Intrapancreatic Accessory Spleen Mimicking Pancreatic neoplasm

Abstract

s / Pancreatology 12 (2012) 502–597 564 Department of Human Morphology and Developmental Biology, Semmelweis University Budapest, Hungary Department of Diagnostic Radiology and Oncotherapy, Semmelweis University Budapest, Hungary 1st Department of Surgery, Semmelweis University Budapest, Hungary Introduction: The complex arterial system makes the pancreatic interventions technically challenging for surgeons, and interventional radiologists. The arterial variants may alter the tumor resectability, and cause complications in arterial embolization. Aims: Data on the pancreatic blood supply in different countries are variable; therefore, we aimed to determine the frequency of pancreatic arterial variants in the Hungarian population. Methods: Arteries of abdominal organ complexes (36) were injected with resin mixture, then corroded. Digital photos and CT images were taken. Results: Classic anatomical variation occurred in less than 50%. Replaced and accessory right hepatic arteries were detected in 9.9% and 3.3%, respectively. In one case the proper hepatic artery branched off from the superior mesenteric artery (SMA). The gastroduodenal artery arose from the common hepatic in 94%, from the splenic in 3%, and from the right hepatic in 3%. Superior pancreaticoduodenal artery was found in 12.1%, while the anterior and posterior superior pancreaticoduodenal artery stem separately from the gastroduodenal artery in 69.7%. Inferior pancreaticoduodenal artery arose from the SMA in 42.8% and originated with the 1st jejunal in 25.7%. Anterior and posterior inferior pancreaticoduodenal arteries stem separately from SMA in 20%, from the accessory hepatic (from SMA) in 5.4%. Single transverse pancreatic artery occurred in 80%, and two in 20%. Except one case, multiple dorsal pancreatic arteries arose from the splenic. Conclusion: Our results stress on the importance of the preoperative radiological analysis. Detection of replaced or accessory right hepatic artery is critical when performing pancreaticoduodenectomy, if not identified, may be injured.