Reversed arterial flow in the paramedian segments of the liver after pancreaticoduodenectomy.
Variation of splanchnic arterial anatomy is frequent and may complicate pancreatic surgery, leading to life-threatening postoperative complications. We report a case of severe hepatic dysfunction after pancreaticoduodenectomy due to accidental section of the right hepatic artery. Bedside ultrasound examination showed a reversed arterial flow in the paramedian segments of the liver. Based on intraoperative and ultrasound findings, a retrograde arterial supply of the right liver from the left hepatic artery through spontaneous anastomosis between the arteries of segment 4 and the right paramedian segments was assumed and confirmed by postoperative CT examination.
Department of General Surgery and Organ Transplantation, San Martino University Hospital of Genoa, Italy.
Stefano
S
Di Domenico
Elena
E
Santacroce
Arianna
A
Magoni Rossi
Antonella
A
Giannone
Umberto
U
Valente
D000368:Aged; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D008099:Liver / Q000098:blood supply* / Q000503:physiopathology; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging* / Q000601:surgery; D009392:Nephrectomy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery; D011859:Radiography; D013152:Splanchnic Circulation; D018615:Ultrasonography, Doppler, Color