title: Celiac axis stenosis and lethal liver ischemia after pancreaticoduodenectomy.
abstract: Celiac axis stenosis can lead to a fatal hepatic ischemia after pancreaticoduodenectomy unless a simultaneous revascularisation of the celiac circulation is performed. In the present study are reported three cases of celiac axis stenosis, all of which had histologically confirmed periampullary cancer. Case 1: a 50-year-old male with a history of myocardial infarction and liver steatosis; visceral arteriography prior to the surgery demonstrated a celiac axis stenosis. Whipple operation was performed. After removing the specimen, no signs of liver ischemia were found (liver was cholestatic) and pulsation of the hepatic artery was strong. The patient died on the second postoperative day after an abrupt irreversible cardiac arrest. Autopsy proved acute severe hepatic ischemia. Case 2: a 64-year-old female. Preoperative visceral angiography showed significant celiac axis stenosis. As a first step of surgery the root of the celiac trunk was exposed, a fibrotic ring around it was divided. Standard D1 pylorus preserving pancreaticoduodenectomy was performed. Case 3: a 58-year-old female without preoperative angiography, indicated for surgery. After an occlusion test of the gastroduodenal artery the liver became ischemic. Division of the fibrotic ring around celiac axis was performed together with a standard D1 pylorus preserving pancreaticoduodenectomy. No postoperative complications were reported in both case 2 and 3.
authors.affiliation: Department of Surgery, 1st Faculty of Medicine, Charles University and Thomayer's Teaching Hospital, Prague, Czech Republic. ludmila.lipska@ftn.cz
authors.forename: Ludmila
authors.initials: L
authors.lastname: Lipska
authors.forename: Vladimir
authors.initials: V
authors.lastname: Visokai
authors.forename: Miroslav
authors.initials: M
authors.lastname: Levy
authors.forename: Boris
authors.initials: B
authors.lastname: Koznar
authors.forename: Pavel
authors.initials: P
authors.lastname: Zaruba
mesh_terms: D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology*; D002445:Celiac Artery; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000209:etiology; D003287:Contrast Media; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology*; D008107:Liver Diseases / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*
chemical_list: D003287:Contrast Media