PMC7314924_01
MRI scan showing the tumor in pancreatic region in axial projection.
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AP, 941 U/L), transaminase (GPT, 472 U/L), and lipase (227 U/L). A MRCP and CT scan displayed intra- and extrahepatic cholestasis as well as a tumor in the pancreatic head region (Figure 1).
Upper panel: CT-angiography showing only a prominent Riolan anastomosis and possibly partly re-stenotic patch plastics of the celiac trunk and superior mesenteric artery; the red arrow points to a vessel that appears like a terminal branch of the gastroduodenal artery without any connection to the superior mesenteric artery; lower panel: virtual 3D-vascular and interactive reconstructions showing the Buhler anastomosis as connection between the superior mesenteric artery and the celiac trunk.
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Figure 2 shows the results of the two different visualization techniques. With the visualization depicted in Figure 2 (lower panel), a 360  representation is also possible. Figure 3 shows the 3D print derived from the reconstruction depicted in Figure 2 (lower panel) with the pancreas added.
3D print of the abdominal site clearly showing the Buhler anastomosis; the yellow structure in the background represents the tumor. Because of the lack of close relationship to the vessel, an oncological resection with preservation of the vascular connection was technically feasible.
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Figure 3 shows the 3D print derived from the reconstruction depicted in Figure 2 (lower panel) with the pancreas added.
The Buhler anastomosis can be surmised in the axial projection of the CT scan. The red arrow points to the vascular variant, the green one to the stent in the hepatic duct.
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