RESUMO
PURPOSE: To assess anatomical variations in the celiac trunk (Ct) in patients with Median Arcuate Ligament Syndrome (MALS) using computed tomography (CT). The primary objectives were to investigate the celiac trunk angle (CtA), origin level, length (CtL), and their relationships with the superior mesenteric artery (SMA) in MALS patients. Additionally, the study intended to evaluate gender differences in these parameters and explore correlations between variables. METHODS: Retrospectively, reports of abdominal CT scans taken between January 2018, and Sepmtember 2021, in the hospital image archive were screened vey two observers independently for MALS diagnosis. Parameters such as CtA, CtL, Ct-SMA distance, SMA angle (SMAA), and median arcuate ligament thickness (MALT) were measured. Statistical analyses were conducted using SPSS software. RESULTS: Among the 81 patients (25 females, 56 males), significant differences were observed in MALT between genders (p = 0.001). CtA showed a negative correlation with CtL and Ct-SMA (p < 0.001), and a positive correlation was found between CtL and Ct-SMA (p = 0.002). CtL was measured as 25 mm for the all group. Origin levels of Ct and SMA were evaluated in comparison to vertebral levels. Ct-SMA distance was relatively shorter (9.19 mm) compared to the literature. SMAA findings were consistent with normal population values. CONCLUSION: This study provided valuable insights into the anatomical parameters of the Ct ans SMA in MALS patients. Despite some differences compared to normal population parameters, no evidence supported the hypothesis of a superiorly placed Ct contributing to MALS.
Assuntos
Variação Anatômica , Artéria Celíaca , Síndrome do Ligamento Arqueado Mediano , Tomografia Computadorizada por Raios X , Humanos , Masculino , Feminino , Artéria Celíaca/diagnóstico por imagem , Artéria Celíaca/anormalidades , Síndrome do Ligamento Arqueado Mediano/diagnóstico por imagem , Estudos Retrospectivos , Adulto , Pessoa de Meia-Idade , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/anormalidades , Artéria Mesentérica Superior/anatomia & histologia , Idoso , Adulto Jovem , Fatores Sexuais , AdolescenteRESUMO
Most variations of the abdominal blood supply are related to branching of the coeliac trunk and superior mesenteric artery. This case details a remarkable variation in the branching pattern of the left colic artery (LCA) observed during routine cadaveric dissection of an 84-year-old male donor. An anomalous common trunk, originating from the common hepatic artery, gave rise to three branches: 1) an accessory posterior pancreaticoduodenal artery to the head of the pancreas and adjacent duodenum, 2) the dorsal pancreatic artery anastomosing with branches of the splenic artery, and 3) the LCA. The LCA descended between the splenic vein and superior mesenteric artery to supply the left colic flexure and form a collateral route with the middle colic artery by contributing to the marginal artery of Drummond. Knowledge of this variation is clinically relevant for surgical and radiological procedures in the abdomen.
Assuntos
Artéria Mesentérica Inferior , Pâncreas , Masculino , Humanos , Idoso de 80 Anos ou mais , Artéria Celíaca , Artéria Hepática/anormalidades , Artéria Mesentérica Superior/anormalidadesRESUMO
A common origin of the celiac trunk and superior mesenteric artery is exceedingly rare, and aneurysms of this common trunk are even rarer. According to our literature search, there are no reported cases of nutcracker syndrome or phenomenon involving this rare aneurysmal anomaly. Repair of such anomalies is standardly via open surgical approach with few reported cases of endovascular repair. We describe a patient with an aneurysm of the celiomesenteric trunk resulting in nutcracker phenomenon of the left renal vein. The celiomesenteric trunk aneurysm was repaired endovascularly, resulting in decreased surrounding inflammation and improvement of the left renal vein compression.
