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Uraoka M, Funamizu N, Sogabe K, Shine M, Honjo M, Tamura K, Sakamoto K, Ogawa K, Takada Y. Novel embryological classifications of hepatic arteries based on the relationship between aberrant right hepatic arteries and the middle hepatic artery: A retrospective study of contrast-enhanced computed tomography images. PLoS One 2024; 19:e0299263. [PMID: 38416748 PMCID: PMC10901311 DOI: 10.1371/journal.pone.0299263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/06/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Variations in hepatic arteries are frequently encountered during pancreatoduodenecomy. Identifying anomalies, especially the problematic aberrant right hepatic artery (aRHA), is crucial to preventing vascular-related complications. In cases where the middle hepatic artery (MHA) branches from aRHAs, their injury may lead to severe liver ischemia. Nevertheless, there has been little information on whether MHA branches from aRHAs. This study aimed to investigate the relationship between aRHAs and the MHA based on the embryological development of visceral arteries. METHODS This retrospective study analyzed contrast-enhanced computed tomography images of 759 patients who underwent hepatobiliary-pancreatic surgery between January 2011 and August 2022. The origin of RHAs and MHA courses were determined using three-dimensional reconstruction. All cases of aRHAs were categorized into those with or without replacement of the left hepatic artery (LHA). RESULTS Among the 759 patients, 163 (21.4%) had aRHAs. Five aRHAs patterns were identified: (Type 1) RHA from the gastroduodenal artery (2.7%), (Type 2) RHA from the superior mesenteric artery (SMA) (12.7%), (Type 3) RHA from the celiac axis (2.1%), (Type 4) common hepatic artery (CHA) from the SMA (3.5%), and (Type 5) separate branching of RHA and LHA from the CHA (0.26%). The MHA did not originate from aRHAs in Types 1-3, whereas in Type 4, it branched from either the RHA or LHA. CONCLUSIONS Based on the developmental process of hepatic and visceral arteries, branching of the MHA from aRHAs is considered rare. However, preoperative recognition and intraoperative anatomical assessment of aRHAs is essential to avoid injury.
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Affiliation(s)
- Mio Uraoka
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Naotake Funamizu
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Kyosei Sogabe
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Mikiya Shine
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Masahiko Honjo
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Kei Tamura
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Katsunori Sakamoto
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Kohei Ogawa
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
| | - Yasutsugu Takada
- Department of Hepatobiliary-Pancreatic Surgery and Breast Surgery, Ehime University Hospital, Shitsukawa Toon City, Ehime, Japan
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Hvizdosova N, Vecanova J, Vrzgula M, Hodorova I. Atypical variable origins of the left inferior phrenic artery and left gastric artery. BRATISL MED J 2024; 125:55-58. [PMID: 38041847 DOI: 10.4149/bll_2024_010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
OBJECTIVES The current report describes the combined unusual origin of the left inferior phrenic and left gastric arteries observed during a routine dissection of the upper abdominal region. BACKGROUND The branches of the abdominal aorta are important vessels that supply blood to various organs and structures in the abdominal cavity. While there is typically a common pattern of branching, anatomical variations can occur, leading to differences in the branching patterns of the abdominal aorta. METHODS An accidental finding in an 80-year-old male cadaver within anatomical dissection was assessed. RESULTS We observed that the left inferior phrenic artery originated from the celiac trunk and gives off middle and superior suprarenal arteries, while the left gastric artery arose from the abdominal aorta independently. CONCLUSION The identification of anatomic vascular abnormalities of the abdominal aorta and its branches is clinically important in surgical and invasive arterial procedures and preoperative knowledge of vascular anomalies should prevent iatrogenic vascular trauma and complications during surgery (Fig. 3, Ref. 14).
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Tekinhatun M, Alver KH. Bilateral pulmonary sequestrations: Distinct types sharing a common celiac artery origin, presented with pneumonia and associated findings in a pediatric case. Pediatr Pulmonol 2024; 59:218-220. [PMID: 37877734 DOI: 10.1002/ppul.26735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/01/2023] [Accepted: 10/14/2023] [Indexed: 10/26/2023]
Abstract
A 14-year-old boy presented with shortness of breath, cough, and mild chest pain, with a history of intermittent milder symptoms. Physical examination and initial tests showed mild iron deficiency anemia, elevated C-reactive protein, and normal vital signs. Chest radiograph revealed abnormalities in the left lower zone, leading to contrast-enhanced chest CT. The CT scan revealed bilateral intrapulmonary sequestrations, both deriving blood supply from a common trunk originating from the celiac artery. The patient's symptoms initially attributed to a pulmonary infection improved with antibiotic therapy. Pulmonary sequestration is a congenital anomaly characterized by aberrant lung tissue lacking connections to bronchial tree or pulmonary arteries. It can lead to recurrent pulmonary infections and postinfectious sequelae. This case presented a unique bilateral sequestration, both originating from the celiac artery. Radiologists should be aware of sequestration types and associated anomalies, even in atypical locations. Blood supply can originate from various arteries, not just the aorta.
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Affiliation(s)
| | - Kadir Han Alver
- Radiology Department, Denizli State Hospital, Denizli, Turkey
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Rossi UG, Ierardi AM, Cariati M. The anatomic variant of common celiacomesenteric trunk. Rev Gastroenterol Mex (Engl Ed) 2020; 85:86-87. [PMID: 31810780 DOI: 10.1016/j.rgmx.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 06/10/2023]
Affiliation(s)
- U G Rossi
- Departamento de Imagen Diagnóstica, Unidad de Radiología Intervencionista, E.O. Hospital Galliera, Génova, Italia; Departamento de Diagnóstico y Terapia de Tecnología Avanzada, Hospital San Carlo Borromeo, Milán, Italia.
| | - A M Ierardi
- Departamento de Radiología Diagnóstica e Intervencionista, Universidad de Milán, Milán, Italia; Unidad de Radiología y de Radiología Intervencionista, ASST Santi Paolo y Carlo, Hospital San Paolo, Milán, Italia
| | - M Cariati
- Departamento de Diagnóstico y Terapia de Tecnología Avanzada, Hospital San Carlo Borromeo, Milán, Italia
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Sánchez AM, Tortorelli AP, Caprino P, Rosa F, Menghi R, Quero G, Doglietto GB, Alfieri S. Incidence and Impact of Variant Celiacomesenteric Vascularization and Vascular Stenosis on Pancreatic Surgery Outcomes: Personal Experience. Am Surg 2018; 84:181-187. [PMID: 29580343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ischemic complications after pancreatic surgery can raise postoperative mortality from 4 to 83 per cent. Variants in vascular anatomy play a major role in determining such complications, but they have been only occasionally reported in the literature. We retrospectively analyzed 100 records of patients consecutively treated between January 2011 and December 2013 for resectable malignant diseases who underwent pancreaticoduodenectomy (PD) or total pancreatectomy to state the statistical impact of anatomical vascular variations in surgical outcomes (mean surgical timing, mean blood loss during surgery, and postoperative major complications onset) and to state whether preoperatively undetected vascular anomalies (VA) can raise the risk of postoperative ischemic complications. PD was performed in 89 patients, requiring multiorgan resections in three cases and total pancreatectomy was performed in 11 cases, which was associated to splenectomy in four patients. Incidence of VA was 25/100 (25%), whereas in 18/25 cases (72%) they were detected by preoperative radiologic setting. Their presence in patients undergoing PD significantly raised mean surgical timing (P = 0.003) and increased mean blood loss (P < 0.0001). Preoperatively undetected VA resulted in a major risk of postoperative acute liver ischemia (P = 0.008). Celiacomesenteric aberrant anatomy was proven to be related to an increased risk of intraoperative complications. If undetected preoperatively, they can be associated with anastomotic complications and liver failure. Maximal efforts must be done to detect and to preserve vascular anatomy of celiacomesenteric district.
