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. 2024 Aug 8;10(1):184.
doi: 10.1186/s40792-024-01983-x.

Intraoperative severe gastric venous congestion during total pancreatectomy with replaced common hepatic artery: a case report

Takahiro Yamanaka  1   2 , Kenichiro Araki  3 , Hideki Suzuki  2 , Hidenobu Osawa  2 , Ken Shirabe  1
Affiliations

Intraoperative severe gastric venous congestion during total pancreatectomy with replaced common hepatic artery: a case report

Takahiro Yamanaka et al. Surg Case Rep. .

Abstract

Background: Gastric venous congestion (GVC) is one of the complications of total pancreatectomy (TP). Here, we report a case of intraoperative severe GVC during TP with a replaced common hepatic artery (RCHA).

Case presentation: A 65-year-old female patient was diagnosed with intraductal papillary mucinous carcinoma. Her CHA branched from the superior mesenteric artery as RCHA. She underwent subtotal stomach preserving TP. The tumor was resected with splenic artery (SpA) and total gastric vein transections. Severe GVC and bleeding from the stomach tube occurred intraoperatively. A strong pulsation was observed in the left gastric artery (LGA), and we suspected an increased blood flow from the celiac artery (CeA) to the LGA after SpA resection. Total gastrectomy (TG) was then performed to control the severe GVC-related bleeding. The patient was discharged without complications 19 days postoperatively.

Conclusion: TP with RCHA may increase the risk of severe GVC due to increased blood flow from CeA to LGA.

Keywords: Gastric venous congestion (GVC); Replaced common hepatic artery (RCHA); Total pancreatectomy (TP).

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Computed tomography (CT) and magnetic resonance imaging (MRI) of the case. a The enhanced CT detected the pancreatic body tumor and main pancreatic duct dilation in the pancreatic body and tail. The arrows indicated that the tumor was in contact with splenic artery (SpA). b The enhanced CT shows that the tumor was in contact with the left gastric vein (LGV). The arrows indicated the LGV. c Three-dimensional artery image from enhanced CT. Celiac artery (CeA), left gastric artery (LGA), SpA, superior mesenteric artery (SMA), replaced common hepatic artery (RCHA), left hepatic artery (LHA), right hepatic artery (RHA), gastroduodenal artery (GDA) and right gastric artery (RGA) were indicated. d MRI diffusion-weighted image revealed high intensity in the pancreatic body. The arrow indicated the tumor
Fig. 2
Fig. 2
The images of resection specimens of the case. a, b Distal pancreatectomy (DP) was performed and the tumor was detected in the pancreatic body. The intraoperative frozen section diagnosis revealed residual cancer at the pancreatic stump. The arrows indicated the tumor. c The subtotal stomach preserving TP (SSPTP) was performed (pancreaticoduodenectomy was performed adding to DP)
See this image and copyright information in PMC

References

    1. Casadei R, Ricci C, Ingaldi C, Alberici L, Minni F. Contemporary indications for upfront total pancreatectomy. Updat Surg. 2021;73(4):1205–17.10.1007/s13304-021-01145-w - DOI - PubMed
    1. Nakao A, Yamada S, Fujii T, Tanaka H, Oshima K, Oshima Y, et al. Gastric venous congestion and bleeding in association with total pancreatectomy. J Hepatobiliary Pancreat Sci. 2018;25(2):150–4. 10.1002/jhbp.523 - DOI - PMC - PubMed
    1. Stoop TF, von Gohren A, Engstrand J, Sparrelid E, Gilg S, Del Chiaro M, et al. Risk factors, management, and outcome of gastric venous congestion after total pancreatectomy: an underestimated complication requiring standardized identification, grading, and management. Ann Surg Oncol. 2023;30(12):7700–11. 10.1245/s10434-023-13847-z - DOI - PMC - PubMed
    1. Loos M, Mehrabi A, Ramouz A, Contin P, Strobel O, Müller-Stich BP, et al. Gastric venous congestion after total pancreatectomy is frequent and dangerous. Ann Surg. 2022;276(6):e896–904. 10.1097/SLA.0000000000004847 - DOI - PubMed
    1. Covey AM, Brody LA, Maluccio MA, Getrajdman GI, Brown KT. Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients. Radiology. 2002;224(2):542–7. 10.1148/radiol.2242011283 - DOI - PubMed

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