Transpancreatic Hepatomesenteric Trunk Complicating Pancreaticoduodenectomy
Transpancreatic Hepatomesenteric Trunk Complicating Pancreaticoduodenectomy
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DOI：
10.6092/1590-8577/1641
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发表时间：
2013-11-01
影响因子：
0.2
通讯作者：
Govindan, Manoharan
中科院分区：
文献类型：
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作者：
Rammohan, Ashwin;Sathyanesan, Jeswanth;Govindan, Manoharan
大约60%的患者存在标准的腹腔动脉和肝动脉解剖结构;对于其余的患者，已经描述了多种变异。为了避免不必要的并发症，彻底了解这些异常是很重要的。在这份报告中，我们描述了一个最罕见的动脉异常，肝肠系膜动脉干供应肝脏。我们试图阐明它的影响有关的安全性能的胰腺癌切除术。病例报告一位45岁男性，因持续一个月的无痛性进行性黄疸而被诊断为壶腹周围生长。术前成像未提示任何动脉异常。术中发现肝总动脉起源于上级肠系膜动脉。他接受了保留幽门的胰管切除术，并仔细解剖和保留了迷走的肝肠系膜干。他的术后期间平安无事，随访情况良好。结论肝动脉和腹腔动脉解剖变异是常见的，术前影像学检查可能无法发现。沿着对正常解剖结构的精确了解和对异常解剖结构的认识，对每一位患者的高度怀疑是安全进行胰腺切除术的必要条件。
Context Standard celiac and hepatic arterial anatomy occur in approximately 60% of the patients; for the remaining, multiple variations have been described. A thorough knowledge of these anomalies is important in order to avoid unnecessary complications. In this report we describe one of the rarest arterial anomalies, a hepatomesenteric trunk supplying the liver. We attempt to elucidate its implications pertaining to the safe performance of a pancreaticoduodenectomy. Case report A 45-year-old male with a one-month duration painless progressive jaundice was evaluated and diagnosed as having a periampullary growth. Preoperative imaging did not suggest any arterial anomalies. Intraoperatively, the common hepatic artery was found to originate from the superior mesenteric artery. He underwent a pylorus preserving pancreaticoduodenectomy with a meticulous dissection and preservation of the aberrant hepatomesenteric trunk. His postoperative period was uneventful and is doing well on follow up. Conclusion Variations in hepatic and celiac arterial anatomy are common, and may not get picked up on preoperative imaging. A high index of suspicion in every patient along with a precise knowledge of the normal anatomy and awareness of the aberrant anatomy is a sine qua non to the performance of a safe pancreaticoduodenectomy.