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 2/2 - What organ(s) might show reduced blood flow, but are at little risk of ischemia due to collateral circulation to the organ(s)?

Click on your selected option(s) below  (correct = 1, over-thinking = 2+)

Incorrect.  We concluded in the prior question that the liver lacked collateral circulation from the injury and was at ischemic risk.

Incorrect. The spleen is supplied by the splenic artery, a direct branch of the celiac trunk arising from the aorta. As it is not part of the common hepatic artery system flow to the organ will generally be normal.

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, so flow to the small intestines will generally be normal. 

Incorrect.  We concluded in the prior question that the gallbladder lacked collateral circulation from the injury and was at ischemic risk.  

Correct! The stomach has multiple blood supplies (left/right gastric, left/right gastro-omental, and short gastric) that can compensate for the injury.  The transection of the common hepatic artery reduces flow into the proper hepatic artery (thus no flow in the right gastric artery) and the gastroduodenal artery (thus no flow into the right gastro-omental artery). There is sufficient flow from these intact arteries to compensate for the flow loss so the organ is at limited 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.

Correct! The duodenum receives supply from the gastroduodenal artery (which is in turn is supplied by the transected common hepatic artery). But the organ also receives supply from a network of shared pancreas vessels and from the superior mesenteric vessels (as the duodenum sits at the foregut/midgut boundary, with that boundary line is right at the entry point of the common bile duct and pancreatic duct in part 2 of the duodenum). Thus, the organ is at limited ischemic risk.