PMC3332186_01
(a) Preoperative arterial phase contrast-enhanced CT scan showing a 3.3 cm lesion in the body of the pancreas. (b) The coronary slice displays tumor infiltration of the celiac trunk, and the superior mesenteric artery is not involved.
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Subsequent contrast-enhanced computed tomography depicted a 3.3 cm lesion in the body of the pancreas with invasion of the celiac axis (Figure 1(a)).
(a) Embolization of the celiac axis with an 8 mm Amplatzer vascular plug 4. (b) The immediate angiographic control after embolization shows a collateral circulation from the superior mesenteric artery via the pancreatoduodenal arcades to the gastroduodenal artery. This ensures sufficient arterial flow to the right gastroepiploic artery (arrow) and the proper hepatic artery (arrowhead).
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Corp., Plymouth, MN USA) was placed in the common hepatic artery (Figure 2(a)). Completion angiograms of the celiac trunk and the superior mesenteric artery confirmed complete occlusion of the common hepatic artery and retrograde arterial perfusion of the liver and the stomach through the pancreatoduodenal arcade (Figure 2(b)).
Operative photograph taken after the removal of the specimen. 1: head of the pancreas, 2: portal vein, 3: superior mesenteric vein, 4: gastroduodenal artery, and 5: celiac axis stump.
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The body and tail of the pancreas, the spleen, the celiac axis, and the surrounding lymph nodes and nerve plexus were removed en bloc (Figure 3).
The postoperative arterial contrast-enhanced CT scan shows an excellent arterial flow to the hepatobiliary system via gastroduodenal artery and pancreatoduodenal arcades from the superior mesenteric artery.
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A postoperative CT scan revealed sufficient arterial flow of the hepatic arteries via the pancreatoduodenal arcades (Figure 4).