Successful pancreaticoduodenectomy with immediate vascular reconstruction in a patient with cancer of the pancreatic head and celiac artery stenosis. A case report.
BACKGROUND
Celiac artery stenosis is observed in a significant percentage of individuals in the general population. Although usually clinically silent and insignificant, due to the presence of extensive collaterals between the celiac artery and the superior mesenteric artery, celiac artery stenosis may be associated with potentially catastrophic ischemic complications in patients undergoing pancreaticoduodenectomy, due to the abrupt interruption of the collateral pathways. Therefore, revascularization may be indicated in selected patients with celiac artery stenosis undergoing a PD.


METHODS
We present a patient with celiac artery stenosis diagnosed intraoperatively during a PD, who underwent vascular reconstruction at the time of the PD. In the immediate postoperative period, he developed hepatic ischemia due to stenosis at the anastomosis of the stent with the hepatic artery. He was subsequently treated successfully with the endovascular placement of a stent. In retrospect, a careful reevaluation of the preoperative abdominal CT scan showed the stenosis at the origin of celiac artery.


CONCLUSIONS
A careful evaluation of abdominal CT scan is required to preoperatively identify this not uncommon vascular obstructive disease, especially in asymptomatic patients. Otherwise, the astute surgeon should suspect celiac artery stenosis based on intraoperative findings/changes immediately following ligation of the gastroduodenal artery during a PD.
Peros
George
G
Fourth Department of Surgery, Athens University Medical School, Attikon University Hospital. Athens, Greece.
Sakorafas
George H
GH
Giannopoulos
George A
GA
Manikis
Dimitrios
D
Vassiliu
Pantelis
P
Brountzos
Elias N
EN
D000714:Anastomosis, Surgical / Q000379:methods; D021441:Carcinoma, Pancreatic Ductal / Q000150:complications / Q000601:surgery*; D002445:Celiac Artery / Q000473:pathology / Q000601:surgery*; D003251:Constriction, Pathologic / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods; D019651:Plastic Surgery Procedures; D013997:Time Factors; D016896:Treatment Outcome