Aneurysm of gastroduodenal artery (GDA) is rare. Most reported cases are due to pancreatitis and atherosclerosis; however, those following pancreatic trauma have not been reported. We encoun- tered GDA aneurysm in a patient of blunt abdominal trauma, who had pancreatic contusion and retroduodenal air on contrast enhanced computed tomography of abdomen. Emergency laparotomy for suspected duodenal injury revealed duodenal wall and pancreatic head contusion, mild hemo- peritoneum and no evidence of duodenal perforation. In the postoperative period, the patient developed upper gastrointestinal hemorrhage on day 5. Repeat imaging revealed GDA aneurysm, which was managed successfully by angioembolization. This case highlights, one, delayed presen- tation of GDA aneurysm after blunt pancreatic trauma and two, its successful management using endovascular technique.
Abdominal Injuries ; complications ; Adult ; Aneurysm ; etiology ; Duodenum ; blood supply ; Embolization, Therapeutic ; Humans ; Male ; Pancreas ; injuries ; Stomach ; blood supply ; Wounds, Nonpenetrating ; complications

The role of neoadjuvant chemoradiation therapy in locally advanced pancreatic cancer (LAPC) is still controversial. The aim of this study was to evaluate surgical downstaging after concurrent chemoradiation therapy (CCRT) for LAPC by measuring the objective changes after treatment. From January 2003 through July 2011, 54 patients with LAPC underwent neoadjuvant CCRT. Computed tomography findings of the tumor size, including major vessel invasion, were analyzed before and after CCRT. Among the total recruited patients, 14 had borderline resectable malignancy and another 40 were unresectable before CCRT. After CCRT, a partial response was achieved in four patients. Stable disease and further disease progression were achieved in 36 and 14 patients, respectively. Tumor size showed no significant difference before and after CCRT (3.6 +/- 1.1 vs. 3.6 +/- 1.0 cm, P = 0.61). Vessel invasion showed improvement in two patients, while 13 other patients showed further tumor progression. Thirty-nine patients with unresectable malignancy and 11 patients with borderline resectable malignancy at time of initial diagnosis remained unchanged after CCRT. Four patients with borderline pancreatic malignancy progressed to an unresectable stage, whereas one unresectable pancreatic malignancy improved to a borderline resectable stage. Only one patient with borderline resectable disease underwent operation after CCRT; however, curative resection failed due to celiac artery invasion and peritoneal seeding. The adverse events associated with CCRT were tolerable. In conclusion, preoperative CCRT in LAPC rarely leads to surgical downstaging, and it could lower resectability rates.
Adenocarcinoma/radiography/therapy ; Adult ; Aged ; Aged, 80 and over ; Antimetabolites, Antineoplastic/therapeutic use ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Capecitabine/therapeutic use ; Carcinoma, Pancreatic Ductal/*radiography/*therapy ; Chemoradiotherapy/adverse effects/*methods ; Combined Modality Therapy ; Deoxycytidine/analogs & derivatives/therapeutic use ; Disease Progression ; Female ; Fluorouracil/therapeutic use ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Pancreas/blood supply/pathology ; Pancreatic Neoplasms/*radiography/*therapy ; Retrospective Studies ; Treatment Outcome

Since the introduction of pancreas transplantation more than 40 years ago, surgical techniques and immunosuppressive regiments have improved and both have contributed to increase the number and success rate of this procedure. However, graft survival corresponds to early diagnosis of organ-related complications. Thus, knowledge of the transplantation procedure and postoperative image anatomy are basic requirements for radiologists. In this article, we demonstrate the imaging spectrum of pancreas transplantation with enteric exocrine drainage.
Adult ; Anastomosis, Surgical/methods ; Diagnostic Imaging/methods ; Drainage/methods ; Female ; Graft Rejection/pathology ; Graft Survival ; Humans ; Iliac Artery/radiography/surgery ; Immunosuppressive Agents ; Kidney Transplantation ; Male ; *Medical Illustration ; Mesenteric Artery, Superior/radiography/surgery ; Middle Aged ; Pancreas/*blood supply/radiography ; Pancreas Transplantation/adverse effects/*methods ; Pancreatitis, Graft/etiology ; Portal Vein/radiography/surgery ; Postoperative Complications/radiography ; Postoperative Hemorrhage/etiology ; Survival Rate

Pancreaticoduodenal artery pseudoaneurysm is one kind of rare splanchnic artery aneurysm. Hemorrhage from the lesion could be life-threatening. We present a case which color Doppler ultrasound and computed tomography angiography (CTA) only showed pancreatic pseudocyst on the background of chronic pancreatitis at first, but contrast-enhanced ultrasound detected blood flow in the pseudocyst and a pancreaticoduodenal artery pseudoaneurysm was worked up several days after. Finally, the pancreaticoduodenal artery pseudoaneurysm was confirmed by digital subtracted angiography. It might suggest the potential advantage of contrast-enhanced ultrasound in evaluating this kind of disease in comparison of CTA.
Adult ; Aneurysm, False ; diagnostic imaging ; Duodenum ; blood supply ; diagnostic imaging ; Humans ; Male ; Pancreas ; blood supply ; diagnostic imaging ; Ultrasonography

