Celiac axis stenosis as a rare but critical condition treated with pancreatoduodenectomy: report of 2 cases.
We describe 2 cases of patients with loss of hepatic arterial flow during surgery for pancreatic head cancer due to celiac stenosis caused by median arcuate ligament compression. The first case underwent pylorus-resecting pancreatoduodenectomy for pancreatic head cancer. After resection of the gastroduodenal artery, flow in the common hepatic artery disappeared, and celiac axis stenosis was identified. Interventional stent insertion was attempted, however, it failed due to the acute angle of the celiac orifice (os). This problem was resolved by arterial reconstruction. The second case underwent pylorus-preserving pancreatoduodenectomy for pancreatic head cancer and the same phenomenon occurred during the procedure. Interventional stent insertion was also tried; in this patient, however, it failed due to the acute angle of the celiac os. The problem was resolved by changing a femoral approach to a brachial approach, and the stent was inserted into the celiac os successfully.
Center for Liver Cancer, National Cancer Center, Goyang, Korea.
Hyeong Min
HM
Park
Center for Liver Cancer, National Cancer Center, Goyang, Korea.
Seung Duk
SD
Lee
Center for Liver Cancer, National Cancer Center, Goyang, Korea.
Eung Chang
EC
Lee
Center for Liver Cancer, National Cancer Center, Goyang, Korea.
In Joon
IJ
Lee
Center for Liver Cancer, National Cancer Center, Goyang, Korea.
Sung-Sik
SS
Han
Center for Liver Cancer, National Cancer Center, Goyang, Korea.
Hyun Boem
HB
Kim
Center for Liver Cancer, National Cancer Center, Goyang, Korea.
Seoung Hoon
SH
Kim
Center for Liver Cancer, National Cancer Center, Goyang, Korea.
Soon-Ae
SA
Lee
Center for Liver Cancer, National Cancer Center, Goyang, Korea.
Sang-Jae
SJ
Park
Celiac axis stenosis; Median arcuate ligament; Pancreatoduodenectomy