The arc of Buhler: special considerations when performing pancreaticoduodenectomyReportar como inadecuado

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Surgical Case Reports

, 2:21

First Online: 07 March 2016Received: 12 January 2016Accepted: 03 March 2016


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.

KeywordsArc of Buhler Pancreaticoduodenectomy Celiac trunk Stenosis AbbreviationsAOBarc of Buhler

CTcomputed tomography

DPAdorsal pancreatic artery

GDAgastroduodenal artery

SMAsuperior mesenteric artery

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Autor: Yumiko Kageyama - Takashi Kokudo - Katsumi Amikura - Yoshihiro Miyazaki - Amane Takahashi - Hirohiko Sakamoto


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