PURPOSE: The purpose of this study is to provide better understanding as to how the "double" vascular arcades, in contrast to other intestinal marginal vessels, develop along the right margin of the pancreatic head. MATERIALS AND METHODS: In human fetuses between 8-30 weeks, we described the topographical anatomy of the vessels, bile duct, duodenum as well as the ventral and dorsal primordia of the pancreatic head with an aid of pancreatic polypeptide immunohisto-chemistry. RESULTS: The contents of the hepatoduodenal ligament crossed the superior side of the pylorus. Moreover, the right hepatic artery originating from the superior mesenteric artery ran along the superior aspect of the pancreatic head. An arterial arcade, corresponding to the posterior pancreaticoduodenal arteries, encircled the superior part of the pancreatic head, whereas another arcade, corresponding to the anterior pancreaticoduodenal arteries, surrounded the inferior part. The dorsal promordium of the pancreas surrounded and/or mixed the ventral primordium at 13-16 weeks. Thus, both arterial arcades were likely to attach to the dorsal primordium. CONCLUSION: The fetal anatomy of the pancreaticoduodenal vascular arcades as well as that of the hepatoduodenal ligament were quite different from adults in topographical relations. Thus, in the stage later than 30 weeks, further rotation of the duodenum along a horizontal axis seemed to be required to move the pylorus posterosuperiorly and to reflect the superior surface of the pancreatic head posteriorly. However, to change the topographical anatomy of the superior and inferior arterial arcades into the final position, re-arrangement of the pancreatic parenchyma might be necessary in the head.
Arteries/*embryology ; Duodenum/anatomy & histology/*blood supply/*embryology ; Female ; Fetus/*blood supply ; Gestational Age ; Humans ; Immunohistochemistry ; Male ; Pancreas/anatomy & histology/*blood supply/*embryology ; Pregnancy

Adenocarcinoma, Papillary ; blood supply ; metabolism ; pathology ; Adult ; Aged ; Carcinoma, Pancreatic Ductal ; blood supply ; metabolism ; pathology ; Chemokine CXCL12 ; metabolism ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Lymph Nodes ; metabolism ; Lymphatic Metastasis ; Male ; Microvessels ; pathology ; Middle Aged ; Neoplasm Staging ; Neovascularization, Pathologic ; metabolism ; pathology ; Pancreas ; metabolism ; Pancreatic Neoplasms ; blood supply ; metabolism ; pathology ; Receptors, CXCR4 ; metabolism

OBJECTIVETo observe the changes in surface microcirculation of pancreas after high-voltage electric burn (HEB).

METHODSThirty rabbits were divided into electrical injury (E) group and control (C) group in a simple random method, with 15 rabbits in each group. Rabbit model of HEB was reproduced from E group with TC-30-20KVA type voltage regulator and YDJ-10KVA type experimental transformer. Rabbits in C group were shamly burned with the same equipment as in E group but not electrified. Intravenous blood of rabbits in both groups was drawn 15 mins before HEB and 0, 1, 2, 4, 8 h after to determine the levels of serum amylase and blood glucose. The morphology of the pancreas microvessels and its surrounding tissues, and the dynamic changes in microvascular blood flow were observed with WX-9 microscope and its image analytical system.

RESULTSThe level of serum amylase of rabbits in E group increased gradually and peaked (849 +/- 39) U/L at 8 post HEB h (PHH), which decreased gradually reaching the nadir (153 +/- 21) U/L at 8 PHH in C group (P < 0.05). The blood glucose levels of rabbits in E group and C group increased gradually, with the former level obviously higher than the latter (P < 0.05). Arteriole, venule and capillary network on the surface of pancreatic lobules of rabbits in both groups were clearly seen and well-distributed in the natural way before HEB. In E group, arterioles of rabbits contracted at 0 PHH, and increased gradually in caliber size at 1 PHH; venules of rabbits were unevenly thickened at 2 PHH, and dilated at 8 PHH; the capillaries were contracted or with interrupted flow or completely obstructed at 0 PHH, and their thickness were uneven at 2 PHH, showing exudation at 8 PHH. There was no obvious change of microvessels in rabbits in C group at each time point. There was no exudation and bleeding around the microvessels on the pancreas surface of rabbits in both groups before HEB. In E group exudation was observed around microvessels at 1 PHH, bleeding was observed at 2 PHH and became obvious at 4 PHH; exudation and diffuse bleeding from capillaries were observed at 8 PHH. There was no exudation and bleeding in rabbits in C group as observed at each time point. Before HEB, blood flow speed in microvessels of rabbits in 2 groups was similar to each other (P > 0.05), and no erythrocyte aggregation or microthrombus was found in both groups. In E group, blood flow speed slowed down at 0 PHH as compared with that before HEB, it accelerated at 1 h and slowed down later; erythrocyte aggregation in venules and capillaries was found at 0 PHH, and it aggregated gradually. No above-mentioned change was found in C group.

