title: Total gastric necrosis due to aberrant arterial anatomy and retrograde blood flow in the gastroduodenal artery: a complication following pancreaticoduodenectomy.
abstract: Patients with coeliac artery occlusion often remain asymptomatic due to the rich collateral blood supply (pancreaticoduodenal arcades) from the superior mesenteric artery. However, division of the gastroduodenal artery (GDA) during pancreaticoduodenectomy may result in compromised blood supply to the liver, stomach and spleen. Postoperative complications associated with this condition are rarely reported in the literature. We report two cases of coeliac artery occlusion encountered during pancreaticoduodenectomy, one of which was complicated by hepatic ischaemia and total gastric infarction postoperatively. Based on our experience and review of the literature, a management algorithm for coeliac artery stenosis encountered during pancreaticoduodenectomy is proposed.
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Royal Surrey County Hospital, Guildford, UK. jinbong@doctors.net.uk
authors.forename: Jin J
authors.initials: JJ
authors.lastname: Bong
authors.forename: Nariman D
authors.initials: ND
authors.lastname: Karanjia
authors.forename: Neville
authors.initials: N
authors.lastname: Menezes
authors.forename: Tim R
authors.initials: TR
authors.lastname: Worthington
authors.forename: Robin G
authors.initials: RG
authors.lastname: Lightwood