A rare variation of celiac trunk and hepatic artery complicating pancreaticoduodenectomy

Abstract

Rationale:Anatomical variations of the celiac trunk and the hepatic artery are of considerable importance in hepatopancreatobiliary surgery, liver transplants, and radiological abdominal interventions.Patient concerns:Here, we report a 57-year-old man with 2 weeks of painless progressive jaundice. Preoperative imaging and cytology brush results suggested an ampullary tumor and common hepatic artery anomaly (CTA) was reported. The patient underwent pancreaticoduodenectomy (PD). Intraoperatively, the CHA and gastroduodenal artery (GDA) were abnormal. The CHA emerged from the superior mesenteric artery (SMA). Computer tomography angiography (CTA) was performed postoperatively; surprisingly, the left gastric artery (LGA) and splenic artery (SA) arising from the anterior wall of the abdominal aorta replaced the normal structure of the celiac trunk, and an accessory left hepatic artery (LHA) emerged from the LGA.Diagnoses:The patient was diagnosed with cholangiocarcinoma and accompanying extremely rare variation of celiac trunk and hepatic artery.Interventions and outcomes:The patient underwent PD and had an uneventful postoperative evolution. There was no recurrence of the tumor and with normal liver function during the 10-month follow-up.Interventions:The patient underwent PD and had an uneventful postoperative evolution.Outcomes:There was no recurrence of the tumor and with normal liver function during the 10-month follow-up.Lessons:Surgeons must keep in mind that arterial variation may be present in the vascular structures intraoperatively, even if it was not revealed in preoperative imaging. The preoperative identification of arterial variation and its relationship with the tumor is necessary to avoid intraoperative vascular injury and complications after surgery.

Variations in the Configuration of the Celiac Trunk Among South Africans: Clinical Relevance

“…This becomes complicated when there are variations in the hepato-biliary vasculature which usually originates from the celiac trunk. Ye et al (2017) recently reported a case in which they successfully performed pancreaticoduodenectomy in a cholangiocarcinoma patient without a classic celiac trunk. In this patient, the LGA and SA arose from the abdominal aorta and an accessory LHA arising from the LGA.…”

Branching pattern variations of the celiac trunk and superior mesenteric artery in a 72-year-old white female cadaver

“…The CT is normally 1.5 to 2.3 cm long, and its trunk traverses horizontally forward, trifurcating into the LGA, CHA, and SA (55-100% of the population) [1,3,4,[6][7][8][9][10]12,14,16,18,[23][24][25][26]28,29,33,34,[39][40][41][42][43][44]. This trifurcation was first described by Haller in 1756 as tripus Halleri [7,8,18,21,22,24,28,30,35,45,46]. The origin of the CT from the abdominal aorta, however, can vary.…”

“…Makisalo et al (1993) and Raviprasanna and Kulkarni (2018) reported one case in each of their cohorts that had an accessory LHA arising from the CT [45,56,57]. In its absence (0.38-1.4%), branches of the CT may arise from the aorta [4,7,8,27,28,34,35,38,[42][43][44]58].…”

A case report combining Dunbar syndrome and pancreatic neuroendocrine tumor

“…Some studies report the coexistence of Dunbar syndrome with pancreatic carcinoma [ [9] , [10] , [11] , [12] , [13] ] with present a surgical challenge during the resection of the pancreatic head. To our knowledge, silent PNETs was not reported in combination of Dunbar syndrome.…”