Gastric venous congestion and bleeding in association with total pancreatectomy

Abstract

Background: Gastric venous congestion and bleeding in association with total pancreatectomy (TP) were evaluated.

Methods: Thirty-eight patients of TP were retrospectively analyzed. TP was classified as TP with distal gastrectomy (TPDG), pylorus-preserving TP (PPTP), subtotal stomach-preserving TP (SSPTP), and TP with segmental duodenectomy (TPSD).

Results: Portal vein or superior mesenteric vein resection and reconstruction was performed in 24 patients (62.2%). Gastric bleeding occurred immediately after tumor resection in one of eight patients who underwent SSPTP, and urgent anastomosis between the right gastroepiploic and left ovarian vein stopped the bleeding. Another case of gastric bleeding was observed a few hours after TP in one of nine patients who underwent PPTP, and hemostasis was achieved after conservative therapy. Gastric bleeding was not observed in 16 patients who underwent TPDG and five who underwent TPSD. Some patients underwent preservation of gastric drainage veins (left gastric vein, right gastric vein, or right gastroepiploic vein). Neither patient with bleeding underwent preservation of a gastric drainage vein.

Conclusions: To preserve the subtotal or whole stomach when performing TP, one of the gastric drainage veins should undergo preservation or reconstruction, and anastomosis between the right gastroepiploic vein and left ovarian vein may be beneficial.

Keywords: Gastric bleeding; Gastric venous congestion; Pancreatic cancer; Portal vein resection; Total pancreatectomy.

Figure 1

Types of total pancreatectomy according to the type of gastrectomy (1993–2015). PPTP pylorus‐preserving total pancreatectomy, SSPTP subtotal stomach‐preserving total pancreatectomy, TPDG total pancreatectomy with distal gastrectomy, TPSD total pancreatectomy with segmental duodenectomy

Figure 2

Anastomosis between the RGEV and LOV in subtotal stomach‐preserving total pancreatectomy with PV and SMV resection. LOV left ovarian vein,LRV left renal vein, PV portal vein, RGEV right gastroepiploic vein, SMA superior mesenteric artery, SMV superior mesenteric vein

Figure 3

Preservation of the LGV in subtotal stomach‐preserving total pancreatectomy with PV and SMV resection. CHA common hepatic artery, CHD common hepatic duct, LGV left gastric vein, PV portal vein, SA splenic artery, SMA superior mesenteric artery, SMV superior mesenteric vein, ST stomach

Figure 4

Preservation of the RGEV in total pancreatectomy with segmental duodenectomy. CBD common bile duct, GCT gastrocolic trunk, GDA gastroduodenal artery, IMV inferior mesenteric vein, RGEV right gastroepiploic vein, SMV superior mesenteric vein, ST stomach, SV splenic vein