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A significant vascular variant in oncologic pancreaticoduodenectomy: the arc of Buhler

BACKGROUND: The arc of Buhler (AOB), a rare anastomosis connecting the superior mesenteric artery (SMA) to the celiac trunk (CA), was found in a patient suffering from an adenocarcinoma of the pancreatic head. CASE PRESENTATION: Oncologic pancreaticoduodenectomy required resection of the AOB to achi...

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Autores principales: Schumacher, L., Albrecht, H. C., Gretschel, S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8891398/
https://www.ncbi.nlm.nih.gov/pubmed/35235066
http://dx.doi.org/10.1186/s40792-022-01387-9
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author Schumacher, L.
Albrecht, H. C.
Gretschel, S.
author_facet Schumacher, L.
Albrecht, H. C.
Gretschel, S.
author_sort Schumacher, L.
collection PubMed
description BACKGROUND: The arc of Buhler (AOB), a rare anastomosis connecting the superior mesenteric artery (SMA) to the celiac trunk (CA), was found in a patient suffering from an adenocarcinoma of the pancreatic head. CASE PRESENTATION: Oncologic pancreaticoduodenectomy required resection of the AOB to achieve complete tumor removal. After an uneventful clinical course in the first days, the patient suffered a severe complication. Due to ischemia of the stomach and spleen, complete resection of the stomach, spleen, and remaining pancreas had to be performed. CONCLUSIONS: The hemodynamic impact of this arterial variant has been discussed mainly for liver perfusion, which remained intact at all times in our case. Because of the serious obstacles mentioned above, we strongly recommend that the presence of AOB be considered in preoperative diagnosis and preservation when possible. If the AOB is likely to be ligated, stenosis of the SMA or CA should be excluded and resolved before surgery.
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spelling pubmed-88913982022-03-08 A significant vascular variant in oncologic pancreaticoduodenectomy: the arc of Buhler Schumacher, L. Albrecht, H. C. Gretschel, S. Surg Case Rep Case Report BACKGROUND: The arc of Buhler (AOB), a rare anastomosis connecting the superior mesenteric artery (SMA) to the celiac trunk (CA), was found in a patient suffering from an adenocarcinoma of the pancreatic head. CASE PRESENTATION: Oncologic pancreaticoduodenectomy required resection of the AOB to achieve complete tumor removal. After an uneventful clinical course in the first days, the patient suffered a severe complication. Due to ischemia of the stomach and spleen, complete resection of the stomach, spleen, and remaining pancreas had to be performed. CONCLUSIONS: The hemodynamic impact of this arterial variant has been discussed mainly for liver perfusion, which remained intact at all times in our case. Because of the serious obstacles mentioned above, we strongly recommend that the presence of AOB be considered in preoperative diagnosis and preservation when possible. If the AOB is likely to be ligated, stenosis of the SMA or CA should be excluded and resolved before surgery. Springer Berlin Heidelberg 2022-03-02 /pmc/articles/PMC8891398/ /pubmed/35235066 http://dx.doi.org/10.1186/s40792-022-01387-9 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Case Report
Schumacher, L.
Albrecht, H. C.
Gretschel, S.
A significant vascular variant in oncologic pancreaticoduodenectomy: the arc of Buhler
title A significant vascular variant in oncologic pancreaticoduodenectomy: the arc of Buhler
title_full A significant vascular variant in oncologic pancreaticoduodenectomy: the arc of Buhler
title_fullStr A significant vascular variant in oncologic pancreaticoduodenectomy: the arc of Buhler
title_full_unstemmed A significant vascular variant in oncologic pancreaticoduodenectomy: the arc of Buhler
title_short A significant vascular variant in oncologic pancreaticoduodenectomy: the arc of Buhler
title_sort significant vascular variant in oncologic pancreaticoduodenectomy: the arc of buhler
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8891398/
https://www.ncbi.nlm.nih.gov/pubmed/35235066
http://dx.doi.org/10.1186/s40792-022-01387-9
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