004697

Three-dimensional visualization reconstruction, the 3-D visualization model reconstructed by software using 2-D CT images, has been widely applied in medicine; but it has rarely been applied in pancreaticoduodenectomy. Although the hepatic artery is very important for the liver, it has to be removed when tumor invades it. Therefore, portal vein arterialization has been used in clinic as a remedial measure, but there still is professional debate on portal vein arterialization. Here, we report 1 case that was diagnosed with poorly differentiated adenocarcinoma of the duodenum. The tumor had large size and invaded surrounding organs and vessels. Preliminary diagnoses were poorly differentiated adenocarcinoma of the duodenum and viral hepatitis B. Pancreaticoduodenectomy assisted by 3-D visualization reconstruction and portal vein arterialization were performed in this case. The tumor was removed. Liver function returned to normal limits 1 week after operation. Digital subtraction arteriography showed compensatory artery branches within the liver 1 month after operation. 3-D visualization reconstruction can provide a reliable assistance for the accurate assessment and surgical design before pancreatoduodenectomy, and it is certainly worth adopting portal vein arterialization when retention of hepatic artery is impossible or conventional arterial anastomosis is required during pancreatoduodenectomy.