Journal of JPRDT

Pancreatic Research, Disorders & Therapy
Short Communication
Volume 1 Issue 1 - 2017
Intrapancreatic replaced Common Hepatic Artery: A Rare Anomaly and its Clinical Implications
Bramhadatta Pattnaik, Deeplaxmi Borle and Senthil Kumar*
Department of HPB surgery and Liver transplantation, Institute of Liver and Biliary Sciences, India
Received: February 13, 2017 | Published: March 22, 2017
*Corresponding author: Senthil Kumar, Department of HPB surgery and Liver transplantation, Institute of Liver and Biliary Sciences, Vasant Kunj-110070, New Delhi, India, Tel: 00-91-9540946809; Email:
Citation: Pattnaik B, Borle D, Kumar S (2017) Intrapancreatic replaced Common Hepatic Artery: A Rare Anomaly and its Clinical Implications. J Pancreat Res Disord Ther 1(1): 00002. DOI: 10.15406/jprdt.2017.01.00002

Short Communication

A replaced common hepatic artery (CHA) traversing the pancreatic parenchyma is rare [1-3]. However, recognition of this has important practical implications in both multi-organ retrieval and pancreatic surgery. In elective pancreatic surgery, it is essential for the surgeon to meticulously trace the arterial anatomy of the celiac axis and the superior mesenteric artery (SMA), on preoperative imaging, as such anomalies may not be reported by the radiologist. If unrecognized, it may lead to torrential intra-operative haemorrhage or more dangerously, compromise hepatic arterial inflow.

A 21 year old gentleman presented with significant recurrent pain in epigastrium needing opiates and a history of steatorrhea of many months. On evaluation with a contrast enhanced CT, the body and tail of the pancreas were mildly atrophic with an inflammatory head mass. Multiple parenchymal calcifications were seen throughout the pancreas, with a dilated main pancreatic duct with multiple intra-ductal calculi consistent with chronic calcific pancreatitis. He was planned for a Frey’s procedure. On pre-operative review of the arterial anatomy, a replaced CHA was found to be originating from the SMA and traversing through posterior pancreatic parenchyma (Figures 1 & 2). This changed the surgical options that the patient could be offered.

Figure 1: Common Hepatic Artery traversing through pancreatic parenchyma (arrow).

Figure 2: Intra-pancreatic Common Hepatic artery (arrow) with parenchymal calcifications (star).

Intra-operatively, there were stones deep in the head and the uncinate which could be sounded with a probe, but could not be extracted without risking injury to the aberrant CHA. A head coring operation such as Frey’s procedure which would have been ideal, was not done in view of the risk of injury to the CHA in its trans-pancreatic course. He underwent a Lateral pancreaticojejunostomy.

References

  1. Padín JM, Ramisch DA, Maraschio M, Samamé J, Farinelli PA, et al. (2013) Intrapancreatic common hepatic artery arising from the superio
  2. r mesenteric artery, a challenging anatomic variation in a multiorgan harvesting. Transplant Proc 45(2): 820-823.
  3. Lee HY, Ha HI, Kim MJ, Lim HK (2013) Compression of the main pancreatic duct by the intrapancreatic-replaced common hepatic artery. Korean J Radiol 14(3): 412-415.
  4. Wang L, Xu J, Sun D, Zhang Z (2016) Aberrant hepatic arteries running through pancreatic parenchyma encountered during pancreatoduodenectomy: Two rare case reports and strategies for surgical treatment. Medicine 95(49): e3867.
Scholar Awards

At MedCrave we believe that knowledge should be shared. We also believe that   Read more...

Paper of the Year

In regard to the novelty and excellence of the manuscript MedCrave Group (MCG)   Read more...

Financial Support

MedCrave loves to recognize all the outstanding services delivered in the realms   Read more...

Sponsors

MedCrave accelerates the advancement of scientific research by convening   Read more...

MedCrave Reprints

MedCrave Group is ardent to provide article reprints at an instant affordable Read more...

 
© 2014-2017 MedCrave Group, All rights reserved. No part of this content may be reproduced or transmitted in any form or by any means as per the standard guidelines of fair use.
Creative Commons License Open Access by MedCrave Group is licensed under a Creative Commons Attribution 4.0 International License.
Based on a work at http://medcraveonline.com
Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version | Opera |Privacy Policy