Pancreaticoduodenectomy in a patient with a rare celiac trunk and hepatic artery anomaly, a case report from Syria

Abstract

Pancreaticoduodenectomy is still one of the biggest and high complicated surgeries. It still has high morbidity and mortality rates. liver receives its blood supply from one hepatic artery a branch of the celiac trunk However variations of hepatic and celiac trunk are not rare. We present a case of a 60-year-old patient who underwent pancreaticoduodenectomy for ampulla tumor in which there were some rear anomalies. Angiographic CT after procedure confirmed the absence of celiac trunk, the absence of left gastric, the splenic artery arising from aorta directly and common hepatic artery arising from superior mesenteric artery. These anomalies are not considered contraindication and should not be. with good surgical experience the procedure may be done safely giving the patient his last choice to fight the disease.

A rare variation of common hepatic artery identified during pancreaticoduodenectomy: a case report and literature review from Syria

“…In three out of eight cases 1 – 3 , the abnormalities weren’t detected until the surgical intervention.…”

“…During the surgery, the doctors encountered the absence of a clear coeliac trunk and a common hepatic artery. A postoperative CTA revealed a rare anomaly: both the coeliac trunk and LGA were absent, while the SA arose from the aorta, and the CHA arose straight from the SMA 1 . In the paper by Malki and colleagues, they reported a case of a 44-year-old female patient undergoing a PD for a mass in the neck and the body of the pancreas.…”

“…The liver is typically nourished by a single hepatic artery originating from the coeliac trunk. However, it’s important to note that this standard blood supply is applicable to only 50–60% of cases 1 . In ~1.5–4.0% of cases, the liver may receive its blood supply from the replaced common hepatic artery (RCHA), which emerges from the superior mesenteric artery (SMA) 2 .…”

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.…”