The cure rate (16%) after complete CRS of colorectal peritoneal carcinomatosis, followed by IPC, in selected patients is close to that obtained after resection of colorectal liver metastases.
Background:
Pancreaticoduodenectomy is the usual surgical option for curative treatment
of periampullary cancer and carries a significant mortality. Arterial
anomalies of the celiac axis are not uncommon and might lead to iatrogenic
lesions or requiring arterial resection/reconstruction in a
pancreatoduodenectomy.
Aim:
Determine the prevalence of arterial variations having implications in
pancreatoduodenectomy.
Methods:
Celiac trunk and hepatic arterial system anatomy was retrospectively
evaluated in 200 abdominal enhanced computed tomography studies.
Results:
Normal anatomy of hepatic arterial system was found in 87% of cases. An
anomalous right hepatic artery was identified in 13% of cases. In 12 cases
there was a substitute right hepatic artery arising from superior mesenteric
artery and in two cases an accessory right hepatic artery with similar
origin. A hepatomesenteric trunk was identified in seven cases and in five
there was a right hepatic artery directly from the celiac trunk. All cases
of anomalous right hepatic artery had a route was behind the pancreatic head
and then, posteriorly and laterally, to the main portal vein before reaching
the liver.
Conclusions:
Hepatic artery variations, such as anomalous right hepatic artery crossing
posterior to the portal vein, are frequently seen (13%). These patients,
when undergoing pancreatoduodenectomy, may require a change in the surgical
approach to achieve an adequate resection. Preoperative imaging can clearly
identify such variations and help to achieve a safer pancreatic head
dissection with proper surgical planning.
Paracoccidioidomycosis is endemic to southern Brazil. Most cases with mucocutaneous manifestations affect the head and neck region. Given that risk factors and clinical manifestations are similar to those of head and neck carcinomas, a differential diagnosis has to be done.
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