Reversed arterial flow in the paramedian segments of the liver after pancreaticoduodenectomy

Variation of splanchnic arterial anatomy is frequent and may complicate pancreatic surgery, leading to life‐threatening postoperative complications. We report a case of severe hepatic dysfunction after pancreaticoduodenectomy due to accidental section of the right hepatic artery. Bedside ultrasound examination showed a reversed arterial flow in the paramedian segments of the liver. Based on intraoperative and ultrasound findings, a retrograde arterial supply of the right liver from the left hepatic artery through spontaneous anastomosis between the arteries of segment 4 and the right paramedian segments was assumed and confirmed by postoperative CT examination. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 39:99–103, 2011