A significant vascular variant in oncologic pancreaticoduodenectomy: the arc of Buhler
Abstract 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...
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Japan Surgical Society
2022-03-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-022-01387-9 |
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| author | L. Schumacher H. C. Albrecht S. Gretschel |
| author_facet | L. Schumacher H. C. Albrecht S. Gretschel |
| author_sort | L. Schumacher |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-e00699b41b2f438589d53434c2dfb0db |
| institution | Kabale University |
| issn | 2198-7793 |
| language | English |
| publishDate | 2022-03-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-e00699b41b2f438589d53434c2dfb0db2025-08-20T03:39:25ZengJapan Surgical SocietySurgical Case Reports2198-77932022-03-01811510.1186/s40792-022-01387-9A significant vascular variant in oncologic pancreaticoduodenectomy: the arc of BuhlerL. Schumacher0H. C. Albrecht1S. Gretschel2Faculty of Health Brandenburg, Brandenburg Medical School, Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital NeuruppinFaculty of Health Brandenburg, Brandenburg Medical School, Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital NeuruppinFaculty of Health Brandenburg, Brandenburg Medical School, Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital NeuruppinAbstract 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.https://doi.org/10.1186/s40792-022-01387-9Arc of Buhler (AOB)Arterio-arterial anastomosis (shunt)Superior mesenteric artery (SMA)Celiac trunk (CA)Gastroduodenal artery (GDA)Pancreaticoduodenectomy |
| spellingShingle | L. Schumacher H. C. Albrecht S. Gretschel A significant vascular variant in oncologic pancreaticoduodenectomy: the arc of Buhler Surgical Case Reports Arc of Buhler (AOB) Arterio-arterial anastomosis (shunt) Superior mesenteric artery (SMA) Celiac trunk (CA) Gastroduodenal artery (GDA) Pancreaticoduodenectomy |
| 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 | Arc of Buhler (AOB) Arterio-arterial anastomosis (shunt) Superior mesenteric artery (SMA) Celiac trunk (CA) Gastroduodenal artery (GDA) Pancreaticoduodenectomy |
| url | https://doi.org/10.1186/s40792-022-01387-9 |
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