The purpose of the current case is to describe a very rare coexistence of a replaced common hepatic artery (rCHA) and dorsal pancreatic agenesis with notable surgical implications. Preoperative computed tomography angiography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography were performed in a 53-year-old female with cholangiocarcinoma. Imaging revealed an rCHA arising from the superior mesenteric artery (SMA) and coursing anterior to the pancreatic head, supplying the right and left hepatic arteries, right gastroepiploic artery, and both the superior and inferior pancreaticoduodenal arteries. The gastroduodenal artery was absent. Dorsal pancreatic agenesis was confirmed, with the absence of the pancreatic body and tail. This configuration places the rCHA at high intraoperative risk and eliminates a major coeliac–SMA collateral route. Detailed preoperative vascular mapping and tailored surgical strategies are essential to prevent catastrophic ischemia during pancreatic or hepatic surgery and to guide appropriative operative approach.

PURPOSE: Gastric cancer (GC) patients with peritoneal metastasis (PM) have poor prognosis. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) in combination with systemic chemotherapy is a novel treatment option for patients in stage IV of the disease. MATERIALS AND METHODS: Between November 2015 and June 2018, prospective data collection was performed in 24 patients with GC and PM (median age, 57; range, 44–75 years). These patients underwent 46 PIPAC procedures with a median number of 2 interventions per patient (range, 1–6). A laparoscopic access was used and a combined therapy of cisplatin and doxorubicin aerosol was administered. RESULTS: The median peritoneal carcinomatosis index before the 1st PIPAC was 14 (range, 2–36), and the median ascites volume in patients before the 1st PIPAC was 100 mL (range, 0–6 mL, 300 mL). Eleven patients, who received 2 or more PIPAC procedures, had decreased and stable volumes of ascites, while only 3 patients displayed increasing volume of ascites. The median overall survival was 121 days (range, 66–625 days) after the 1st PIPAC procedure, while 8 patients who received more than 3 PIPAC procedures had a median survival of 450 days (range, 206–481 days) (P=0.0376). CONCLUSIONS: Our data show that PIPAC is safe and well tolerated, and that the production of ascites can be controlled by PIPAC in GC patients. Patients, who received 2 or more PIPAC procedures, reported a stable overall quality of life. Further studies are required to document the significance of PIPAC as a palliative multimodal therapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03100708
Ascites ; Carcinoma ; Cisplatin ; Data Collection ; Doxorubicin ; Drug Therapy* ; Humans ; Neoplasm Metastasis* ; Prognosis ; Prospective Studies ; Quality of Life ; Stomach Neoplasms*