Case

A patient is admitted to Shock Trauma with a gunshot wound to the abdomen. A CT angiogram shows the bullet has transected the common hepatic artery at the junction of the gastroduodenal artery.

Question 1/2 - What organ(s) are at most risk of ischemia?

Click on your selected option(s) below  (correct = 2, over-thinking = 3+)

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Correct!  The common hepatic artery provides blood to the proper hepatic artery, which in turn splits into the left and right hepatic artery supplying the left and right regions of the liver. Since the injury is at the junction of the gastroduodenal artery, this prevents retrograde supply from the gastroduodenal artery to the proper hepatic artery. Thus, the liver in this case now has no blood supply and at ischemic risk.

Incorrect. The spleen is supplied by the splenic artery, a direct branch of the celiac trunk arising from the aorta. It is not part of the common hepatic artery system.

Incorrect. The bulk of the small intestines are supplied by the superior mesenteric artery via intestinal branches. These are not part of the common hepatic artery system. 

Correct!  The gallbladder is supplied by the cystic artery, which is most commonly a branch from the right hepatic artery. The common hepatic artery provides blood to the proper hepatic artery, which in turn splits into the left and right hepatic artery supplying the left and right regions of the liver. Since the injury is at the gastroduodenal artery, this prevents retrograde supply from the gastroduodenal artery to the proper hepatic artery. Thus, the gallbladder in this case now has no blood supply and at ischemic risk.  

Incorrect. The pancreas has multiple blood supplies that can compensate for the single branch arising from the common hepatic artery system (that branch is the pancreaticoduodenal artery, arising from the gastroduodenal artery which is a branch of the common hepatic artery, but as there are other branches including splenic and branches from the superior mesenteric system, the pancreas has sufficient blood to be a lesser ischemic risk).

Incorrect. The transverse colon is supplied by the middle colic artery, a branch of the superior mesenteric artery. Thus, no ischemic risk from a common hepatic artery transection.

Incorrect. The ascending colon is supplied by the right colic artery, a branch of the superior mesenteric artery. Thus, no ischemic risk from a common hepatic artery transection.

Incorrect. The descending colon is supplied by the left colic artery, a branch of the inferior mesenteric artery. Thus, no ischemic risk from a common hepatic artery transection.