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Affiliation(s)
- Alejandro M Sánchez
- Digestive Surgery Unit, Department of Surgical Sciences, Catholic University School of Medicine, Rome, Italy
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Yuan H, Wu P, Chen J, Lu Z, Chen L, Wei J, Guo F, Cai B, Yin J, Xu D, Jiang K, Miao Y. Radical antegrade modular pancreatosplenectomy for adenocarcinomaof the body of the pancreas in a patient with portal annular pancreas, aberrant hepatic artery, and absence of the celiac trunk: A case report. Medicine (Baltimore) 2017; 96:e8738. [PMID: 29310347 PMCID: PMC5728748 DOI: 10.1097/md.0000000000008738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Portal annular pancreas is a rare anatomic variation, where the uncinated process of the pancreas connects with the dorsal pancreas and the pancreas tissue encases the portal vein (PV), superior mesenteric vein (SMV) or splenic vein (SV). Malignancies are quite uncommon in the patients, who have an annular pancreas especially portal annular pancreas. Ectopic common hepatic artery and absence of the celiac trunk (CT) are the other infrequent abnormalities. PATIENT CONCERNS A 74-year-old man suffered from upper abdominal and back pain. DIAGNOSES AND INTERVENTIONS Contrast enhanced computed tomography indicated a low-density mass in the body of the pancreas. Pathological report showed adenocarcinoma of the body of pancreas after radical antegrade modular pancreatosplenectomy (RAMPS). OUTCOMES In the operation, we found the superior vein and portal vein was surrounded by the pancreatic tissue. The left gastric artery and splenic artery originated respectively from abdominal aorta, and celiac trunk was not viewed. In addition, the common hepatic artery was a branch from the superior mesenteric artery. LESSONS In general, this is a novel clinical case of pancreatic carcinoma happening in the portal annular pancreas which was accompanied with aberrant hepatic artery and absence of the celiac trunk at the same time. Confronted with the pancreatic neoplasms, the possibility of coexistent annular pancreas and arterial variations should be considered.
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Affiliation(s)
- Hao Yuan
- Department of General Surgery, Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute of Nanjing Medical University, Nanjing, People's Republic of China
| | - Pengfei Wu
- Department of General Surgery, Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jianmin Chen
- Department of General Surgery, Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute of Nanjing Medical University, Nanjing, People's Republic of China
| | - Zipeng Lu
- Department of General Surgery, Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute of Nanjing Medical University, Nanjing, People's Republic of China
| | - Lei Chen
- Department of General Surgery, Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jishu Wei
- Department of General Surgery, Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute of Nanjing Medical University, Nanjing, People's Republic of China
| | - Feng Guo
- Department of General Surgery, Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute of Nanjing Medical University, Nanjing, People's Republic of China
| | - Baobao Cai
- Department of General Surgery, Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jie Yin
- Department of General Surgery, Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute of Nanjing Medical University, Nanjing, People's Republic of China
| | - Dong Xu
- Department of General Surgery, Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute of Nanjing Medical University, Nanjing, People's Republic of China
| | - Kuirong Jiang
- Department of General Surgery, Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute of Nanjing Medical University, Nanjing, People's Republic of China
| | - Yi Miao
- Department of General Surgery, Pancreas Center, The First Affiliated Hospital of Nanjing Medical University
- Pancreas Institute of Nanjing Medical University, Nanjing, People's Republic of China
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Ozgokce M, Ayyildiz V, Ogul H. An uncommon variation of the coeliac trunk in an adult patient with a splenic infarct : computed tomography angiography findings. Acta Gastroenterol Belg 2017; 80:331-333. [PMID: 29560707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Mesut Ozgokce
- Department of Radiology, Van Regional Training and Research Hospital, Van, Turkey
| | - Veysel Ayyildiz
- Department of Radiology, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Hayri Ogul
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
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Guilbaud T, Ewald J, Turrini O, Delpero JR. Pancreaticoduodenectomy: Secondary stenting of the celiac trunk after inefficient median arcuate ligament release and reoperation as an alternative to simultaneous hepatic artery reconstruction. World J Gastroenterol 2017; 23:919-925. [PMID: 28223737 PMCID: PMC5296209 DOI: 10.3748/wjg.v23.i5.919] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 10/29/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
In patients undergoing pancreaticoduodenectomy (PD), unrecognized hemodynamically significant celiac axis (CA) stenosis impairs hepatic arterial flow by suppressing the collateral pathways supplying arterial flow from the superior mesenteric artery and leads to serious hepatobiliary complications due to liver and biliary ischemia, with a high rate of mortality. CA stenosis is usually due to an extrinsic compression by a previously asymptomatic median arcuate ligament (MAL). MAL is diagnosed by computerized tomography in about 10% of the candidates for PD, but only half are found to be hemodynamically significant during the gastroduodenal artery clamping test with Doppler assessment, which is mandatory before any resection. MAL release is usually efficient to restore an adequate liver blood inflow and prevent ischemic complications. In cases of failure in MAL release, postponed PD with secondary stenting of the CA and reoperation for PD should be considered as an alternative to immediate hepatic artery reconstruction, which involves the risk of postoperative thrombosis of the arterial reconstruction. We recently used this two-stage strategy in a patient undergoing surgery for pancreatic adenocarcinoma.
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9
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Dăescu E, Sztika D, Lăpădatu AA, Zăhoi DE. Rare variant of celiac trunk branching pattern associated with modifications of hepatic arterial vascularization. Rom J Morphol Embryol 2017; 58:969-975. [PMID: 29250676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The routine dissection of a male body revealed multiple anatomical variations of the celiac trunk and hepatic artery vascularization. The origin of the celiac trunk was on the left side of the abdominal aorta, next to the T12-L1 intervertebral disk. The celiac trunk gave off five branches: the left inferior phrenic artery, the left gastric artery, the accessory right hepatic artery, the common hepatic artery and the splenic artery (the last two arteries had a common origin in a hepatosplenic trunk). A right branch detached off the left gastric artery and anastomosed with the hepatic artery proper. The proper hepatic artery also anastomosed with the accessory right hepatic artery at the same level. Consequently, the entire hepatic arterial supply was from the celiac trunk - through two arteries directly and a third via the left gastric artery. The anatomical variant described in this case can be considered very rare. Thorough knowledge of such variants is important both for upper abdominal surgery and for imagistic and interventional radiology.
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Affiliation(s)
- Ecaterina Dăescu
- Department of Anatomy and Embryology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania;
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Fiorucci B, Tsilimparis N. Fenestrated Endovascular Aneurysm Repair of a Stent Graft-induced New Entry Tear in a Patient with a Celiacomesenteric Trunk. Eur J Vasc Endovasc Surg 2016; 53:184. [PMID: 27890523 DOI: 10.1016/j.ejvs.2016.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/28/2016] [Indexed: 11/17/2022]
Affiliation(s)
- B Fiorucci
- Department of Vascular Medicine, German Aortic Center, Hamburg, Germany; Unit of Vascular Surgery, Ospedale S. Maria della Misericordia, University of Perugia, Perugia, Italy.
