Retrospective Three-Dimensional CT Reconstruction in Complex Emergency Hepato-Pancreato-Biliary Surgery: A Proof-of-Concept Case Series with Anatomical Concordance to Intraoperative Findings and Narrative Review

Background/Objectives: Three-dimensional (3D) reconstruction of contrast-enhanced computed tomography (CT) data has shown value in elective hepato-pancreato-biliary (HPB) surgery, but its role in complex abdominal emergencies remains poorly defined. Complex emergency HPB operations are high-acuity procedures in which precise preoperative anatomical knowledge directly influences outcome, because inadequate characterization of vascular relationships in these operations may lead to intraoperative catastrophe, unrecognized vascular injury, incomplete resection, or perioperative death. We report a retrospective proof-of-concept case series designed to test whether 3D reconstructions generated from preoperative CT datasets, when read by an operator blinded to the intraoperative findings, correspond to the intraoperative findings used as ground truth and provide anatomical information beyond the original conventional CT report. Methods: Single-center retrospective consecutive case series of five patients who underwent complex emergency HPB surgery at the Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor,” Cluj-Napoca, Romania, between July 2018 and July 2022. All operations were guided by conventional contrast-enhanced CT. Three-dimensional reconstructions were generated after surgery, from the archived preoperative CT datasets by a single reader who was blinded to the intraoperative findings, to the operative note, and to the histopathological diagnosis. The 3D reconstructions were compared qualitatively with the intraoperative findings (ground truth) and with the original radiological report. Results: Five patients (3 women, 2 men; mean age 62.2 years) were analyzed: a right colonic flexure tumor with duodenal invasion, a duodenal gastrointestinal stromal tumor (GIST), an aortoduodenal fistula, a complex bilioduodenal fistulization with right hepatic artery pseudoaneurysm, and a periampullary tumor in contact with the inferior vena cava (IVC). In all five cases the blinded 3D reconstruction corresponded closely with the intraoperative findings, whereas the original conventional CT report did not match the intraoperative ground truth as precisely—particularly with respect to the exact location, the longitudinal and circumferential extent, and the local topography of vascular involvement and of fistulous tracts. Conclusions: Under blinded retrospective comparison, post hoc 3D reconstructions—generated through independent reassessment of the archived CT imaging by a reader blinded to the intraoperative findings—corresponded more closely with intraoperative findings than the original same-day emergency CT report in depicting vascular topography across five complex emergency HPB operations. These hypothesis-generating findings motivate a prospective study of preoperative 3D reconstruction within the emergency imaging pathway.