Document Detail

Preservation of an intra-pancreatic hepatic artery during duodenopancreatectomy for melanoma metastasis.
MedLine Citation:
PMID:  21221968     Owner:  NLM     Status:  Publisher    
We describe the case of a hepatic artery originating from a hepato-mesenteric trunk and traveling through the head of the pancreas, found preoperatively in a 44-year-old woman presenting two metachrone intra-pancreatic metastasis of a skin melanoma. Few cases with this anatomic variation have been found in the published literature consulted and this is the first case of duodenopancreatectomy for melanoma metastasis associated with this anatomic variant. In this patient, multidetector CT image with angiography and 3-D reconstruction demonstrated that the common hepatic artery arose from the superior mesenteric artery without any other arterial supply to the liver. Pancreatoduodenectomy with arterial conservation and without reconstruction was performed. Routine preoperative computerized tomographic angiography helps to recognize the hepatic vascular anatomy and thereby prepares the surgeon to better deal with at risk vascular variants intraoperatively. During pancreatic resection, every attempt should be made to preserve the variant hepatic vessels, particularly if they irrigate the entire liver. Increased alertness of the vascular anatomy would decrease the probability of intraoperative vascular injury and consequent postoperative complications such as biliary necrosis, biliary anastomotic leaks or hemorrhage.
David Moszkowicz; Frédérique Peschaud; Mostafa El Hajjam; Philipe Saiag; Bernard Nordlinger
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-1-9
Journal Detail:
Title:  Surgical and radiologic anatomy : SRA     Volume:  -     ISSN:  1279-8517     ISO Abbreviation:  -     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-1-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8608029     Medline TA:  Surg Radiol Anat     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Surgery, Ambroise Paré Hospital, Boulogne-Billancourt, France,
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