| | - N Tsilimparis
- Department of Vascular Medicine, German Aortic Center, Hamburg, Germany
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11
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Long Q, Zha Y, Yang Z. Evaluation of pulmonary sequestration with multidetector computed tomography angiography in a select cohort of patients: A retrospective study. Clinics (Sao Paulo) 2016; 71:392-8. [PMID: 27464296 PMCID: PMC4946534 DOI: 10.6061/clinics/2016(07)07] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/14/2016] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the role of multidetector computed tomography angiography in diagnosing patients with pulmonary sequestration. METHODS We retrospectively analyzed the computed tomography studies and clinical materials of 43 patients who had undergone preoperative multidetector computed tomography angiography in our hospital and had pathologically proven pulmonary sequestration. Each examination of pulmonary sequestration was reviewed for type, location, parenchymal changes, arterial supply and venous drainage on two-dimensional and three-dimensional computed tomography images. RESULTS Multidetector computed tomography successfully detected all pulmonary sequestrations in the 43 patients (100%). This included 40 patients (93.0%) with intralobar sequestration and 3 patients (7.0%) with extralobar sequestration. The locations of pulmonary sequestration were left lower lobe (28 cases, 70% of intralobar sequestrations), right lower lobe (12 cases, 30% of intralobar sequestrations) and costodiaphragmatic sulcus (3 cases). Cases of sequestered lung presented as mass lesions (37.2%), cystic lesions (32.6%), pneumonic lesions (16.3%), cavitary lesions (9.3%) and bronchiectasis (4.6%). The angioarchitecture of pulmonary sequestration, including feeding arteries from the thoracic aorta (86.1%), celiac truck (9.3%), abdominal aorta (2.3%) and left gastric artery (2.3%) and venous drainage into inferior pulmonary veins (86.0%) and the azygos vein system (14.0%), was visualized on multidetector computed tomography. Finally, the multidetector computed tomography angiography results of the sequestered lungs and angioarchitectures were surgically confirmed in all the patients. CONCLUSIONS As a noninvasive modality, multidetector computed tomography angiography is helpful for making diagnostic decisions regarding pulmonary sequestration with high confidence and for visualizing the related parenchymal characteristics, arterial supply, and venous drainage features to help plan surgical strategies.
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Affiliation(s)
- Qihua Long
- Renmin Hospital of Wuhan University, Department of Radiology, Wuhan, China
- #Contributed equally to this work
| | - Yunfei Zha
- Renmin Hospital of Wuhan University, Department of Radiology, Wuhan, China
- #Contributed equally to this work
| | - Zhigang Yang
- Sichuan University, West China Hospital, Department of Radiology, Chengdu, China
- E-mail:
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Mak GZ, Lucchetti AR, Drossos T, Fitzsimmons-Craft EE, Accurso EC, Stiles-Shields C, Newman EA, Skelly CL. Pediatric Chronic Abdominal Pain and Median Arcuate Ligament Syndrome: A Review and Psychosocial Comparison. Pediatr Ann 2016; 45:e257-64. [PMID: 27403674 DOI: 10.3928/00904481-20160613-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chronic abdominal pain (CAP) occurs in children and adolescents with a reported prevalence of 4% to 41% with significant direct and indirect costs to the child, family, and society. Median arcuate ligament syndrome (MALS) is a vascular compression syndrome of the celiac artery that may cause symptoms of epigastric pain and weight loss and is a frequently overlooked cause of CAP in the pediatric population. We have observed that the psychosocial presentation of patients with MALS is notable for various psychiatric comorbidities. In this article, we review MALS as well as our study results of the psychosocial profile of 30 MALS patients. Our data suggest that children and adolescents with MALS have similar psychosocial profiles to children with other gastrointestinal disorders resulting in CAP. The overlap of physical and psychosocial symptoms of patients who have MALS with other CAP disorders leads us to recommend that patients with CAP should be evaluated for MALS. [Pediatr Ann. 2016;45(7):e257-e264.].
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Abstract
Superior mesenteric artery and pancreaticoduodenal artery aneurysms are rare. Agenesis of the celiac axis has only been reported four times. The reported etiologies of superior mesenteric artery and branch artery aneurysms include infection, atherosclerosis, inflammatory processes such as pancreatitis, dissection, collagen vascular disorders, polyarteritis nodosa, and trauma. We report an aneurysm of the superior mesenteric artery (SMA) branch, the inferior pancreaticoduodenal artery, arising in a patient with congenital absence of the celiac trunk. The patient presented with intermittent left upper quadrant pain without weight loss or change in bowel habits. The aneurysm was identified on abdominal computed tomography scan with angiographic confirmation of the aberrant anatomy. The patient was treated by aneurysmectomy and pancreaticoduodenal artery reconstruction with an interposition vein graft from the SMA. The patient recovered without complications and is asymptomatic with a patent vein graft 2 years after operation.
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Affiliation(s)
- Peter J Armstrong
- Section of Vascular Surgery, Geisinger Medical Center, Danville, PA,
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Akan D, Ozel A, Orhan O, Bozdag E, Basak M. Doppler ultrasound diagnosis of an unusual variant of median arcuate ligament syndrome: concomitant involvement of celiac and superior mesenteric arteries. A case report. Med Ultrason 2015; 17:557-560. [PMID: 26649356 DOI: 10.11152/mu.2013.2066.174.ppd] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome is a rare condition characterized by chronic mesenteric ischemia, secondary to the compression of the celiac artery by the median arcuate ligament. Occasionally, in addition to the celiac artery, the superior mesenteric artery may be partially compressed by the median arcuate ligament. We report a case with complaints of chronic abdominal pain from compression of both the celiac artery and the superior mesenteric artery due to MALS, which was primarily detected by Doppler ultrasound. The diagnosis was confirmed with CT-angiography.
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Affiliation(s)
- Deniz Akan
- Sisli Hamidiye Etfal Training and Research Hospital, Department of Radiology, Istanbul.
| | - Alper Ozel
- Sisli Hamidiye Etfal Training and Research Hospital, Department of Radiology, Istanbul
| | - Ozge Orhan
- Bingol State Hospital, Department of Radiology, Bingol, Turkey
| | - Emre Bozdag
- Sisli Hamidiye Etfal Training and Research Hospital, Department of General Surgery, Istanbul, Turkey
| | - Muzaffer Basak
- Sisli Hamidiye Etfal Training and Research Hospital, Department of Radiology, Istanbul
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Huang Y, Mu GC, Qin XG, Chen ZB, Lin JL, Zeng YJ. Study of celiac artery variations and related surgical techniques in gastric cancer. World J Gastroenterol 2015; 21:6944-6951. [PMID: 26078572 PMCID: PMC4462736 DOI: 10.3748/wjg.v21.i22.6944] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/03/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate celiac artery variations in gastric cancer patients and the impact on gastric cancer surgery, and also to discuss the value of the ultrasonic knife in reducing the risk caused by celiac artery variations.
METHODS: A retrospective analysis was conducted to investigate the difference in average operation time, intraoperative blood loss, number of harvested lymph nodes, average postoperative drainage within 3 d, and postoperative hospital stay between the group with vascular variations and no vascular variations, and between the ultrasonic harmonic scalpel and conventional electric scalpel surgery group.
RESULTS: One hundred and fifty-eight cases presented with normal celiac artery, and 80 presented with celiac artery variation (33.61%). The average operation time, blood loss, average drainage within 3 d after surgery in the celiac artery variation group were significantly more than in the no celiac artery variation group (215.7 ± 32.7 min vs 204.2 ± 31.3 min, 220.0 ± 56.7 mL vs 163.1 ± 52.3 mL, 193.6 ± 41.4 mL vs 175.3 ± 34.1 mL, respectively, P < 0.05). In celiac artery variation patients, the average operation time, blood loss, average drainage within 3 d after surgery in the ultrasonic harmonic scalpel group were significantly lower than in the conventional electric scalpel surgery group (209.5 ± 34.9 min vs 226.9 ± 29.4 min, 207.5 ± 57.1 mL vs 235.6 ± 52.9 mL, 184.4 ± 38.2 mL vs 205.0 ± 42.9 mL, respectively, P < 0.05), and the number of lymph node dissections was significantly higher than in the conventional surgery group (25.5 ± 9.2 vs 19.9 ± 7.8, P < 0.05).
CONCLUSION: Celiac artery variation increases the difficulty and risk of radical gastrectomy. Preoperative imaging evaluation and the application of ultrasonic harmonic scalpel are conducive to radical gastrectomy.
