Injury to the superior mesenteric artery during pancreatectomy for chronic pancreatitis

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.