title: A new test to avoid arterial complications during pancreaticoduodenectomy.
abstract: Celiac trunk or superior mesenteric artery stenosis are usually innocuous conditions. In such patients, arterial blood supply to the stomach, spleen, liver and bowel is sustained through extraordinarily well-developed pathways through the pancreas. If division of these collateral vessels is necessary during a surgical procedure such as pancreaticoduodenectomy, life-threatening celiac organ or bowel ischemia may occur. The authors describe a new test, using pancreatic inflow occlusion, to reliably identify celiac trunk or superior mesentery artery stenosis. The authors describe two cases of celiac axis occlusion and one case of superior mesenteric artery stenosis. In all three presented cases the gastroduodenal artery clamping test was negative and ischemia was only noticed after pancreatic section, suggesting that in severe occlusions this test may fail in diagnosing the vascular abnormality. All patients were successfully treated by revascularization with no operative mortality. If the diagnosis is unsuspected and in cases where appropriate angiographic studies have not been obtained before pancreatic resection, a test occlusion of the gastroduodenal artery should always precede its ligation. However, this test may not be effective in all cases and in instances where high suspicion of celiac axis or mesenteric stenosis is present, other maneuvers, such as pancreatic inflow test, could be helpful for the diagnosis of these rare and morbid situations.
authors.affiliation: Department of Abdominal Surgery, Cancer Hospital, São Paulo, Brazil. dr@drmarcel.com.br
authors.forename: Marcel Autran C
authors.initials: MA
authors.lastname: Machado
authors.forename: Paulo
authors.initials: P
authors.lastname: Herman
authors.forename: André L
authors.initials: AL
authors.lastname: Montagnini
authors.forename: Marcelo L V
authors.initials: ML
authors.lastname: Costa
authors.forename: Kenji
authors.initials: K
authors.lastname: Nishinari
authors.forename: Nelson
authors.initials: N
authors.lastname: Wolosker
authors.forename: Marcel C C
authors.initials: MC
authors.lastname: Machado
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000175:diagnosis*; D002445:Celiac Artery / Q000473:pathology* / Q000601:surgery; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000517:prevention & control; D008297:Male; D008638:Mesenteric Arteries / Q000473:pathology* / Q000601:surgery; D008643:Mesentery / Q000098:blood supply; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D010195:Pancreatitis / Q000175:diagnosis / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome