Unexpected finding of arc of Buhler with celiac artery stenosis during workup for a suspected pancreatic lesion.

Knowledge about normal and pathological anatomical variants is a key point for all surgeons to perform safe procedures and manage unexpected findings. One example of this is vascular anomalies involving the celiac and superior mesenteric arteries (CA and SMA) and their anastomoses. During a routine workup of a suspected calcified pancreatic lesion, an asymptomatic arc of Buhler was found, connecting the CA and SMA, with 90% stenosis of the celiac trunk. This embryological variant, despite being a rare occurrence, has significance in various surgical procedures, including pancreatoduodenectomy, liver transplantation and interventional radiological procedures, such as gastroduodenal artery ligation and embolisation.

Spontaneous periduodenal hematoma: a rare surgical and radiological conundrum.

This is a case of a 68-year-old female with spontaneous and rare periduodenal hematoma of unknown origin without any signs or symptoms of duodenal stenosis. All causes of known precipitating factors, such as trauma, intervention, anticoagulation, pancreatitis or malignant processes, were ruled out. She was managed conservatively, with a series of radiological investigations performed throughout her 7-day admission to further define stability and investigate the possible cause for the periduodenal hemorrhage. A repeat magnetic resonance imaging 4 weeks later showed near resolution of the hematoma. The underlying cause in this case remains unclear.