Assuntos
Aneurisma/complicações , Artéria Celíaca/anormalidades , Artéria Mesentérica Superior/anormalidades , Síndrome do Quebra-Nozes/etiologia , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Artéria Celíaca/diagnóstico por imagem , Artéria Celíaca/cirurgia , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/cirurgia , Pessoa de Meia-Idade , Síndrome do Quebra-Nozes/diagnóstico por imagem , Stents , Resultado do TratamentoRESUMO
RATIONALE: Splenic artery originating from the superior mesenteric artery is extremely rare. Because of this, its significance in laparoscopic distal pancreatectomy has never been reported. Here, we present the first case of laparoscopic distal pancreatectomy in a patient with a splenic artery arising from the superior mesenteric artery. PATIENT CONCERNS: A 46-year-old Japanese woman with type 2 diabetes mellitus presented with worsening glycemic control. Abdominal ultrasonography revealed a pancreatic tail mass. DIAGNOSES: The patient was diagnosed with pancreatic neuroendocrine tumor by endoscopic ultrasound-guided fine needle aspiration. Preoperative computed tomography showed that the splenic artery with branches of dorsal pancreatic artery originated from the superior mesenteric artery. INTERVENTIONS: The patient underwent laparoscopic distal pancreatectomy. Prior to pancreatectomy, the splenic artery and its dorsal pancreatic branches were clamped using the superior and inferior approaches, respectively, to avoid bleeding and congestion. OUTCOMES: The postoperative course was uneventful. LESSONS: Preoperative evaluation of anatomical variants and development of strategies are important to avoid intraoperative complications in pancreatic surgery. Our results revealed that laparoscopic distal pancreatectomy can be performed safely by strategic approach even in a patient with a rare aberrant splenic artery.
Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Laparoscopia/métodos , Pâncreas/irrigação sanguínea , Pancreatectomia/métodos , Artéria Esplênica/anormalidades , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Laparoscopia/efeitos adversos , Artéria Mesentérica Superior/anormalidades , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/cirurgia , Pâncreas/patologia , Pâncreas/cirurgia , Pancreatectomia/efeitos adversos , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgia , Artéria Esplênica/diagnóstico por imagem , Artéria Esplênica/lesões , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
PURPOSE: Annular pancreas encountered in adults and jejunal arterial variations are rare. Anatomical variations can cause conflicts between oncology and surgical safety. METHODS: Case report of a 68-year-old man suffering from vomiting because of an annular pancreas and a ductal adenocarcinoma of the pancreas head invading the second portion of the duodenum. RESULTS: Contrast-enhanced computed tomography showed multiple arterial variations describing the absence of the coeliac trunk such that the left gastric artery (LGA), splenic artery and superior mesenteric artery (SMA) were arising separately from the aorta. The accessory left hepatic artery arose from the LGA; and both the common hepatic artery and combined trunk of the replaced right hepatic artery with the higher replaced first jejunal artery separately arose close to the root of the SMA. The patient underwent curative pancreaticoduodenectomy which achieved 3 years of recurrence-free survival. CONCLUSION: This was an extraordinary case of annular pancreas with first jejunal arterial variation detailing an embryological interpretation as well as considerations for balancing short- and long-term outcomes.
Assuntos
Carcinoma Ductal Pancreático/cirurgia , Artéria Mesentérica Superior/anormalidades , Pâncreas/anormalidades , Pancreatopatias/diagnóstico , Neoplasias Pancreáticas/cirurgia , Idoso , Carcinoma Ductal Pancreático/complicações , Carcinoma Ductal Pancreático/patologia , Angiografia por Tomografia Computadorizada , Humanos , Imageamento Tridimensional , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/patologia , Pâncreas/irrigação sanguínea , Pâncreas/patologia , Pancreatopatias/complicações , Pancreatopatias/patologia , Neoplasias Pancreáticas/complicações , Pancreaticoduodenectomia/métodos , Resultado do TratamentoRESUMO
We found a variational case relating to the arteries distributed to the liver and pancreas during the routine cadaver dissection course. The common hepatic artery originated from the superior mesenteric artery as the first branch. The common hepatic artery was soon divided into the left and right hepatic arteries and distributed to the left and right lobe of the liver. The superior pancreaticoduodenal artery arose from the gastroduodenal artery, a branch of the left hepatic artery. The inferior pancreaticoduodenal artery originated from the superior mesenteric artery. Besides, two posterior branches of the right hepatic artery supplied the duodenum and the head of the pancreas. The arterial arcades were formed behind the head of the pancreas among the superior pancreaticoduodenal artery and these two posterior branches of the right hepatic artery. In conclusion, this case can be considered a rare case in which the replaced common hepatic artery and replaced right hepatic artery occurred simultaneously. The coexisting of these two replaced arteries suggests that the developmental processes to form these variations are independent.
