Truncus Coeliacus Stenosis in Duodenopancreatectomy
Authors:
F. Čečka 1; B. Jon 1; E. Havel 1; Miroslav Lojík 2; J. Raupach 2; Z. Bělobrádek 1; Č. Neoral 3; Z. Šubrt 1,4; A. Ferko 1,4
Authors‘ workplace:
Chirurgická klinika Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Hradci Králové
přednosta kliniky: doc. MUDr. A. Ferko, CSc.
1; Radiologická klinika Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Hradci Králové
přednosta kliniky: prof. MUDr. P. Eliáš, CSc.
2; I. chirurgická klinika Lékařské fakulty Univerzity Palackého a Fakultní nemocnice v Olomouci
přednosta kliniky: doc. MUDr. Č. Neoral, CSc.
3; Katedra válečné chirurgie, Fakulta vojenského zdravotnictví, Univerzita Obrany Brno
vedoucí katedry: doc. MUDr. L. Klein, CSc.
4
Published in:
Rozhl. Chir., 2009, roč. 88, č. 4, s. 192-195.
Category:
Monothematic special - Original
Overview
Introduction:
Patients with celiac axis stenosis are asymptomatic due to the rich collateral blood supply through superior mesenteric artery. Ligating and dividing gastroduodenal artery during pancreatoduodenectomy can cause ischemic threat especially to liver, less frequently stomach and spleen, or failure of anastomoses.
Case Report:
The authors present a case of 27-year-old female who underwent duodenopancreatectomy for pseudopapillary tumour of the head of pancreas. Celiac axis stenosis was found peroperatively and proven during angiography. Although an attempt of endovascular dilatation of celiac axis was unsuccessful, blood supply to the liver was sufficient and therefore we did not perform any other intervention to improve blood flow to the liver. Postoperative course was uneventful.
Discussion:
Celiac axis stenosis can be caused by tumour infiltration or lymphadenopathy in malignant disease, atherosclerosis or compression of the median arcuate ligament. The stenosis can be managed by endovascular treatment or arterial reconstruction.
In conclusion the authors propose a management algorithm to prevent the consequences of celiac axis stenosis.
Key words:
duodenopancreatectomy – celiac axis stenosis – liver ischemia
Sources
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Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2009 Issue 4
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