title: The arc of Buhler: special considerations when performing pancreaticoduodenectomy.
abstract: A 74-year-old female was diagnosed as having a carcinoma of the papilla of Vater. Preoperative computed tomography showed stenosis of the celiac trunk and an enlarged artery arising from the superior mesenteric artery (SMA) joining the root of the splenic artery. Since this artery communicated with the SMA and the celiac trunk, independently of the gastroduodenal and dorsal pancreatic arteries, it was considered to be the arc of Buhler (AOB). The arterial blood flow to the liver, spleen, and stomach appeared to depend on the AOB, such that AOB preservation was considered to be essential. A subtotal stomach-preserving pancreaticoduodenectomy with preservation of the AOB was thus performed. Although AOB is a relatively infrequent type of arterial communication between the SMA and the celiac trunk, it needs to be preserved during pancreaticoduodenectomy when celiac trunk stenosis is present.
authors.affiliation: Division of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita-adachi gun, Saitama, Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kageyama
authors.affiliation: Division of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita-adachi gun, Saitama, Japan. kokudo-tky@umin.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kokudo
authors.affiliation: Division of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita-adachi gun, Saitama, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Amikura
authors.affiliation: Division of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita-adachi gun, Saitama, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyazaki
authors.affiliation: Division of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita-adachi gun, Saitama, Japan.
authors.forename: Amane
authors.initials: A
authors.lastname: Takahashi
authors.affiliation: Division of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita-adachi gun, Saitama, Japan.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Sakamoto
keywords: Arc of Buhler; Celiac trunk; Pancreaticoduodenectomy; Stenosis