Assuntos
Artéria Hepática/anormalidades , Artéria Mesentérica Superior/anormalidades , Idoso de 80 Anos ou mais , Humanos , MasculinoRESUMO
BACKGROUND: The celiac trunk (CT) commonly trifurcates into the left gastric artery, common hepatic artery (CHA), and splenic artery (SA). The CHA then sends off the proper hepatic artery and gastroduodenal artery (GDA). The arcades of the head of the pancreas are celiacomesenteric anastomoses between branches of the GDA and the superior mesenteric artery. A quadrifurcation of the CT commonly occurs when a different branch is added to the 3 normal ones. An uncommon quadrifurcation of the CT occurs when only one or 2 of the normal branches of the CT participate. METHODS: The CT quadrifurcations were documented on 112 computed tomography angiograms. RESULTS: Five different types of CT quadrifurcation-3 uncommon (types 1-3) and 2 common (types 4-5)-were found in 15/112 cases (13.39%). A marginal significant association was found between the presence of quadrifurcations and male gender (P = 0.05; Fisher's exact test). Type 1 showed a hepatogastric trunk+SA + right hepatic artery+GDA pattern, type 2 had an HGT + right inferior phrenic artery + CHA + SA pattern, type 3 had a gastrophrenic trunk + left inferior phrenic artery+CHA + SA pattern, type 4 showed an left gastric artery + CHA + SA + left inferior phrenic artery combination, and type 5 had an additional common inferior phrenic trunk. One of the type 4 cases showed a buildup of a mesentericomesenteric anastomotic pancreatic arcade between the inferior pancreaticoduodenal arteries, rather than a celiacomesenteric one. CONCLUSIONS: Anatomic variation of the celiacomesenteric axis is important during hepatobiliary and duodenopancreatic approaches. Therefore, preoperative evaluation is essential because theoretical anatomic possibilities could be real arterial variants.
Assuntos
Artéria Celíaca/anormalidades , Artéria Gástrica/anormalidades , Artéria Hepática/anormalidades , Artéria Mesentérica Superior/anormalidades , Artéria Esplênica/anormalidades , Malformações Vasculares/classificação , Artéria Celíaca/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Artéria Gástrica/diagnóstico por imagem , Artéria Hepática/diagnóstico por imagem , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Artéria Esplênica/diagnóstico por imagem , Malformações Vasculares/diagnóstico por imagemAssuntos
Dor Abdominal/etiologia , Dor Crônica/etiologia , Síndrome do Ligamento Arqueado Mediano/complicações , Artéria Mesentérica Superior/anormalidades , Artéria Esplênica/anormalidades , Malformações Vasculares/complicações , Dor Abdominal/diagnóstico , Adulto , Dor Crônica/diagnóstico , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Síndrome do Ligamento Arqueado Mediano/diagnóstico por imagem , Artéria Mesentérica Superior/diagnóstico por imagem , Medição da Dor , Artéria Esplênica/diagnóstico por imagem , Malformações Vasculares/diagnóstico por imagemAssuntos
Aneurisma/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Esplênica/diagnóstico por imagem , Feminino , Humanos , Artéria Mesentérica Superior/anormalidades , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Artéria Esplênica/anormalidadesRESUMO
We present our experience of incidence and management of aberrant hepatic arterial anatomy encountered during pancreaticoduodenectomy (PD). Patients undergoing PD between December 2014 and November 2016 at the Shaukat Khanum Memorial Cancer Hospital, Lahore were included in this short report. Preoperative imaging and operative findings of these patients were reviewed to evaluate the hepatic arterial anatomy and classified according to Hiatt classification. Sixty-four PD were performed with aberrant arterial anatomy identified in 24 (37.5%) of the cases. Most common anomaly was replaced right hepatic artery (rRHA) arising from the superior mesenteric artery seen in seven (11%) of the patients. Aberrant vessels were recognised and preserved in 23 cases. In one patient, the rRHA was coursing through the pancreatic parenchyma needing resection and reconstruction with uneventful postoperative recovery. Hepatic arterial anomalies are common and it is possible to preserve these vessels with careful surgical dissection using artery first technique.
