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MORPHOLOGY AND VARIATIONS OF THE DUODENAL VASCULATURE:  Relationship to the Problems of Leakage from a Postgastrectomy Duodenal Stump, Bleeding Peptic Ulcer and Injury to the Common Duct

ALFRED L. SHAPIRO, M.D.; GREGORY L. ROBILLARD, M.D.
Arch Surg. 1946;52(5):571-602. doi:10.1001/archsurg.1946.01230050579006.
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DESPITE its increasing clinical importance, the blood supply of the duodenum has as yet been accorded little emphasis by anatomists. With a few exceptions, the meager and partially inaccurate descriptions in standard surgical and anatomic texts still reflect the teachings of a period when detailed consideration of the duodenal vasculature was pointedly dismissed as unwarranted because of its presumed surgical inaccessibility.1 Accurate knowledge of the arterial distribution of the duodenum, however, has become significant in the light of the relatively recent development of gastroduodenal, common duct and pancreatic surgical procedures. Of the several studies published since the turn of the century, almost all have been essentially concerned with the problem of massive hemorrhage in duodenal ulcer. The present investigation was initially undertaken to determine primarily the possible contributory role of devascularization incident to the usual surgical mobilization of the duodenum in dehiscence of the postgastrectomy stump but was later

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