Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 Jan 25;2018(1):rjy002.
doi: 10.1093/jscr/rjy002. eCollection 2018 Jan.

Pancreaticoduodenectomy with hepatic arterial revascularization for pancreatic head cancer with stenosis of the celiac axis due to compression by the median arcuate ligament: a case report

Takashi Miyata  1 , Yusuke Yamamoto  1 , Teiichi Sugiura  1 , Yukiyasu Okamura  1 , Takaaki Ito  1 , Ryo Ashida  1 , Sunao Uemura  1 , Yoshiyasu Kato  1 , Katsuhisa Ohgi  1 , Atsushi Kohga  1 , Tsuneyuki Uchida  1 , Shusei Sano  1 , Masahiro Nakagawa  2 , Katsuhiko Uesaka  1
Affiliations
Case Reports

Pancreaticoduodenectomy with hepatic arterial revascularization for pancreatic head cancer with stenosis of the celiac axis due to compression by the median arcuate ligament: a case report

Takashi Miyata et al. J Surg Case Rep. .

Abstract

A 71-year-old woman presented to our hospital because pancreatic head cancer was suspected on a medical checkup. Computed tomography showed a 30 mm low-density lesion in the pancreatic head, and the stenosis of the celiac axis (CA) due to the median arcuate ligament (MAL) compression. We made a preoperative diagnosis of pancreatic head cancer and performed laparotomy. Transection of the MAL failed to restore adequate hepatic arterial flow, necessitating arterial revascularization, which was achieved by end-to-end anastomosis between the gastroduodenal artery and the middle colic artery. After reconstruction, Doppler ultrasonography showed improved hepatic arterial signal. The patient was discharged 16 days after surgery with no complications. When planning pancreaticoduodenectomy (PD) for such patients with CA stenosis due to MAL compression, surgeons should simulate a situation of insufficient hepatic arterial flow after division of the MAL, and prepare for reconstruction of the hepatic artery during PD.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
(a) Enhanced abdominal CT showed a low-density tumor (red arrow), 30 mm in diameter, in the pancreatic head. The superior mesenteric vein (SMV, blue arrow) and gastroduodenal artery (GDA, yellow arrow) were involved by this tumor. (b) Stenosis of the celiac artery (CA) was shown (green arrow). (c) Preoperative 3D CT angiogram showed the development of pancreatic artery arcade and a saccular aneurysm (purple arrow) of the inferior pancreaticoduodenal artery (IPDA), 20 mm in diameter. CHA, common hepatic artery; PHA, proper hepatic artery; SMA, superior mesenteric artery; MCA, middle colic artery.
Figure 2:
Figure 2:
(a) The median arcuate ligament (green arrow) compressed the CA. (b) Compression of the origin of the CA by the ligament was released. (c) The image shows that the GDA was clamped. (d) We checked the hepatic artery flow under GDA clamping, but the flow had not improved satisfactory.
Figure 3:
Figure 3:
(a) The purple arrow indicates the stump of the aneurysm. (b) The image was after reconstruction by end-to-end anastomosis of the GDA and the MCA (yellow arrow). The blue arrow indicates the anastomotic part of the SMV. (c) We checked the hepatic arterial flow after reconstruction, the hepatic arterial signal had increased.
See this image and copyright information in PMC

References

    1. Thompson NW, Eckhauser FE, Talpos G, Cho KJ. Pancreaticoduodenectomy and celiac occlusive disease. Ann Surg 1981;193:399–406. - PMC - PubMed
    1. Peros G, Sakorafas GH, Giannopoulos GA, Manikis D, Vassiliu P, Brountzos EN. Successful pancreaticoduodenectomy with immediate vascular reconstruction in a patient with cancer of the pancreatic head and celiac artery stenosis. A case report. JOP 2009;10:667–70. - PubMed
    1. Kurosaki I, Hatakeyama K, Nihei KE, Oyamatsu M. Celiac axis stenosis in pancreaticoduodenectomy. J Hepatobiliary Pancreat Surg 2004;11:119–24. - PubMed
    1. Machado MA, Herman P, Montagnini AL, Costa ML, Nishinari K, Wolosker N, et al. . A new test to avoid arterial complications during pancreaticoduodenectomy. HepatoGastroenterology 2004;51:1671–3. - PubMed
    1. Sharafuddin MJ, Olson CH, Sun S, Kresowik TF, Corson JD. Endovascular treatment of celiac and mesenteric arteries stenoses: applications and results. J Vasc Surg 2003;38:692–8. - PubMed

Publication types