Assuntos
Adenocarcinoma/cirurgia , Artéria Gástrica/anormalidades , Artéria Hepática/anormalidades , Artéria Mesentérica Superior/anormalidades , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Adenocarcinoma/complicações , Ampola Hepatopancreática , Variação Anatômica , Artéria Celíaca/anormalidades , Artéria Celíaca/anatomia & histologia , Artéria Celíaca/diagnóstico por imagem , Neoplasias Duodenais/complicações , Neoplasias Duodenais/cirurgia , Artéria Gástrica/anatomia & histologia , Artéria Gástrica/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/cirurgia , Artéria Hepática/anatomia & histologia , Artéria Hepática/diagnóstico por imagem , Humanos , Artéria Mesentérica Superior/anatomia & histologia , Artéria Mesentérica Superior/diagnóstico por imagem , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/cirurgia , Paquistão , Neoplasias Pancreáticas/complicações , Malformações Vasculares/classificação , Malformações Vasculares/complicações , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/epidemiologiaRESUMO
Visceral artery aneurysms are rare in infants and children. The majority of cases are caused by genetic syndromes, trauma, or infection. Although the majority of aneurysms are asymptomatic, visceral artery aneurysms can present with abdominal pain, nausea/vomiting, or rupture. Aneurysm rupture can manifest as hemodynamic instability and/or gastrointestinal bleeding. We present the case of a congenital idiopathic aneurysm of the superior mesenteric artery in a 6-week-old infant who presented with gastrointestinal bleeding. We report a stepwise surgical approach to achieving aneurysm exclusion and thrombosis, and highlight the robust mesenteric collateral circulation that can develop in pediatric patients.
Assuntos
Aneurisma/congênito , Hemorragia Gastrointestinal/etiologia , Artéria Mesentérica Superior/anormalidades , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/cirurgia , Humanos , Lactente , Ligadura , MasculinoRESUMO
We report an extremely rare case of splenic artery arising from hepatic artery proper in a patient with celiacomesenteric trunk variant. This anatomical variation was detected angiographically during hepatic mapping prior to transarterial radioembolization (TARE) for hepatocellular carcinoma in an 84-year-old man. TARE of hepatic tumors is one of the frequent procedures done by interventional radiologists. The identification of such rare vascular aberrations is of great importance not only in current interventional radiology procedures such as radioembolization but also in surgery and diagnostic radiology. To the best of our knowledge, this vascular variant is a novel discovery.
Assuntos
Variação Anatômica , Embolização Terapêutica/métodos , Artéria Hepática/anatomia & histologia , Artéria Esplênica/anatomia & histologia , Idoso de 80 Anos ou mais , Angiografia Digital , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/terapia , Artéria Celíaca/anormalidades , Artéria Hepática/diagnóstico por imagem , Humanos , Achados Incidentais , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Masculino , Artéria Mesentérica Superior/anormalidades , Artéria Esplênica/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Anatomic variations involving arterial supply of the large intestines are of clinical significance. Variations range from the pattern of origin, branching and territorial supply. The colon, the part of the large intestine, usually receives its arterial blood supply from branches of the superior and inferior mesenteric arteries. However, anatomic variation in this vascular arrangement has been reported, with vascular anatomy of the right colon being described as complex and more variable compared with the left colon. During routine cadaveric dissection of the supracolic and infracolic viscera, we encountered an additional mesenteric artery originating directly from the anterior surface of the abdominal aorta between the origins of the superior and inferior mesenteric arteries. This additional "inferior mesenteric artery" ran obliquely superiorly toward the left colon giving rise to two branches supplying the distal part of the ascending colon, the transverse colon and the proximal part of the descending colon. Awareness and knowledge of this anatomic variation are important for radiologists and surgeons to improve the quality of surgery and avoid both intra- and postoperative complications during surgical procedures of the colon.