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Arazińska A, Polguj M, Wojciechowski A, Trębiński Ł, Stefańczyk L. An unusual case of left renal artery compression: a rare type of median arcuate ligament syndrome. Surg Radiol Anat 2015; 38:379-82. [PMID: 25940812 PMCID: PMC4823334 DOI: 10.1007/s00276-015-1478-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/25/2015] [Indexed: 11/28/2022]
Abstract
Compression from median arcuate ligament was observed during multidetector 64-row computed tomography in a Caucasian 30-year-old female. The patient was referred for examination to exclude anatomical pathologies causing hypertension. The examination demonstrated that left renal artery, which had its origin in the chest (at the level of upper one-third of Th12), was compressed as it passed by median arcuate ligament of the diaphragm. In addition, aortic compression and kinked shape was also revealed.
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Affiliation(s)
- Agata Arazińska
- Department of Radiology, Medical University of Łódź, Kopcińskiego 22, 90-153, Lodz, Poland
| | - Michał Polguj
- Department of Angiology, Medical University of Łódź, Narutowicza 60, 90-136, Lodz, Poland.
| | - Andrzej Wojciechowski
- Department of Radiology, Medical University of Łódź, Kopcińskiego 22, 90-153, Lodz, Poland
| | - Łukasz Trębiński
- Department of Radiology, Medical University of Łódź, Kopcińskiego 22, 90-153, Lodz, Poland
| | - Ludomir Stefańczyk
- Department of Radiology, Medical University of Łódź, Kopcińskiego 22, 90-153, Lodz, Poland
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17
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Demelo-Rodríguez P, Marcelo-Ayala A, González-Benítez RD. Clinical images in gastroenterology. Median arcuate ligament syndrome. Rev Gastroenterol Mex 2015; 80:163-164. [PMID: 25823773 DOI: 10.1016/j.rgmx.2014.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 10/31/2014] [Accepted: 12/16/2014] [Indexed: 06/04/2023]
Affiliation(s)
- P Demelo-Rodríguez
- Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - A Marcelo-Ayala
- Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - R D González-Benítez
- Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España
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18
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Duckheim M, Geisler T, Zuern CS, Gawaz M. A patient presenting with stress-induced epigastric pain. BMJ Case Rep 2015; 2015:bcr-2014-207799. [PMID: 25678616 DOI: 10.1136/bcr-2014-207799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The median arcuate ligament passes the truncus coeliacus superior to its ostium. If it is thickened and located too low, it can cause external compression and stenosis of the truncus coeliacus, leading to postprandial abdominal pain and vomiting. This combination of symptoms is called median arcuate ligament syndrome. We report the case of a 79-year-old patient who suffered from chronic epigastric pain, which was initially assumed to be caused by either coronary artery disease or atherosclerotic stenosis of the coeliac artery. Angiography excluded coronary artery disease, but showed severe external stenosis of the truncus. The patient underwent laparoscopic release of the median arcuate ligament, which resulted in relief of his symptoms. The median arcuate ligament syndrome should be considered in patients with epigastric stress-induced pain. Further underlying pathologies, especially coronary artery disease, as life-threatening diagnosis have to be initially excluded.
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Affiliation(s)
- Martin Duckheim
- Abteilung für Kardiologie und Kreislauferkrankungen, Universitätsklinik Tübingen, Tübingen, Germany
| | - Tobias Geisler
- Abteilung für Kardiologie und Kreislauferkrankungen, Universitätsklinik Tübingen, Tübingen, Germany
| | - Christine Stefanie Zuern
- Abteilung für Kardiologie und Kreislauferkrankungen, Universitätsklinik Tübingen, Tübingen, Germany
| | - Meinrad Gawaz
- Abteilung für Kardiologie und Kreislauferkrankungen, Universitätsklinik Tübingen, Tübingen, Germany
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19
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Thoolen SJJ, van der Vliet WJ, Kent TS, Callery MP, Dib MJ, Hamdan A, Schermerhorn ML, Moser AJ. Technique and outcomes of robot-assisted median arcuate ligament release for celiac artery compression syndrome. J Vasc Surg 2015; 61:1278-84. [PMID: 25600337 DOI: 10.1016/j.jvs.2014.10.084] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 10/22/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Celiac artery compression by the median arcuate ligament (MAL) is a potential cause of postprandial abdominal pain and weight loss that overlaps with other common syndromes. Robotic technology may alter the current paradigm for surgical intervention. Open MAL release is often performed with concurrent bypass for celiac stenosis due to the morbidity of reintervention, whereas the laparoscopic approach is associated with high rates of conversion to open due to bleeding. We hypothesized that a robot-assisted technique might minimize conversion events to open, decrease perioperative morbidity, and defer consideration of vascular bypass at the initial operative setting. METHODS We retrospectively analyzed patients treated for MAL syndrome by a multidisciplinary team at a tertiary medical center between September 2012 and December 2013. Diagnosis was based on symptom profile and peak systolic velocity (PSV) >200 cm/s during celiac artery duplex ultrasound imaging. All patients underwent robot-assisted MAL release with simultaneous circumferential neurolysis of the celiac plexus. Postoperative celiac duplex and symptom profiles were reassessed longitudinally to monitor outcomes. RESULTS Nine patients (67% women) were evaluated for postprandial pain (100%) and weight loss (100%). All patients had celiac stenosis by mesenteric duplex ultrasound imaging (median PSV, 342; range, 238-637 cm/s), and cross-sectional imaging indicated a fishhook deformity in five (56%). Robot-assisted MAL release was completed successfully in all nine patients (100%) using a standardized surgical technique. Estimated blood loss was <50 mL, with a median hospital stay of 2 days (range, 2-3 days). No postoperative complications of grade ≥3, readmissions or reoperations were observed. All patients (100%) improved symptomatically at the 25-week median follow-up. Three patients experienced complete resolution on postoperative celiac duplex ultrasound imaging, and six patients showed an improved but persistent stenosis (PSV >200 cm/s) compared with preoperative velocities (P < .05 by Wilcoxon signed rank). No patients required additional treatment. CONCLUSIONS Robot-assisted MAL release can be performed safely and effectively with avoidance of conversion events and minimal morbidity. Potential factors contributing to success are patient selection by a multidisciplinary team and replication of the open surgical technique by means of robot-assisted dexterity and visualization. The need for delayed reintervention for persistently symptomatic celiac stenosis is uncertain.
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Affiliation(s)
- Stijn J J Thoolen
- Institute for Hepatobiliary and Pancreatic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Walderik J van der Vliet
- Institute for Hepatobiliary and Pancreatic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Tara S Kent
- Institute for Hepatobiliary and Pancreatic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Mark P Callery
- Institute for Hepatobiliary and Pancreatic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Martin J Dib
- Institute for Hepatobiliary and Pancreatic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Allen Hamdan
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - A James Moser
- Institute for Hepatobiliary and Pancreatic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
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Daraghmeh A, Feldman D, Barbat J, Zughaib M. Ectopic right renal artery originating from anomalous common celio-mesenteric trunk: multifaceted imaging approach. Tex Heart Inst J 2015; 41:673-4. [PMID: 25593541 DOI: 10.14503/thij-13-3453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Romero ME, Alcaraz Á, Saleg P, Roussy Otero G, Moser F, Eynard HG. [Celiac trunk compression syndrome by the median arcuate ligament. Laparoscopic approach]. Medicina (B Aires) 2015; 75:169-172. [PMID: 26117608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Median arcuate ligament syndrome (MALS), or celiac trunk compression syndrome, is caused by extrinsic compression of median arcuate ligament, prominent fibrous bands and periaortic nodal tissue. In many cases is asymptomatic, but it may manifests with symptoms such as postprandial abdominal pain or during exercise, nauseas, vomiting and weight loss. Trough less invasive diagnostic techniques, such as doppler ultrasound for screening and preoperative angiotomograhpy, it is possible to obtain good results, comparable to those with arteriography. Surgical treatment by laparoscopic approach is a safe and effective technique. A symptomatic case that required surgical treatment, a laparoscopic approach, with clinical and imaging improvement after the procedure, is presented.
