One reason for the hopeless prognosis is based on the fact that these tumors are apt to spontaneously rupture. Our experience suggests that appropriate surgical treatment, including repeat resections, will be able to result in a favorable prognosis. What was the mechanism of metastasis into the left gastric vein? Because the portal trunk connects the liver and left gastric vein anatomically, the metastasis must have been caused by hematogenous implantation. The typical blood flow of the portal trunks is hepatopetal. In some patients with portal hypertension, it has been reported that the portal flow is hepatofugal. 3 In our patient, the exact causes of the metastasis are unknown, but they may be related to factors such as the blood flow in the left gastric vein, tumor histocompatibilty, or angiogenetic factors. Several patients with gastric or hepatic cancer have been reported to have serial portal thromboses and metastases to the left gastric vein. However, we found no previous reports of PHAs that metastasized into the left gastric vein that were curatively resected. These cases should be accumulated, because this may contribute to a better understanding of this phenomenon and lead to a new strategy for the treatment of this disease.
Celiac artery aneurysms are rare vascular lesions and represent 4% of all splanchnic aneurysms. Media degeneration and atherosclerosis are the most common underlying etiologic factors. The risk of rupture and the associated mortality rate are 13% and 40% respectively. In contrast, elective repair carries a low mortality rate of 5%. Most of celiac artery aneurysms are asymptomatic and in the past nearly 80% of the cases were diagnosed when ruptured. Recently, there is an increased recognition of all splanchnic aneurysm types, probably because of better diagnostic techniques. We report a case of celiac artery aneurysm with severe atherosclerotic stenosis of the common hepatic artery. We performed, through a midline supraumbilical laparotomy, extended partial aneurysmectomy and common hepatic artery ostium endarterectomy. For the closure we used Dacron patch. The uncomplicated postoperative patient's course, with no evidence of liver dysfunction and excellent patency of the common hepatic artery, suggests that this technique offered good results and minimized the perioperative risk.
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