Assuntos
Variação Anatômica , Colo/irrigação sanguínea , Artéria Mesentérica Inferior/anormalidades , Artéria Mesentérica Superior/anormalidades , Idoso de 80 Anos ou mais , Aorta Abdominal/anormalidades , Cadáver , Colo/cirurgia , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controleRESUMO
The superior mesenteric artery (SMA) provides vital blood supply to the midgut, and an acute abnormality can rapidly precipitate bowel ischemia and infarction and lead to morbidity and mortality. Vascular diseases that acutely compromise the SMA threaten its tributaries and include occlusion, dissection, aneurysm rupture, pseudoaneurysm, vasculitis, and SMA branch hemorrhage into the bowel. Emergency medicine physicians rely on the radiologist to identify SMA abnormalities, to characterize them, and to detail findings that guide the appropriate triage of these patients. As such, radiologists must be cognizant of the features that influence patient treatment to assist vascular surgeons and interventional radiologists in decision making. Some patients can be treated medically, while clinical and radiographic findings may suggest the need for interventional or surgical repair of the artery. In the latter case, multidetector CT findings aid in determining which of the various surgical and endovascular treatment options is optimal, and both vascular and gastrointestinal sequelae of acute SMA abnormalities contribute to these determinations. The authors review acute life-threatening conditions involving the SMA including acute occlusion, dissection, aneurysm, pseudoaneurysm, and hemorrhage and discuss the vascular and gastrointestinal multidetector CT findings in each of these conditions that help to guide surgical and interventional management. ©RSNA, 2019.
Assuntos
Artéria Mesentérica Superior/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Doenças Vasculares/diagnóstico por imagem , Aneurisma/diagnóstico por imagem , Aneurisma/terapia , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/terapia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Medicina de Emergência , Humanos , Artéria Mesentérica Superior/anormalidades , Artéria Mesentérica Superior/anatomia & histologia , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/terapia , Radiografia Intervencionista , Radiologistas , Doenças Vasculares/terapia , Vasculite/diagnóstico por imagem , Vasculite/terapiaAssuntos
Pâncreas/anormalidades , Pâncreas/cirurgia , Neoplasias Pancreáticas/cirurgia , Veia Porta/anormalidades , Idoso , Artéria Gástrica/anormalidades , Artéria Gástrica/diagnóstico por imagem , Humanos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Masculino , Artéria Mesentérica Superior/anormalidades , Artéria Mesentérica Superior/diagnóstico por imagem , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Ductos Pancreáticos/anormalidades , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/cirurgia , Fístula Pancreática/prevenção & controle , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia/métodos , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Veia Porta/cirurgia , Complicações Pós-Operatórias , Veia Esplênica/patologia , Veia Esplênica/cirurgia , Tomografia Computadorizada por Raios X/métodos , Neoplasias PancreáticasRESUMO
Splenic artery aneurysm with systemic lupus erythematosus is rare but serious. We report a case of a 45-year-old female with systemic lupus erythematosus who presented with a splenic artery aneurysm of anomalous origin from the superior mesenteric artery. This is the first time to report about using an endovascular approach to treat splenic artery aneurysm combined with systemic lupus erythematosus. Endovascular repair of the aneurysm was conducted using a covered stent and multiple coils to exclude both the aneurysm and total splenic artery embolization for treating thrombocytopenia, and this approach was determined to be safe and effective for yielding short-term results.
Assuntos
Aneurisma/terapia , Embolização Terapêutica , Procedimentos Endovasculares , Lúpus Eritematoso Sistêmico/complicações , Artéria Mesentérica Superior/anormalidades , Artéria Esplênica/anormalidades , Malformações Vasculares/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/etiologia , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Artéria Esplênica/diagnóstico por imagem , Stents , Trombocitopenia/etiologia , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagemRESUMO
PURPOSE: The arc of Bühler, an anastomotic vessel between celiac artery and superior mesenteric artery, is a rare anatomic variation. Various radiologic and surgical procedures can be affected by its existence. We aim to review all available information and identify possible clinical implications. METHODS: A systematic review was conducted in accordance to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. The following terms were utilized in various combinations: "Bühler", "arc of Bühler", "visceral aneurysm", "pancreaticoduodenal arcades". RESULTS: Only 53 cases have been described until today in the literature. The arc of Bühler enhances collateral circulation between celiac artery and superior mesenteric artery alongside with pancreaticoduodenal arcades and dorsal pancreatic artery. Computerized tomography and angiography are the main studies used for its detection and evaluation. Aneurysms of Bühler's arc have been rarely described and seem to share common pathophysiological mechanisms with aneurysms of the pancreaticoduodenal arcades. CONCLUSIONS: Various radiologic and surgical procedures such as embolization or pancreaticoduodenectomy are potentially affected by its existence.