Variations in Origin of Gastroduodenal Artery: A Cadaveric Study.

Background: Gastroduodenal artery (GDA) is usually the first branch of the common hepatic artery from celiac trunk. In patients with chronic pancreatitis visceral artery aneurysms, incidence of up to 10% has been reported. The aneurysms occur most frequently in the splenic artery (10.4%); the common hepatic, gastroduodenal (1.5%), and pancreaticoduodenal arteries are affected. Material and Methods: It was a cross-sectional study conducted in the Department of General Surgery and Forensic Medicine, N.S.C.B. Medical College, Jabalpur during the period from August 2012 to August 2013. Abdomen of the cadaver will be accessed by the standard postmortem midline incision (sternum to pubes). Vascular anatomy of the GDA and vein will be dissected out in-situ using standard surgical instruments. The distance from the pylorus to the GDA will be measured by measuring tape. Results: In our study, out of total 31 cadavers, 19 (61.2%) were of male and 12 (38.8%) were of females. In all the cases, the site of origin of GDA is from the celiac axis of the common hepatic artery. Out of total 19 male cadavers, 17 (89%) showed a distance of 2.5-3 cm between pylorus and GDA and remaining 2 (11%) showed a distance of 3-3.5 cm. Conclusion: In our study, GDA has been seen arising from common hepatic artery from the celiac axis in 100% of cases. Previous studies have also given very less percentage of rare sites of origin but with the advent of newer modalities of investigations such as Doppler studies and computed tomography angiograms this very less percentage of rare variations can be diagnosed if there are knowledge and suspicion. This will help a lot to prevent major catastrophe during surgeries and radiological interventions.

Inferior Pancreatico-Duodenal Artery Pseudoneurysm - MDCT features.

Visceral artery aneurysms is a rare entity and should be managed timely due to their propensity to rupture and associated high mortality. We report a 49-year-old man, presented with a six-month history of persistent epigastric pain associated with indigestion, steatorrhea and weight loss. Ultrasonography (US) and Doppler US showed a cystic mass in the region of pancreatic head with turbulent flow, suggesting a Pseudoaneurysm supplied by the Superior mesenteric artery. Contrast-enhanced Multi Detector Computed Tomography (MDCT) revealed a large Pseudoaneurysm adjacent to the head of pancreas exerting a direct pressure over the head of the pancreas and duodenum. Non-selective abdominal MDCT angiography confirmed the aneurysm stemming from the inferior pancreatico-duodenal artery.

The display of the artery located at anterolateral region next to pancreatic head on enhanced CT and its clinical significance / 实用放射学杂志

Objective To observe the display and source of the artery located at anterolateral region next to pancreatic head on en-hanced CT,and to investigate its clinical value.Methods Imaging data of 200 consecutive patients who underwent abdominal CT scan were collected,and their CT images were analyzed.The reconstructed images were obtained at a post-processing workstation. After reconstruction,the display rate,source and branches of the artery located at anterolateral region next to pancreatic head were analyzed,and the diameters of these vessels were measured.Results The arterial vessel located at anterolateral region next to pan-creatic head was found on axial CT image in arterial phase with a display rate of 100%.By using post-reconstruction images,most vessels were gastroduodenal artery with mean diameter of 0.33 cm± 0.05 cm,and other ones were pancreaticoduodenal artery or right gastroomental artery.Conclusion The artery located at anterolateral region next to pancreatic head can be found on axial ab-dominal CT image in the arterial phase.Most vessels are gastroduodenal artery with a fixed position and traveling.

Damage control surgery in patient with delayed rupture of pseudoaneurysm after blunt abdominal trauma / 대한외과학회지

Delayed rupture of post-traumatic pseudoaneurysms of the visceral arteries, especially the pancreaticoduodenal artery, is uncommon. Here, we describe a 55-year-old man hemorrhaging from a pseudoaneurysm of the inferior pancreaticoduodenal artery (IPDA). Computed tomography of the abdomen showed active bleeding in the IPDA and large amounts of hemoperitoneum and hemoretroperitoneum. Selective mesenteric angiography showed that the pseudoaneurysm arose from the IPDA, and treatment by angioembolization failed because the involved artery was too tortuous to fit with a catheter. Damage control surgery with surgical ligation and pad packing was successfully performed. The patient had an uncomplicated postoperative course and was discharged 19 days after the operation. To our knowledge, this is the first report of ruptured pseudoaneurysm of an IPDA after blunt abdominal trauma from Korea.

