School: South West Clinical School UNSW Medicine Sydney Australia

A 55yo lady undergoing open pancreaticoduodenectomy for duodenal adenocarcinoma was intra-operatively found to have macroscopic tumour involvement of the proper hepatic artery and its bifurcation. The diseased segment was resected and a novel technique for reconstruction was performed- the remnant common hepatic artery was anastomosed to the remnant right hepatic artery, and the left gastric to the remnant left hepatic artery. Doppler ultrasound confirmed  patency of all anastomoses prior to closure. Synthetic function of the liver and bilirubin recovered to appropriate levels postoperatively, and the patient was planned for adjuvant chemotherapy.