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Affiliation(s)
- María Eugenia Romero
- Servicio de Cirugía General, Hospital Privado de Córdoba, Córdoba, Argentina. E-mail:
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22
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Ignashov AM, Kovaleva LF, Antonov MM, Gichkitn AY, Balandov SG, Kachalov DV, Mamchenkova MV, Vesel'skiy AB. [Celiac compression syndrome, sliding hernia of esophageal opening, Gilbert's syndrome, primary mitral valve prolapse and bronchial asthma in two blood brothers]. Vestn Khir Im I I Grek 2015; 174:94-99. [PMID: 27066668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
MESH Headings
- Adolescent
- Adult
- Asthma/diagnosis
- Asthma/physiopathology
- Celiac Artery/abnormalities
- Compartment Syndromes/congenital
- Compartment Syndromes/diagnosis
- Compartment Syndromes/physiopathology
- Compartment Syndromes/surgery
- Decompression, Surgical/methods
- Endoscopy, Digestive System/methods
- Gilbert Disease/diagnosis
- Gilbert Disease/physiopathology
- Hernias, Diaphragmatic, Congenital/diagnosis
- Hernias, Diaphragmatic, Congenital/physiopathology
- Hernias, Diaphragmatic, Congenital/surgery
- Herniorrhaphy/methods
- Humans
- Male
- Mitral Valve Prolapse/diagnosis
- Mitral Valve Prolapse/physiopathology
- Siblings
- Tomography, Spiral Computed/methods
- Treatment Outcome
- Ultrasonography, Doppler, Color/methods
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23
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Ostrom K, Syan R, Barber L, Miller D, Venkatasubramani N, Ravindra A, Jhaveri P, Jhaveri P, Alexander C, Nagan MR, Hauptman M, Grover A, Hadland SE. Index of suspicion. Pediatr Rev 2014; 35:396-404. [PMID: 25183775 DOI: 10.1542/pir.35-9-396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Kathleen Ostrom
- Children's Hospital Los Angeles/University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Raveen Syan
- Children's Hospital Los Angeles/University of Southern California Keck School of Medicine, Los Angeles, CA
| | - LaToya Barber
- Children's Hospital Los Angeles/University of Southern California Keck School of Medicine, Los Angeles, CA
| | | | | | | | - Pooja Jhaveri
- Division of Pediatric Gastroenterology, Penn State Children's Hospital, Hershey, PA
| | - Punit Jhaveri
- Division of Pediatric Gastroenterology, Penn State Children's Hospital, Hershey, PA
| | - Chandran Alexander
- Division of Pediatric Gastroenterology, Penn State Children's Hospital, Hershey, PA
| | - Margot R Nagan
- Boston University School of Medicine, Department of Pediatrics; Boston Children's Hospital, Department of Medicine; Harvard Medical School, Department of Pediatrics, Boston, MA
| | - Marissa Hauptman
- Boston University School of Medicine, Department of Pediatrics; Boston Children's Hospital, Department of Medicine; Harvard Medical School, Department of Pediatrics, Boston, MA
| | - Amit Grover
- Boston Children's Hospital, Department of Medicine; Harvard Medical School, Department of Pediatrics, Boston, MA
| | - Scott E Hadland
- Boston University School of Medicine, Department of Pediatrics; Boston Children's Hospital, Department of Medicine; Harvard Medical School, Department of Pediatrics, Boston, MA
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24
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Bao T, Liang H, Deng J, Jiao X. [Variation and research progress of celiac trunk branch]. Zhonghua Wei Chang Wai Ke Za Zhi 2014; 17:848-850. [PMID: 25164905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Celiac trunk is a wide and short ventral branch. It originates from the anterior abdominal artery at the level of L1 vertebra, and divides into three branches: the left gastric, common hepatic and splenic arteries, supplying the upper abdominal organs such as stomach, liver, spleen, pancreas, and duodenum. However, there are many types of branches variations. The branches of celiac trunk are classified into several types. We establish a classification of variation type according to the origin of left gastric, common hepatic and splenic arteries, which includes hepatogastrosplenic trunk type, hepatosplenic trunk type, hepatogastric trunk type, gastrosplenic trunk type, and the others include hepatosplenomesentery trunk type, hepatogastrospleno-mesentery trunk type, hepatogastrosplenocolonic trunk type, hepatogastrosplenopancreatic trunk type, gastrospenic trunk plus hepatomesentery trunk type, hepatogastrosplenoic left liver trunk type, hepatogastro-splenopancreatoduodenal trunk type, hepatogastric trunk plus hepatosplenic trunk type. Development of celiac trunk variation type was introduced based on the classification of Lipshutz, Adachi, Michels and Zhang Nianjia. Mastering the types of branches variations is necessary for us to perform the upper abdominal operations safely and effectively.
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Affiliation(s)
- Tao Bao
- Department of Gastric Cancer, Tianjin Cancer Hospital, Key Laboratory of Cancer Prevention and Treatment of Tianjin City, Tianjin Medical University, Tianjing 300060, China.
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Alnajjar A, Abu-Zaid A, Al-omem DA, Aloufi DS, Azzam A, Amin T. Concurrent pancreatic head and tail arteriovenous malformations in a 40-year-old gentleman: the first published report. JOP 2014. [PMID: 24865541 DOI: 10.6092/1590-8577%2f2392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Pancreatic arteriovenous malformations (AVMs) are uncommon in the gastrointestinal tract. Less than 100 cases have been identified in the medical literature. Approximately 10% of all pancreatic AVMs are sporadic. CASE REPORT Herein, we report the first documented case of sporadic concurrent pancreatic head and tail AVMs in a 40-year-old gentleman who presented with a 10-day history of epigastric pain and one episode of hematemesis. Patient denied any history of traumatic incidents, cigarette smoking, alcohol abuse, chronic gastric/duodenal ulcer, chronic pancreatitis, chronic hepatic disease, difficulty swallowing, respiratory compromise, or weight loss. Physical examination and laboratory results were unremarkable. Contrast-enhanced computed tomography scan showed two hypervascular masses involving the pancreatic head and tail. The celiac trunk angiogram showed proliferating vascular networks involving the pancreatic head and tail. The superior mesenteric angiogram demonstrated significant vascular contribution to the pancreatic head arteriovenous malformation only. Due to the extreme locations of pancreatic AVMs in the head and tail, surgical resection of both lesions (leaving behind the normal pancreatic body) was not possible. Instead, patient underwent intraoperative irradiation therapy (IORT). During the procedure, patient was surgically operated to retract healthy organs/tissues, and then a single concentrated dose of radiation therapy was precisely applied to both pancreatic head and tail AVM lesions. Patient had an uneventful postoperative recovery and was discharged home on the second postoperative day in stable condition. The patient is to be seen in clinic in a 4-month-period during which patient will be completing a 12-month period of postoperative IORT. CONCLUSION This is the first documented case of sporadic concurrent pancreatic head and tail AVMs. Angiography is the gold standard diagnostic modality.
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Affiliation(s)
- Asma Alnajjar
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
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26
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Uga N, Adachi K, Tarukawa T, Okuda Y, Tanigawa K, Nakaya H, Sato T, Hioki I. [Hemothorax complicated with celiac artery compression syndrome (CACS); report of a case]. Kyobu Geka 2014; 67:427-429. [PMID: 24917294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report a case of hemothorax complicated with celiac artery compression syndrome (CACS). A 43-year-old man presented with a sudden onset left back pain. Computed tomography (CT) showed its hemothorax, esophageal artery aneurysm and severe stenosis of the celiac truncus with its anterior compression by median accurate ligament, and a diagnosis of CACS associated with rupture of the aneurysm was made. Emergent transcatheter arterial embolization of the aneurysm resulted in a technical failure, although the patient's condition was stable and performed esophageal artery ligation through video-assisted thoracoscopic surgery on day 5 after onset. After surgery, the patient recovered without significant incidents. A cause of this aneurysmal development was supposed to be a significantly increased esophageal arterial blood flow with its luminal dilation to compensate a decreased celiac blood flow. Segmental arterial mediolysis could not be excluded as another cause.
