Fourteen cases of vascular injury during pancreatobiliary surgery have
been treated at our institution. The patients' mean age was 49 years,
and nine were males. Six operations were performed for chronic pancre
atitis, six for cancer, and two for an inflammatory process. Operation
s included 11 pancreatic resections and one laparoscopic cholecystecto
my, one sphincteroplasty, and one pseudocyst drainage. Vessels injured
included the portal vein (7), superior mesenteric vein (6), superior
mesenteric artery (3), hepatic arteries (4), splenic vein (3). Six pat
ients experienced more than one vascular injury. In all but one case,
the injury was recognized and repaired during the initial operation. P
rimary repair was possible in seven cases. Six cases utilized autogeno
us tissue for repair. The one unrecognized injury was a right hepatic
artery ligation, and a delayed repair was not possible. Follow-up demo
nstrated two occlusions, one following a portal vein repair without cl
inical sequela and a superior mesenteric artery repair which resulted
in a small bowel stricture. The one unrecognized hepatic artery injury
resulted in necrosis of the proximal common hepatic duct. Vascular in
jury following pancreatobiliary injury tends to occur in the presence
of pancreatitis or cancer with its associated dense adhesions and infl
ammatory process. The variable anatomy of this area contributes to vas
cular injuries. Immediate recognition of the injury and repair appears
to yield excellent results.