Pancreaticoduodenectomy and the Celiac Artery Compression Syndrome
Copyright policy )Pancreaticoduodenectomy and the Celiac Artery Compression Syndrome
Celiac compression is usually a benign condition, but when surgery necessitates division of collaterals from the superior mesenteric artery, it may cause life-threatening gut ischemia. We report a case of cholangiocarcinoma necessitating pancreaticoduodenectomy in a patient with celiac artery compression by the median arcuate ligament. Preoperative duplex scanning confirmed the celiac stenosis and revealed retrograde flow through collaterals from the superior mesenteric artery. Intraoperative continuous wave Doppler examination revealed that gastric blood flow disappeared with compression of the superior mesenteric artery. This maneuver no longer affected gastric flow after transection of the compressing structures at the celiac origin. Preoperative identification of celiac artery stenosis is crucial to prevent small bowel ischemia and possible anastomotic breakdown or liver failure. Duplex scanning can provide important insight about collateral circulation, and intraoperative Doppler testing can assess the adequacy of revascularization.
- University of Washington United States
- University of Mary United States
Male, Ligaments, Duodenum, Common Bile Duct Neoplasms, Diaphragm, Arterial Occlusive Diseases, Constriction, Pathologic, Middle Aged, Mesenteric Arteries, Adenoma, Bile Duct, Celiac Artery, Mesenteric Vascular Occlusion, Humans, Pancreas
Male, Ligaments, Duodenum, Common Bile Duct Neoplasms, Diaphragm, Arterial Occlusive Diseases, Constriction, Pathologic, Middle Aged, Mesenteric Arteries, Adenoma, Bile Duct, Celiac Artery, Mesenteric Vascular Occlusion, Humans, Pancreas
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