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Affiliation(s)
- Naoko Uga
- Department of Thoracic Surgery, Mie Chuo Medical Center, Tsu, Japan
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27
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Chaudhry A, Rathore M, Banavaliker JN. Isolated right pulmonary artery agenesis with agenesis of right upper lobe and bronchiectasis of right lower lobe with anomalous arterial supply from celiac axis with normal venous drainage. Indian J Chest Dis Allied Sci 2014; 56:49-52. [PMID: 24930209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Isolated unilateral absence of pulmonary artery (UAPA) is a rare congenital anomaly. When detected in infancy, the condition is commonly associated with cardiovascular defects which are more frequently associated with left pulmonary artery agenesis. Patients with isolated right pulmonary artery agenesis survive into adulthood with minimal or no symptoms and are diagnosed incidentally on the chest radiographs. We report a case of a 19-year-old female patient who presented to us with recurrent haemoptysis. She was symptomatic since the age of four years. We report the rare occurrence of UAPA on right side, agenesis of right upper lobe and bronchiectasis of right lower lobe with anomalous arterial supply of right lung from coeliac axis in this patient.
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28
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Mak GZ, Speaker C, Anderson K, Stiles-Shields C, Lorenz J, Drossos T, Liu DC, Skelly CL. Median arcuate ligament syndrome in the pediatric population. J Pediatr Surg 2013; 48:2261-70. [PMID: 24210197 PMCID: PMC3896126 DOI: 10.1016/j.jpedsurg.2013.03.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 02/20/2013] [Accepted: 03/02/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Median arcuate ligament syndrome (MALS) is a vascular compression syndrome with symptoms that overlap chronic functional abdominal pain (CFAP). We report our experience treating MALS in a pediatric cohort previously diagnosed with CFAP. PATIENTS AND METHODS We prospectively evaluated 46 pediatric (<21years of age) patients diagnosed with MALS at a tertiary care referral center from 2008 to 2012. All patients had previously been diagnosed with CFAP. Patients were evaluated for celiac artery compression by duplex ultrasound and diagnosis was confirmed by computed tomography. Quality of life (QOL) was determined by pre- and postsurgical administration of PedsQL™ questionnaire. The patients underwent laparoscopic release of the median arcuate ligament overlying the celiac artery which included surgical neurolysis. We examined the hemodynamic changes in parameters of the celiac artery and perioperative QOL outcomes to determine correlation. RESULTS All patients had studies suggestive of MALS on duplex and computed tomography; 91% (n=42) positive for MALS were females. All patients underwent a technically satisfactory laparoscopic surgical release resulting in a significant improvement in blood flow through the celiac artery. There were no deaths and a total of 9 complications, 8 requiring a secondary procedure; 33 patients were administered QOL surveys. 18 patients completed the survey with 15 (83%) patients reporting overall improvement in the QOL. Overall, 31/46 patients (67%) reported improvement of symptoms since the time of surgery. CONCLUSIONS MALS was found to be more common in pediatric females than males. Laparoscopic release of the celiac artery can be performed safely in the pediatric population. Surgical release of the artery and resultant neurolysis resulted in significant improvement in the blood flow, symptoms, and overall QOL in this cohort. The overall improvement in QOL outcome measures after surgery leads us to conclude that MALS might be earlier diagnosed and possibly treated in patients with CFAP. We recommend a multidisciplinary team approach to care for these complex patients.
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Affiliation(s)
- Grace Z Mak
- Section of Pediatric Surgery, Department of Surgery, University of Chicago Medicine, Chicago IL, 60637, USA.
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29
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Wu M, Klass D, Strovski E, Salh B, Liu D. Aberrant celio-mesenteric supply of the splenic flexure: Provoking a bleed. World J Gastroenterol 2013; 19:6679-6682. [PMID: 24151398 PMCID: PMC3801385 DOI: 10.3748/wjg.v19.i39.6679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/16/2013] [Indexed: 02/06/2023] Open
Abstract
Lower gastrointestinal hemorrhage presents a common indication for hospitalization and account for over 300000 admissions per year in the United States. Multimodality imaging is often required to aid in localization of the hemorrhage prior to therapeutic intervention if endoscopic treatment fails. Imaging includes computer tomography angiography, red blood cell tagged scintigraphy and conventional angiography, with scintigraphy being the most sensitive followed by computer tomography angiography. Aberrant celio-mesenteric supply occurs in 2% of the population; however failure to identify this may result in failed endovascular therapy. Computer tomography angiography is sensitive for arterial hemorrhage and delineates the anatomy, allowing the treating physician to plan an endovascular approach. If at the time of conventional angiography, the active bleed is not visualized, but the site of bleeding has been identified on computer tomography angiography, provocative angiography can be utilized in order to stimulate bleeding and subsequent targeted treatment. We describe a case of lower gastrointestinal hemorrhage at the splenic flexure supplied by a celio-mesenteric branch in a patient and provocative angiography with tissue plasminogen activator utilized at the time of treatment to illicit the site of hemorrhage and subsequent treatment.
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30
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You JS, Cooper M, Nishida S, Matsuda E, Murariu D. Treatment of median arcuate ligament syndrome via traditional and robotic techniques. Hawaii J Med Public Health 2013; 72:279-281. [PMID: 24349891 PMCID: PMC3848179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Median arcuate ligament syndrome (MALS) is a rare entity characterized by extrinsic compression of the celiac artery and symptoms of postprandial epigastric pain, nausea, vomiting, and weight loss mimicking mesenteric ischemia. We present two patients diagnosed with MALS, the first treated with an open laparotomy by a vascular surgeon and the second using a robot assisted laparoscopic approach by a general surgeon with a vascular surgeon on standby. This is the second ever report of this approach. Both patients recovered without complications and experienced resolution of their symptoms. A discussion of the pathophysiology, literature review, and multispecialty treatment approach are presented.
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Affiliation(s)
- Jae S You
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI
| | - Matthew Cooper
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI
| | - Steven Nishida
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI
| | - Elna Matsuda
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI
| | - Daniel Murariu
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI
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31
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Houissa F, Dachraoui A, Mouelhi L, Bouzaidi S, Debbech R, Najjar T. Median arcuate ligament syndrome: a rare cause of recurrent abdominal pain. Tunis Med 2013; 91:474-476. [PMID: 24008884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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32
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Sanchez AM, Alfieri S, Caprino P, Tortorelli AP, Doglietto GB. Temporary medium arcuate ligament syndrome after pancreatoduodenectomy. Am Surg 2013; 79:E58-E60. [PMID: 23336632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Alejandro M Sanchez
- Department of Surgical Sciences, Catholic University, School of Medicine, Rome, Italy
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33
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Den B, Ignashov AM, Perleĭ VE, Gichkin AI, Ustiuzhaninov AS. [The significance of respiratory and orthostatic tests in duplex scanning in diagnostics of celiac artery compression syndrome]. Vestn Khir Im I I Grek 2013; 172:28-31. [PMID: 24000675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The preoperative transabdominal ultrasonics duplex scanning (UDS) of celiac artery was made in quiet breathing, in inspiration, in expiration, using vertical position in 180 patients. As well as the intra-abdominal UDS was made before the decompression of the celiac artery using the pulmonary ventilation during narcosis and relaxation. Peak systolic blood velocity, degree of stenosis, arterial pressure gradient in the celiac artery and volume blood velocity were hemodynamically significant in quiet breathing, in expiration and intraoperatively, reliably lower in inspiration in vertical position. It is important to use respiratory and orthostatic tests in diagnostics of compressive stenosis of the celiac artery. The data, which were obtained in quiet breathing using vertical position, should be taken into account in order to distinguish the compressive stenosis from atherosclerotic stenosis or other origin.
