title: Emergency celiac revascularization for supramesocolic ischemia during pancreaticoduodenectomy: report of a case.
abstract: Occlusive atherosclerotic disease of the celiac artery may be diagnosed late during pancreatic resection, inducing a sudden ischemic threat to the liver, stomach, pancreas, and new anastomoses. Failure to identify and correct the insufficient supramesocolic flow can result in serious morbidity. We report the case of a 64-year-old man in whom sudden and unexpected visceral ischemia occurred while Whipple's procedure was being performed to resect a cephalopancreatic mass. We diagnosed occlusion of the celiac trunk and achieved celiac revascularization by performing an end-to-side transposition of the celiac artery onto the superior mesenteric artery, which had been dissected during the lymphadenectomy. We describe this technique as an alternative treatment for acute supramesocolic ischemia caused by celiac axis occlusion. It is important that surgeons performing pancreatic surgery are aware of the possibility of this complication because the test occlusion of the gastroduodenal artery, which must always precede its ligation, can be negative.
authors.affiliation: Department of Medical and Surgical Sciences, Surgical Clinic, Brescia University, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
authors.forename: Nazario
authors.initials: N
authors.lastname: Portolani
authors.forename: Guido A M
authors.initials: GA
authors.lastname: Tiberio
authors.forename: Arianna
authors.initials: A
authors.lastname: Coniglio
authors.forename: Gianluca
authors.initials: G
authors.lastname: Baiocchi
authors.forename: Nereo
authors.initials: N
authors.lastname: Vettoretto
authors.forename: Stefano M
authors.initials: SM
authors.lastname: Giulini
mesh_terms: D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D002445:Celiac Artery / Q000601:surgery*; D004638:Emergency Treatment; D004691:Endarterectomy; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000601:surgery*; D008297:Male; D017538:Mesenteric Artery, Superior / Q000601:surgery*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D014781:Viscera / Q000098:blood supply*