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
. 2020 Oct 22;15(12):2710-2713.
doi: 10.1016/j.radcr.2020.10.021. eCollection 2020 Dec.

A case of stent-graft implantation for postpancreaticoduodenectomy hemorrhage in a patient with a reconstructed gastric tube

Tomohiro Komada  1 , Yasushi Tachi  2 , Ken Nagasaka  3 , Suguru Yamada  4 , Masaya Matsushima  1 , Yutaro Sakaki  1 , Shinji Naganawa  1
Affiliations
Case Reports

A case of stent-graft implantation for postpancreaticoduodenectomy hemorrhage in a patient with a reconstructed gastric tube

Tomohiro Komada et al. Radiol Case Rep. .

Abstract

In patients with a reconstructed gastric tube, the right gastroepiploic artery is a very important feeding artery of the tube, which must be preserved when performing a pancreaticoduodenectomy. A 76-year-old man with a reconstructed gastric tube underwent pancreaticoduodenectomy for distal bile duct carcinoma. On postoperative day 8, he had an arterial hemorrhage from a drain, apparently from a ligation of the anterior superior duodenal artery. He, therefore, underwent stent-graft placement in the gastroduodenal artery. The stent-grafts were temporarily occluded, and the gastric tube was necrotizing. However, thrombolytic therapy allowed the stent-grafts to reopen and prevented gastric tube necrosis. We believe our case of stent-graft implantation in the gastroduodenal artery is the first of this kind to successfully prevent lethal necrosis of the gastric tube.

Keywords: Gastric tube; Pancreaticoduodenectomy; Postoperative hemorrhage; Stent-graft.

PubMed Disclaimer

Figures

Fig 1 –
Fig. 1
Dynamic computed tomography. Arterial phase computed tomography shows massive bloody ascites (arrowhead) and contrast leakage anterior to the remaining pancreatic area (arrow).
Fig 2 –
Fig. 2
Stent-graft placement for postpancreaticoduodenectomy hemorrhage in a patient with a reconstructed gastric tube. (A) Angiography does not indicate a contrast leak or pseudoaneurysm. (B) Angiography does not delineate the peripheral vessels. (C) Angiography from the catheter advanced into the peripheral vessel allows blood flow to be observed.
Fig 3 –
Fig. 3
Ischemia of the gastric tube due to stent-graft occlusion and thrombolysis. (A) Dynamic computed tomography shows poor contrast of the wall and intramural gas in the gastric tube (arrowhead). (B) On endoscopy, strong ischemic changes are seen in the gastric tube. (C) Angiography shows patency of the stent-grafts and improved blood flow in the peripheral right gastroepiploic artery. (D) On endoscopy, improvement in ischemic changes are seen in the gastric tube 6 days after thrombectomy.
See this image and copyright information in PMC

References

    1. Jansen S.M., Almasian M., Wilk L.S., de Bruin D.M., van Berge Henegouwen M.I., Strackee S.D. Feasibility of optical coherence tomography (OCT) for intra-operative detection of blood flow during gastric tube reconstruction. Sensors. 2018;18(5):1331. doi: 10.3390/s18051331. - DOI - PMC - PubMed
    1. Milstein D.M., Ince C., Gisbertz S.S., Boateng K.B., Geerts B.F., Hollmann M.W. Laser speckle contrast imaging identifies ischemic areas on gastric tube reconstructions following esophagectomy. Medicine. 2016;95(25):e3875. doi: 10.1097/.0000000000003875. - DOI - PMC - PubMed
    1. Orii T., Yoshimura M., Kitahara H., Karasawa Y. Pylorus-preserving pancreatoduodenectomy for pancreatic head cancer after surgery for esophageal cancer with gastric tube reconstruction in a long-term survivor: A case report. Int J Surg Case Rep. 2019;55:92–98. doi: 10.1016/j.ijscr.2019.01.024. - DOI - PMC - PubMed
    1. Izumi H., Yoshii H., Abe R., Yamamoto S., Mukai M., Nomura E. Pancreaticoduodenectomy following surgery for esophageal cancer with gastric tube reconstruction: a case report and literature review. Surg Case reports. 2019;5(1):191. doi: 10.1186/s40792-019-0751-1. - DOI - PMC - PubMed
    1. Onishi Y., Kimura H., Kanagaki M., Oka S., Fukumoto G., Otani T. Placement of a Viabahn stent-graft for hepatic artery pseudoaneurysm complicated by arterial dissection caused by a guiding sheath. Radiol Case Rep. 2019;14(6):711–713. doi: 10.1016/j.radcr.2019.03.021. - DOI - PMC - PubMed

Publication types

LinkOut - more resources