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Mariani GA, Maroni L, Bianchi L, Broccoli A, Lazzarini E, Marchegiani G, Mazzotti A, Mazzotti MC, Billi AM, Piccari GG, Cocco L, Manzoli L. Hepato-gastric and spleno-mesenteric arterial trunks: anatomical variation report and review of literature. Ital J Anat Embryol 2013; 118:217-222. [PMID: 25338412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The celiac trunk is one of the main arteries arising from abdominal aorta and supplies blood to several abdominal organs. The typical branching in left gastric, splenic and common hepatic arteries undergoes relatively frequent variations. The authors report a rare variation of the celiac trunk in a Caucasian cadaver, with a hepato-gastric and a spleno-mesenteric arterial trunks which arise from the abdominal aorta in a routine dissection of a 98-year-old male cadaver. Detailed knowledge of this kind of variations is important to plan and perform surgery in this district.
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Marina N, Uresandi F, Iriberri M, Hernández L. [Abscessified lung infection as an onset form of pulmonary kidnapping [corrected] ]. Med Clin (Barc) 2011; 137:715. [PMID: 20553860 DOI: 10.1016/j.medcli.2010.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 03/17/2010] [Accepted: 03/18/2010] [Indexed: 11/18/2022]
Affiliation(s)
- Nuria Marina
- Unidad de Neumología, Hospital de Cruces, Baracaldo, Vizcaya, Spain.
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36
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Paraskevas GK, Raikos A. Multiple aberrant coeliac trunk ramifications. Singapore Med J 2011; 52:e147-e149. [PMID: 21808947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study describes a routine educational cadaveric dissection, where multiple aberrant coeliac trunk branches were noticed. Specifically, the accessory left hepatic artery emerged from the left gastric artery, while the left inferior phrenic artery originated from the coeliac trunk. The accessory left suprarenal artery was found to commence from the coeliac trunk, whereas two aberrant left suprarenal arteries branched separately from the origin of the left inferior phrenic artery. Finally, the accessory jejunal artery was observed to originate from the coeliac trunk. Anatomical variations of the coeliac trunk branches can significantly alter the surgical management of the upper abdomen; hence, clinicians and radiologists should be aware of such aberrant vascular anatomy so as to reduce the incidence of surgical complications.
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Affiliation(s)
- G K Paraskevas
- Department of Anatomy, Medical School, Aristotle University of Thessaloniki, PO Box 300, Thessaloniki 54124, Greece.
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Ferreira A, Cerqueira A, Lima E, De Albuquerque R. [Celiac axis revascularization due to median arcuate ligament syndrome]. Rev Port Cir Cardiotorac Vasc 2011; 18:183-184. [PMID: 23596624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Indexed: 06/02/2023]
Affiliation(s)
- Ana Ferreira
- Serviço de Angiologia e Cirurgia Vascular do Centro Hospitalar de S.João, Porto. Portugal
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Gurgacz AM, Horbaczewska A, Klimek-Piotrowska W, Walocha J. Variations in hepatic vascularisation: lack of a proper hepatic artery. Two case reports. Folia Morphol (Warsz) 2011; 70:130-134. [PMID: 21630235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The blood supply of the liver and other abdominal organs plays a significant role during abdominal surgery. Knowledge of the most common patterns of vascularisation should be broadened and new anomalies of the celiac trunk and its branches dutifully reported. This paper presents two case reports which describe the lack of a proper hepatic artery. Case 1 describes the cadaver of a 64-year-old female in whom the right hepatic artery was observed to arise from the common hepatic artery and run behind the portal vein. The common hepatic artery was observed to be divided into three terminal vessels: the left hepatic artery, the gastroduodenal artery, and the right gastric artery. Case 2 describes the cadaver of a 75-year-old male with a liver that was supplied from 3 different sources: the left hepatic artery from the left gastric artery (which arose directly from the aorta), the right hepatic artery from the superior mesenteric artery, and the middle hepatic artery from the common hepatic artery - (branch of the hepato-splenic trunk). Moreover, the left inferior phrenic artery arose from the left hepatic artery.
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Affiliation(s)
- A M Gurgacz
- Department of Anatomy, Collegium Medicum, Jagiellonian University, Kraków, Poland
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Hemanth K, Garg S, Yadav TD, Sahni D, Singh R. Hepato-gastro-phrenic trunk and hepato-spleno-mesenteric trunk: a rare anatomic variation. Trop Gastroenterol 2011; 32:56-59. [PMID: 21922858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- K Hemanth
- Department of General Surgery, Postgraduate Insitute of Medical Education and Research, Chandigarh, India.
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40
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Yoshihara S, Yaegashi T, Naito M, Kutsukake Y, Kamiya M. An anomalous right gastroepiploic artery graft arising from the superior mesenteric artery. Cardiol J 2011; 18:202-203. [PMID: 21432831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- Shu Yoshihara
- Department of Radiology, Iwata City Hospital, Iwata, Japan.
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Natsume T, Shuto K, Yanagawa N, Akai T, Kawahira H, Hayashi H, Matsubara H. The classification of anatomic variations in the perigastric vessels by dual-phase CT to reduce intraoperative bleeding during laparoscopic gastrectomy. Surg Endosc 2010; 25:1420-4. [PMID: 20976496 DOI: 10.1007/s00464-010-1407-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Accepted: 09/03/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laparoscopy-assisted distal gastrectomy (LADG) is a less invasive alternative compared with an open procedure. However, it is difficult to obtain a full-view image and to estimate the three-dimensional (3D) relationships between organs during laparoscopic procedures. Determining the vascular anatomy by 3D CT imaging has been shown to play a critical role in reducing the risks associated with laparoscopic gastric cancer surgery. The purpose of this study was to evaluate the clinical anatomic variations and to estimate its positive contribution in obtaining less intraoperative bleeding. METHODS Scanning was performed using a 64-row MDCT scanner. Three-dimensional CT images in the arterial and portal phase were reconstructed and fused together using the volume-rendering technique. The intraoperative bleeding findings were compared between two periods. RESULTS The anatomic variations of the celiac trunk were divided into six types. There were 159 patients with Adachi's type I, type II=8, type III=1, type IV=1, type V=2, type VI=3, and other=1. The inflows of the left gastric coronary vein (LCV) were divided into three types. The LCV flowed into the portal vein (PV) in 79 patients, into the splenic vein (SpV) in 65, and into the junction of these two veins in 27. The splenic artery was divided into flat type and curved type, and 65 cases (37%) showed the flat type. Intraoperative bleeding was significantly less between 2007 and 2008, in which the operations were performed without first making a 3D anatomy study, than in 2009, in which 3D anatomy studies were made and analyzed before surgery in all patients. CONCLUSIONS Dual-phase 3D CT is a useful and essential modality to visualize the precise anatomy around the stomach. As a result, by comparing 3D CT images with our classifications, it is believed that any surgeons may reduce the degree of intraoperative blood loss.
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Affiliation(s)
- Toshiyuki Natsume
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, and Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan.
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Polguj M, Gabryniak T, Topol M. The right accessory hepatic artery; a case report and review of the literature. Surg Radiol Anat 2009; 32:175-9. [PMID: 19669076 DOI: 10.1007/s00276-009-0536-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 07/25/2009] [Indexed: 11/27/2022]
Abstract
A rare case of the right accessory hepatic artery was observed during multidetector-row Computer Tomography examination in a 65-year-old Caucasian female with portal vein thrombosis. This artery arose from the common hepatic artery near the celiac trunk and ran behind the hepatic portal vein to the right lobe of the liver. The diameter of the right accessory hepatic artery when compared to the diameter of the proper hepatic and common hepatic arteries corroborated the functional importance of this vessel. In-depth knowledge of not only "standard" anatomy but also of the numerous angiological variants is necessary in clinical practice. The variation shown in our case has very rarely been reported in medical literature.