CONCLUSIONSHEB produces microcirculation disturbance and functional disturbance of pancreas.

Animals ; Burns, Electric ; blood ; pathology ; Female ; Male ; Microcirculation ; Pancreas ; blood supply ; pathology ; Rabbits

OBJECTIVETo evaluate the clinical value of color Doppler in monitoring graft flow in patients who underwent simultaneous pancreas-kidney (SPK) transplantation.

METHODSTotally 18 patients received color Doppler ultrasonography on day 1, 3, and 7 after SPK. Volumes and arteriovenous velocities of the kidney and pancreas grafts were recorded, and resistance index (RI) was calculated.

RESULTSColor Doppler ultrasound clearly displayed the modality, size, and flow of the kidney and pancreas grafts. Compared with the single kidney grafts, the modality, volume, and arteriovenous velocity of kidney grafts in SPK was not significantly different. Although the volume of pancreas graft was remarkably larger than the normal control pancreas early after transplantation, no difference in artery velocity was found between pancreas graft and normal pancreas. The spectrum of the portal vein in pancreas grafts showed the typical spectrum of iliac veins.

CONCLUSIONColor Doppler ultrasound is sensitive in monitoring the graft flow of SPK recipients and can be used to identify postoperative vascular complications and evaluate tissue perfusion.

Humans ; Iliac Vein ; diagnostic imaging ; Kidney ; blood supply ; diagnostic imaging ; Kidney Transplantation ; Pancreas ; blood supply ; diagnostic imaging ; Pancreas Transplantation ; Portal Vein ; diagnostic imaging ; Ultrasonography, Doppler, Color

OBJECTIVETo discuss the value of a simple occlusive technique of the triple vessels, ie, portal vein, superior mesenteric vessels and splenic vein, in complicated pancreaticoduodenectomy.

METHODSThe technique was fulfilled with a No.8 urethral catheter to encycle the portal vein, superior mesenteric vessels and its near tissue plus pancreatic tail and splenic vein than the neck of pancreas was transected and well exposure superior mesenteric vein and complete transaction of uncinate. From November 2005 to November 2006 the technique was applied to 12 cases of pancreatic malignancy which presented very infiltrated and adhesive to the hilar vascular structure.

RESULTSThe 12 cases were accomplished according with this technique. The operating time was (292.4 +/- 36.3) min (270 - 390 min) and the intraoperative blood loss was (833.3 +/- 618.4) ml (300 - 2500 ml). The postoperative complication included one case of lymphatic leakage, two cases of pneumonia, one case of abdominal infection and two cases of wound infection. There was no perioperative mortality. The postoperative hospital stay was 17 d (11 - 29 d).

CONCLUSIONSUse this triple vessels occlusive technique can improve the safety and feasibility in complicated cases of pancreaticoduodenectomy.

Aged ; Anastomosis, Surgical ; methods ; Female ; Humans ; Male ; Mesenteric Artery, Superior ; physiopathology ; Middle Aged ; Neoplasm Invasiveness ; Pancreas ; blood supply ; pathology ; surgery ; Pancreatic Neoplasms ; pathology ; surgery ; Pancreaticoduodenectomy ; methods ; Portal Vein ; physiopathology ; Splenic Vein ; physiopathology ; Treatment Outcome

It was reported that pancreatic arteries constricted during the early phase of bile salt-induced acute pancreatitis (AP), leading to pancreatic microcirculatory disturbance. We conducted this experiment to verify whether the above-mentioned finding was true. AP was induced with intraductal injection of taurodeoxyholate. Small pancreatic artery pressure in dogs was recorded. Functional capillaries were counted and calibrated by multiplying wet weight of pancreas. Pancreatic perfusion was measured with Laser Doppler flowmeter. Pancreatic arterioles of rats dilated during the initial 20 min of AP, and pancreatic arterial pressure declined during the early phase of AP in dogs (from 104.5 +/- 4.8 mmHg to 54.6 +/- 5.6 mmHg). The hematocrit of blood from inferior vena cava was significantly lower than that of portal vein at 5 min after pancreatitis induction. The "true" pancreatic functional capillary density increased. The early pancreatic microcirculatory disturbance coincided with a marked increase of portal vein pressure (PVP) as high as 9.18 +/- 0.78 mmHg. Reduction of PVP to baseline level was followed by a marked increase of pancreatic perfusion (by 1.4-fold). Arterial dilatation, but not constriction, occurred during the early phase of bile salt-induced AP. The pancreatic microcirculatory disturbance was due to a marked rise in PVP that greatly reduced the pressure difference in the pancreatic blood vessels and increased plasma extravasation which led. to local hemoconcentration.
Animals ; Bile Acids and Salts ; adverse effects ; Hypertension, Portal ; complications ; Male ; Microcirculation ; drug effects ; physiology ; Pancreas ; blood supply ; Pancreatitis ; etiology ; physiopathology ; Portal Pressure ; Portal Vein ; physiopathology ; Rats ; Rats, Sprague-Dawley