Abstract
Four cases are described of injury to the superior mesenteric artery (SMA) during pancreatectomy for chronic pancreatitis. Review of the literature indicates that this is a rare event. In three patients (arterial ligation, 2; haemorrhage, 1), the injury was immediately recognised and successfully repaired. In the fourth (with probable occlusion of the vessel), the problem was not appreciated at operation and the patient eventually died. Vessels adherent to a pseudocyst are at particular risk of injury, as in two of our patients. Two patients had ectopic origin of the right hepatic artery. Since awareness of such vascular anomalies is important, we now perform selective mesenteric angiography in all patients requiring pancreatic resections, whether proximal or distal.
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- Appleton G. V., Bathurst N. C., Virjee J., Cooper M. J., Williamson R. C. The value of angiography in the surgical management of pancreatic disease. Ann R Coll Surg Engl. 1989 Mar;71(2):92–96. [PMC free article] [PubMed] [Google Scholar]
- Aston S. J., Longmire W. P., Jr Pancreaticoduodenal resection. Twenty years' experience. Arch Surg. 1973 Jun;106(6):813–817. doi: 10.1001/archsurg.1973.01350180047015. [DOI] [PubMed] [Google Scholar]
- Braasch J. W., Gray B. N. Technique of radical pancreatoduodenectomy. With consideration of hepatic arterial relationship. Surg Clin North Am. 1976 Jun;56(3):631–647. doi: 10.1016/s0039-6109(16)40938-2. [DOI] [PubMed] [Google Scholar]
- Brooks J. R., Culebras J. M. Cancer of the pancreas. Palliative operation, Whipple procedure, or total pancreatectomy? Am J Surg. 1976 Apr;131(4):516–520. doi: 10.1016/0002-9610(76)90167-7. [DOI] [PubMed] [Google Scholar]
- Fortner J. G. Regional pancreatectomy for cancer of the pancreas, ampulla, and other related sites. Tumor staging and results. Ann Surg. 1984 Apr;199(4):418–425. doi: 10.1097/00000658-198404000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Guillemin G., Cuilleret J., Michel A., Berard P., Feroldi J. Chronic relapsing pancreatitis. Surgical management including sixty-three cases of pancreaticoduodenectomy. Am J Surg. 1971 Dec;122(6):802–807. doi: 10.1016/0002-9610(71)90450-8. [DOI] [PubMed] [Google Scholar]
- Ikard R., Merendino K. A. Accidental excision of the superior mesenteric artery. Technical and physiological considerations. Surg Clin North Am. 1970 Oct;50(5):1075–1085. doi: 10.1016/s0039-6109(16)39245-3. [DOI] [PubMed] [Google Scholar]
- MONGE J. J., JUDD E. S., GAGE R. P. RADICAL PANCREATODUODENECTOMY: A 22-YEAR EXPERIENCE WITH THE COMPLICATIONS, MORTALITY RATE, AND SURVIVAL RATE. Ann Surg. 1964 Oct;160:711–722. doi: 10.1097/00000658-196410000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Williamson R. C., Cooper M. J. Resection in chronic pancreatitis. Br J Surg. 1987 Sep;74(9):807–812. doi: 10.1002/bjs.1800740919. [DOI] [PubMed] [Google Scholar]