title: Distal gastrectomy for advanced gastric cancer with vascular anomaly after coronary bypass grafting using the right gastroepiploic artery.
abstract: A 77-year-old woman with a history of coronary artery bypass grafting 5 years earlier presented with anemia and was diagnosed with advanced gastric cancer involving the pylorus. Preoperative angiography revealed that the right gastroepiploic artery (RGEA) graft was patent. Multidetector-row computed tomography showed the running pattern of the RGEA graft and also revealed a vascular anomaly belonging to type V of Adachi's classification. Adachi's type V is a rare vascular anomaly in which the common hepatic artery originates from the superior mesenteric artery. The patient was treated successfully with a distal gastrectomy and removal of the D2 lymph node with preservation of the RGEA graft. Because of the difficulty in confirming the running pattern of the artery during the surgery, it is important to define the arterial running pattern preoperatively by using multidetector-row computed tomography, including 3-dimensional angiographic imaging.
authors.affiliation: Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University, Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. makuni49@nagasaki-u.ac.jp
authors.forename: Masaki
authors.initials: M
authors.lastname: Kunizaki
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Hidaka
authors.forename: Takashi
authors.initials: T
authors.lastname: Nonaka
authors.forename: Katsunori
authors.initials: K
authors.lastname: Takagi
authors.forename: Syuichi
authors.initials: S
authors.lastname: Tobinaga
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takeshita
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nanashima
authors.forename: Terumitu
authors.initials: T
authors.lastname: Sawai
authors.forename: Toru
authors.initials: T
authors.lastname: Yasutake
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagayasu
mesh_terms: D000368:Aged; D000792:Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D024405:Gastroepiploic Artery / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000637:transplantation*; D006801:Humans; D013274:Stomach Neoplasms / Q000098:blood supply / Q000150:complications / Q000601:surgery*; D054079:Vascular Malformations / Q000150:complications* / Q000601:surgery