case_images: PMC10466400_01
case_images: Axial (A), coronal (B), and sagittal (C) imaging of contrast-enhanced CT scan. The PPPV was located anterior to the pancreas and posterior to the duodenum, and the L-shaped SV was longitudinally located posterior to the pancreatic neck. PPPV, prepancreatic postduodenal portal vein; SV, spleen vein; SMV, superior mesenteric vein; *The pancreas posterior to PPPV.
case_images: fmed-10-1180759-g001.jpg
case_images: PMC10466400_01_fmed-10-1180759-g001.jpg
case_images: fig1
case_images: The portal-phase imaging showed that the portal vein (PV) was located anterior to the pancreatic head and posterior to the duodenum, and the L-shaped splenic vein (SV) was longitudinally located posterior to the pancreatic neck (Figures 1A-C), with no vascular invasion of the tumor.
case_images: Three-dimensional vascular reconstruction of contrast-enhanced CT scan. The PPPV was located anterior to the pancreas and posterior to the duodenum, and the L-shaped SV was longitudinally located posterior to the pancreatic neck (A). The RHA was located anterior to the CBD, and the ARHA originated from GDA was located posterior to the PV (A). The branches of PV/SMV system were depicted from the anterior (B), posterior (C), and right side (D). PPPV, prepancreatic postduodenal portal vein; SV, spleen vein; SMV, superior mesenteric vein; LGV, left gastric artery; PSPDV, posterior superior pancreaticoduodenal vein; ASPDV, anterior pancreaticoduodenal superior pancreaticoduodenal vein; SRCV, superior right colonic vein; RGEV, right gastroepiploic vein; MCV, middle colon vein; J1V, the first jejunal vein; RHA, right hepatic artery; ARHA, accessory right hepatic artery; GDA, gastroduodenal artery; CBD, common bile duct.
case_images: fmed-10-1180759-g002.jpg
case_images: PMC10466400_01_fmed-10-1180759-g002.jpg
case_images: fig2
case_images: Three-dimensional vascular reconstruction revealed that the PPPV was located anterior to the head of the pancreas, posterior to the duodenum, and on the right side of the common bile duct (Figure 2A). Moreover, an accessory right hepatic artery (ARHA) originated from gastroduodenal artery (GDA) was found to be located posterior to the portal vein, whereas the right hepatic artery (RHA) was located anterior to the common bile duct (CBD) and PPPV (Figure 2A). More detailed vascular anatomy of the PV system was depicted in the three-dimensional vascular reconstruction, including the left gastric artery (LGV), posterior superior pancreaticoduodenal vein (PSPDV), anterior pancreaticoduodenal superior pancreaticoduodenal vein (ASPDV), superior right colonic vein (SRCV), right gastroepiploic vein (RGEV), middle colon vein (MCV), the first jejunal vein (J1V) (Figures 2A-D).
case_images: Intraoperative imaging before (A) and after (B) PPPV isolation. PPPV was located anterior to the pancreatic head, whereas SV was located posterior to the pancreatic neck. PPPV, prepancreatic postduodenal portal vein; SV, spleen vein; SMV, superior mesenteric vein.
case_images: fmed-10-1180759-g003.jpg
case_images: PMC10466400_01_fmed-10-1180759-g003.jpg
case_images: fig3
case_images: After dissection of the duodenum, the PPPV was found to be located anterior to the pancreatic head, posterior to the duodenum, and on the right side of the common bile duct (Figure 3A), which was consistent with preoperative imaging. Consequently, we isolated the PPPV safely with no vascular injury (Figure 3B).