Selective Embolization for Post-Endoscopic Sphincterotomy Bleeding: Technical Aspects and Clinical Efficacy

OBJECTIVE: The objective of this study was to evaluate the technical aspects and clinical efficacy of selective embolization for post-endoscopic sphincterotomy bleeding. MATERIALS AND METHODS: We reviewed the records of 10 patients (3%; M:F = 6:4; mean age, 63.3 years) that underwent selective embolization for post-endoscopic sphincterotomy bleeding among 344 patients who received arteriography for nonvariceal upper gastrointestinal bleeding from 2000 to 2009. We analyzed the endoscopic procedure, onset of bleeding, underlying clinical condition, angiographic findings, interventional procedure, and outcomes in these patients. RESULTS: Among the 12 bleeding branches, primary success of hemostasis was achieved in 10 bleeding branches (83%). Secondary success occurred in two additional bleeding branches (100%) after repeated embolization. In 10 patients, post-endoscopic sphincterotomy bleedings were detected during the endoscopic procedure (n = 2, 20%) or later (n = 8, 80%), and the delay was from one to eight days (mean, 2.9 days; +/- 2.3). Coagulopathy was observed in three patients. Eight patients had a single bleeding branch, whereas two patients had two branches. On the selective arteriography, bleeding branches originated from the posterior pancreaticoduodenal artery (n = 8, 67%) and anterior pancreaticoduodenal artery (n = 4, 33%), respectively. Superselection was achieved in four branches and the embolization was performed with n-butyl cyanoacrylate. The eight branches were embolized by combined use of coil, n-butyl cyanoacrylate, or Gelfoam. After the last embolization, there was no rebleeding or complication related to embolization. CONCLUSION: Selective embolization is technically feasible and an effective procedure for post-endoscopic sphincterotomy bleeding. In addition, the posterior pancreaticoduodenal artery is the main origin of the causative vessels of post-endoscopic sphincterotomy bleeding.

Retroperitoneal Hematoma Caused by Ruptured Pancreaticoduodenal Artery Aneurysm

A ruptured aneurysm of the pancreaticoduodenal arteries is an emergency condition, with a high mortality rate. Therefore, early diagnosis and adequate management are needed. Recently, treatment with a transcatheter arterial embolization has decreased the mortality rate. A 68-year-old man presented with persistent abdominal pain and dyspnea. Contrast abdominal computed tomography revealed a large retroperitoneal hematoma, with an actively bleeding focus. An urgent celiac and superior pancreaticoduodenal arteriogram showed a contrast extravasation, about 15 X 8 mm in size, with a saccular aneurysm of the distal anterior superior pancreaticoduodenal artery; therefore transcatheter arterial embolization was performed. The patient's condition improved without complication after the embolization.

Anterior Superior Pancreaticoduodenal Artery Aneurysm Rupture Associated with Abdominal Pain

Aneurysms of visceral arteries are an uncommon, but potentially lethal, forms of vascular disease. Aneurysms of the pancreaticoduodenal artery and its branches are extremely rare. Recognized causes include acute and chronic pancreatitis, a peptic ulcer, surgery, trauma and connective tissue disease. The major complication of a pancreaticoduodenal artery aneurysm is rupture, usually causing gastrointestinal bleeding and intraabdominal hemorrhage, with an associated high mortality. Angiography is necessary for the diagnosis and is the treatment of choice. We report an unusual case of an anterior superior pancreaticoduodenal artery aneurysm, associated with abdominal pain, that ruptured.

Vascular Anatomy of the Pancreaticoduodenal Region

PURPOSE: Duodenum-preserving pancreatic head resection (DPPHR) is a suitable surgical procedure in the treatment of benign pancreatic head tumor, chronic pancreatitis and low-grade malignancy of pancreatic head. The main advantage of this procedure is the preservation of the duodenum, which plays a key role in digestive functions. To create a practical guideline for vascular preservation during DPPHR, we examined the anatomy of pancreaticoduodenal arteries (PDA) by specimen angiography. METHODS: From March 2000 to September 2001, 9 specimens were obtained from patients undergoing pancreaticoduodenectomy. As soon as the specimens were obtained, 4 PDA were cannulated and specimen angiography was performed. RESULTS: Arcade formation between the superior and inferior PDA was found in all of the cases. The anterior inferior PDA and posterior inferior PDA exhibited common trunk formation. Many communicating arteries between both arcades were found. The papillary branch, originating from the posterior superior PDA, was found in 4 cases. CONCLUSION: To preserve the blood supply to the duodenum, complete preservation of both arteries may not be necessary. However, the preservation of the posterior superior PDA may be needed to maintain the blood supply of the papillary and distal bile ducts.