Case Report
Copyright ©2013 Baishideng Publishing Group Co.
World J Gastroenterol. Dec 7, 2013; 19(45): 8435-8439
Published online Dec 7, 2013. doi: 10.3748/wjg.v19.i45.8435
Figure 1
Open in New Tab Full Size Figure Download Figure
Figure 1 Computed tomography images before and after chemoradiation therapy. A: Computed tomography (CT) image showing a 4.3 cm low-density pancreatic body tumor (T) that involves the common hepatic artery (CHA), splenic artery (SpA), and celiac axis (CeA); B: CT image showing obvious tumor shrinkage after chemoradiation therapy, although the tumor still involves the CHA, SpA, and CeA.
Figure 2
Open in New Tab Full Size Figure Download Figure
Figure 2 Imaging findings before and after endovascular treatment for the pseudoaneurysm. A: Computed tomography (CT) image indicating formation of an intra-abdominal abscess around the remnant pancreas head (arrow) with an occluded portal vein due to the spreading inflammation around the abscess (dotted circle); B: CT image showing the pseudoaneurysm emerging from the common hepatic artery (CHA) stump (black arrow). The white arrow shows the occluded right portal vein; C: Angiography image confirming the pseudoaneurysm emerging from the CHA stump (arrow); D: Covered stent placement (arrows) performed via the IPDA (dotted arrow) originating from the superior mesenteric artery (SMA); E: CT angiography image at the 6-mo follow-up showing the patent covered stent (arrows) and sustained hepatic artery flow. IPDA: inferior pancreaticoduodenal artery; PHA: proper hepatic artery.
Figure 3
Open in New Tab Full Size Figure Download Figure
Figure 3 Schema of the treatment course. A: The range of tumor invasion after the chemoradiation therapy (gray circle) and the resection line of the distal pancreatectomy with en-block celiac axis resection (DP-CAR) (double-headed arrow); B: After DP-CAR: Remnant pancreas head and the arcade of the pancreaticoduodenal artery; C: The pseudoaneurysm (P) at the CHA stump; D: Covered stent delivered via the IPDA (arrow). LGA: Left gastric artery; SpA: Splenic artery; CeA: Celiac axis; CHA: Common hepatic artery; SMA: Superior mesenteric artery; PV: Portal vein; PHA: Proper hepatic artery; GDA: Gastroduodenal artery; IPDA: Inferior pancreaticoduodenal artery; PVR: Portal vein resection.