The Delicate Vascular Anomaly Surrounding a Pancreatic Mass

Area of Science:

• Vascular anatomy
• Surgical oncology
• Radiology

Background:

• The celiac trunk and portal vein are primary pancreatic blood sources.
• Vascular anatomy exhibits significant variability, with pathological conditions potentially inducing compensatory changes.
• Pancreatic cancer can present with complex vascular alterations.

Purpose of the Study:

• To document and analyze an uncommon anatomical variant of the celiac trunk and a compensatory portal vein transformation in a patient with pancreatic cancer.
• To investigate the role of contrast-enhanced computed tomography (CECT) in identifying these vascular anomalies and their impact on pancreatic cancer presentation.
• To highlight the clinical significance of recognizing such variations for patient management.

Main Methods:

• Case study of a patient diagnosed with pancreatic cancer.
• Analysis of contrast-enhanced computed tomography (CECT) scans of the abdomen.
• Detailed examination of the celiac trunk, splenic artery, common hepatic artery, left gastric artery, and portal vein anatomy.
• Assessment of the compensatory remodeling of the portal vein in response to occlusion.

Main Results:

• Identification of an uncommon anatomical variant: the splenic artery arising directly from the aorta abdominalis, separate from the common trunk of the common hepatic artery and left gastric artery.
• Observation of portal vein occlusion leading to compensatory remodeling to restore blood flow.
• Correlation of the pancreatic mass in the head and neck with common bile duct obstruction, causing jaundice and abdominal bloating.
• Demonstration of CECT's efficacy in visualizing complex vascular structures and tumor location.

Conclusions:

• Uncommon vascular variations, such as the described celiac trunk anomaly and portal vein remodeling, can complicate pancreatic cancer treatment.
• Accurate preoperative identification of these anatomical complexities through imaging is essential for surgical planning and interventional procedures.
• Awareness of vascular variability is crucial for improving outcomes in patients with pancreatic cancer and associated vascular pathologies.