Arterial Supply of the Frist, Third and Fourth Portion of the Duodenum -An Anatomical Study with Special Reference to the Minimal Invasive Pancreaticoduodenectomy-

Tadashi Takamuro, Gen Murakami*, Koichi Hirata

First Department of Surgery and Second Department of Anatomy*, School of Medicine, Sapporo Medical University

By using 214 cadavers, we investigated tiny arterial supply to the first, third and fourth portions of the duodenum in order to obtain a better anatomical understanding for a minimal invasive operation in this region, like the modified pylorus-preserving pancreaticoduodenectomy. The supraduodenal artery (SDA) was sometimes (29.9%) present in the first portion. However, the infrapyloric artery (IPA) was a constant (97.6%) feeder of this portion. Moreover, the IPA was frequently (70.5%) distributed to the antrum as well as to the first portion. The posterior superior pancreaticoduodenal artery also extended a branch to the first portion, in contrast to the retroduodenal artery which was sometimes (8.5%) found as a fine twig of the gastroduodenal artery. The nomenclature of these arteries was discussed. The inferior pancreaticoduodenal artery (IPDA) often (55.1%) formed a common trunk with the upper jejunal artery (JA), but sometimes (24.2%) arose directly from the superior mesenteric artery (SMA). In case of the (right) hepatic artery arising from the SMA, the posterior branch originated from the hepatic artery (5.6%). The fourth portion was sometimes (16.7%) supplied by the JA, but never by direct twigs from the SMA. Consequently, preservation of the IPA as well as reconfirmation of the origin of the IPDA seemed to be required essentially during the minimal invasive operation.

Key words
anatomy of the duodenum, blood supply of the duodenum

Reprint requests
Tadashi Takamuro Department of Surgery, Higashi Sapporo Hospital
3-3-7-35 Higashi Sapporo, Shiroishi-ku, Sapporo, 003-8585 JAPAN

Accepted
November 5, 1997

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