Question:medium
During a complex duodenal surgery, a vessel posterior to the duodenum is cut, resulting in massive bleeding and blood collection. Which vessel is most likely injured?
During a complex duodenal surgery, a vessel posterior to the duodenum is cut, resulting in massive bleeding and blood collection. Which vessel is most likely injured?
Show Hint
Major vessel posterior to the duodenum = inferior vena cava.
Updated On: May 14, 2026
- Superior mesenteric artery
- Inferior vena cava
- Aorta
- Portal vein
Show Solution
The Correct Option is B
Solution and Explanation
Step 1: Understanding the Question:
This question tests surgical anatomy, specifically the relations of the duodenum. The "posterior" relationship is critical when performing procedures like the Kocher maneuver.
Step 2: Detailed Explanation:
Duodenal Relations: The second part (descending) of the duodenum lies directly anterior to the hilum of the right kidney and the Inferior Vena Cava (IVC).
Kocher Maneuver: This is a surgical maneuver used to mobilize the duodenum and the head of the pancreas. It involves incising the lateral peritoneal reflection. During this, the surgeon must be extremely careful not to injure the underlying IVC.
Nature of Bleeding: An injury to the IVC results in "massive bleeding and blood collection" due to the high volume of blood and the difficulty in controlling a large venous tear in a deep, narrow space.
Other posterior vessels: The Gastroduodenal Artery lies posterior to the first part of the duodenum (commonest bleeder in peptic ulcer disease). The Aorta and SMA are further to the left or deeper.
Portal Vein: This is formed by the union of the SMV and splenic vein posterior to the neck of the pancreas, slightly higher and more medial than the second part of the duodenum.
Step 3: Final Answer:
The IVC is the major large-caliber vessel located directly posterior to the second part of the duodenum, making it the most likely source of massive bleeding during mobilization.
This question tests surgical anatomy, specifically the relations of the duodenum. The "posterior" relationship is critical when performing procedures like the Kocher maneuver.
Step 2: Detailed Explanation:
Duodenal Relations: The second part (descending) of the duodenum lies directly anterior to the hilum of the right kidney and the Inferior Vena Cava (IVC).
Kocher Maneuver: This is a surgical maneuver used to mobilize the duodenum and the head of the pancreas. It involves incising the lateral peritoneal reflection. During this, the surgeon must be extremely careful not to injure the underlying IVC.
Nature of Bleeding: An injury to the IVC results in "massive bleeding and blood collection" due to the high volume of blood and the difficulty in controlling a large venous tear in a deep, narrow space.
Other posterior vessels: The Gastroduodenal Artery lies posterior to the first part of the duodenum (commonest bleeder in peptic ulcer disease). The Aorta and SMA are further to the left or deeper.
Portal Vein: This is formed by the union of the SMV and splenic vein posterior to the neck of the pancreas, slightly higher and more medial than the second part of the duodenum.
Step 3: Final Answer:
The IVC is the major large-caliber vessel located directly posterior to the second part of the duodenum, making it the most likely source of massive bleeding during mobilization.
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