Ischemic gastropathy after distal pancreatectomy with celiac axis resection.
OBJECTIVE
Stomach-preserving distal pancreatectomy with en bloc resection of the celiac, common hepatic, and left gastric arteries is a radical operation performed for locally advanced cancer of the pancreatic body. However, it is not known whether the collateral pathways that develop immediately from the superior mesenteric artery to the gastroduodenal and hepatic arteries provide sufficient blood flow to support the hepatobiliary system and the stomach. This article examines the ischemic gastropathy that can occur after this procedure and identifies the predisposing conditions.


METHODS
Between 1997 and 2001, nine patients underwent stomach-preserving distal pancreatectomy with en bloc resection of the celiac, common hepatic, and left gastric arteries. Concomitant resection of the right gastric artery or gastroduodenal artery was performed due to cancer infiltration in three patients.


RESULTS
Irregular, shallow, and wide ulcerations thought to be ischemic in origin developed in these three patients, but all the ulcerations healed in 1-2 weeks with antiulcer medication. None of the other six patients had evidence of gastric ischemia.


CONCLUSIONS
Ischemic gastropathy is rare after distal pancreatectomy with celiac axis resection alone; however, division of additional arteries supplying the stomach may predispose to ischemic gastropathy.
Kondo
Satoshi
S
Department of Surgical Oncology, Division of Cancer Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, 060-8638, Sapporo, Japan.
Katoh
Hiroyuki
H
Hirano
Satoshi
S
Ambo
Yoshiyasu
Y
Tanaka
Eiichi
E
Maeyama
Yoshihiro
Y
Morikawa
Toshiaki
T
Okushiba
Shunichi
S
D002447:Celiac Plexus / Q000601:surgery*; D003097:Collateral Circulation; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods; D010190:Pancreatic Neoplasms / Q000601:surgery; D013270:Stomach / Q000098:blood supply*; D013276:Stomach Ulcer / Q000209:etiology