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Affiliation(s)
- Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy, Medical University of Lodz, Narutowicza 60, 90-136, Lodz, Poland.
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Egorov VI, Iashina NI, Fedorov AV, Vishnevskiĭ VA, Karmazanovskiĭ GG, Shevchenko TV. [Arterial celiac-mesenterial aberrations: comparative analysis of intraoperative data and CT-angiography]. Khirurgiia (Mosk) 2009:4-9. [PMID: 20032936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
137 CT-angiograms of arterial celiac-mesenterial vessels were pro- and retrospectively analyzed in 120 patients. Radiological data was compared with intraoperative anatomy during standard and extended pancreatoduodenal resections. The analysis showed a considerable variability in architecture of celiac and superior mesenteric artery branches: hereby, a classical arterial anatomy was found only on 55% of the analyzed CT-scans. Intraoperative revision confirmed CT-data in all cases. CT-angiography is a prompt and reliable method of celiac-mesenterial arterial anatomy determination, making surgical treatment of patients with liver and pancreas diseases safer.
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Nayak SR, Prabhu LV, Krishnamurthy A, Ganesh Kumar C, Ramanathan LA, Acharya A, Prasad Sinha A. Additional branches of celiac trunk and its clinical significance. Rom J Morphol Embryol 2008; 49:247-249. [PMID: 18516334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The anatomical variations of the abdominal arteries are important due to its clinical significance. Various types of vascular anomalies are frequently found in human abdominal viscera, during cadaveric dissection and diagnostic radiological imaging. The present report describes a variation in the celiac trunk as found during routine dissection in a 59-year-old male cadaver. The celiac trunk (CT) was unusually lengthy and took origin from the left antero-lateral surface of the abdominal aorta. Altogether, there were five branches, including three classic branches of CT. The left phrenic artery (LPA) was the first branch of the CT. The remaining four branches were left gastric artery (LGA), splenic artery (SA), common hepatic artery (CHA) and gastroduodenal artery (GDA). There was an arterial loop between the posterior branches of the superior pancreatico-duodenal artery (SPDA), arising from the GDA, and the posterior branch of the inferior pancreatico-duodenal artery (IPDA), arising from the superior mesenteric artery (SMA). The arterial loop formed by the above arteries, supplied the head of the pancreas and duodeno-jejunal flexure. The embryological and clinical significance of above variations has been described.
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Affiliation(s)
- S R Nayak
- Department of Anatomy, Centre for Basic Sciences, Kasturba Medical College, Bejai, Mangalore, Karnataka, India.
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Abstract
The authors report a rare variation, a common celiacomesenteric trunk, which was observed during routine dissection of an 89-year-old Japanese female cadaver in the laboratory of the Anatomy Department. The trunk gave rise to left gastric, common hepatic, splenic and superior mesenteric arteries. The developmental significance of this variation is discussed with a brief review of the literature.
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Affiliation(s)
- Shuang-Qin Yi
- Department of Anatomy, Tokyo Medical University, Shinjuku 6-1-1, Shinjuku-ku, 160-8402 Tokyo, Japan.
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Bhayana D, Raber EL, Mahallati H. Answer to case of the month #123 hereditary hemorrhagic telangiectasiahepatic manifestations. Can Assoc Radiol J 2007; 58:242-245. [PMID: 18186437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Affiliation(s)
- Deepak Bhayana
- Section of Body CT and MRI, Department of Diagnostic Imaging, Foothills Medical Centre, Calgary, AB
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Winston CB, Lee NA, Jarnagin WR, Teitcher J, DeMatteo RP, Fong Y, Blumgart LH. CT angiography for delineation of celiac and superior mesenteric artery variants in patients undergoing hepatobiliary and pancreatic surgery. AJR Am J Roentgenol 2007; 189:W13-9. [PMID: 17579128 DOI: 10.2214/ajr.04.1374] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of our study was to determine the frequency of different arterial variants identified at abdominal CT angiography (CTA) performed before pancreatic and hepatobiliary surgery. CONCLUSION Variant hepatic and celiac arterial anatomy is common. CTA can be used to identify common and uncommon variants that are important for the surgical management of patients with pancreatic and hepatobiliary neoplasms.
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Affiliation(s)
- Corinne B Winston
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 160 E 53rd St., 8th Fl., New York, NY 10022, USA
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Lewandowski RJ, Sato KT, Atassi B, Ryu RK, Nemcek AA, Kulik L, Geschwind JF, Murthy R, Rilling W, Liu D, Bester L, Bilbao JI, Kennedy AS, Omary RA, Salem R. Radioembolization with 90Y microspheres: angiographic and technical considerations. Cardiovasc Intervent Radiol 2007; 30:571-92. [PMID: 17516113 DOI: 10.1007/s00270-007-9064-z] [Citation(s) in RCA: 222] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Revised: 03/26/2007] [Accepted: 04/01/2007] [Indexed: 12/12/2022]
Abstract
The anatomy of the mesenteric system and the hepatic arterial bed has been demonstrated to have a high degree of variation. This is important when considering pre-surgical planning, catheterization, and trans-arterial hepatic therapies. Although anatomical variants have been well described, the characterization and understanding of regional hepatic perfusion in the context of radioembolization have not been studied with great depth. The purpose of this review is to provide a thorough discussion and detailed presentation of the angiographic and technical aspects of radioembolization. Normal vascular anatomy, commonly encountered variants, and factors involved in changes to regional perfusion in the presence of liver tumors are discussed. Furthermore, the principles described here apply to all liver-directed transarterial therapies.
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Affiliation(s)
- Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
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50
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Tosun O, Sanlidilek U, Cetin H, Ozdemir O, Kurt A, Sakarya ME, Tas I. Unusual congenital aortic anomaly with rare common celiamesenteric trunk variation: MR angiography and digital substraction angiography findings. Cardiovasc Intervent Radiol 2007; 30:1061-4. [PMID: 17468907 DOI: 10.1007/s00270-007-9020-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Magnetic resonance angiography and digital substraction angiography (DSA) findings in a case with a rare congenital thoracoabdominal aortic hypoplasia and common celiamesenteric trunk variation with occlusion of infrarenal abdominal aorta are described here. To our knowledge, this aortic anomaly has not been previously described in the English literature. DSA is the optimum imaging modality for determination of aortic hypoplasia, associated vascular malformations, collateral vessels, and direction of flow within vessels.
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MESH Headings
- Angiography, Digital Subtraction
- Aorta, Abdominal/abnormalities
- Aorta, Abdominal/diagnostic imaging
- Aorta, Abdominal/pathology
- Aorta, Abdominal/physiopathology
- Aorta, Thoracic/abnormalities
- Aorta, Thoracic/diagnostic imaging
- Aorta, Thoracic/pathology
- Aorta, Thoracic/physiopathology
- Aortography/methods
- Celiac Artery/abnormalities
- Celiac Artery/diagnostic imaging
- Celiac Artery/pathology
- Celiac Artery/physiopathology
- Collateral Circulation
- Female
- Humans
- Magnetic Resonance Angiography
- Mesenteric Artery, Superior/abnormalities
- Mesenteric Artery, Superior/diagnostic imaging
- Mesenteric Artery, Superior/pathology
- Mesenteric Artery, Superior/physiopathology
- Middle Aged
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Affiliation(s)
- Ozgur Tosun
- Department of Radiology, Ankara Ataturk Education and Research Hospital, Bilkent, 06800 Ankara, Turkey.
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