No-touch isolation technique in emergency pancreaticoduodenectomy for neoplastic hemorrhage: Two case reports and review of literature

Figure 1 Imaging of the duodenal tumor and pancreatic tumor. A: Imaging of the duodenal tumor and pancreatic tumor. Contrast-enhanced computed tomography showed a well-defined, enhancing masse, sized 5.0 cm × 6.0 cm, with heterogeneous density at the second portion of the duodenum (arrow); B: Imaging of the pancreatic tumor. Contrast-enhanced computed tomography showed a huge cystic mass measuring 17 cm, with some solid components and adjacent hematoma (arrow).

Figure 2 Illustration of no-touch isolation technique in emergency pancreaticoduodenectomy. All arteries (A-D) that supply the pancreatic head region are isolated before manipulation of the pancreatic head and duodenum in the early phase of resection during emergency pancreaticoduodenectomy. A: The gastroduodenal artery; B: First jejunal artery, inferior pancreaticoduodenal artery; C: Intrapancreatic arterial arcade, including the inferior pancreatic artery. D: The para-biliary arterial plexus, including the 3 or 9 o’clock arteries, anastomoses to the posterior superior pancreaticoduodenal artery. Panc: Pancreas; Duod: Duodenum; SMV: Superior mesenteric vein; SMA: Superior mesenteric artery; CHA: Common hepatic artery; CBD: Common bile duct; GDA: Gastroduodenal artery; IPDA: Inferior pancreaticoduodenal artery; FJA: First jejunal artery.