Pancreaticoduodenectomy with reconstructing blood flow of the gastric conduit after esophagectomy with concomitant celiac axis stenosis: a case report

Surgical Case Reports

Kota Kato¹  Yoshiaki Kajiyama²  Masaaki Minagawa³  Ryuji Yoshioka³  Hiroshi Imamura³  Yu Gyoda³  Yoshihiro Mise³  Akio Saiura³  Hirofumi Ichida³  Tomoya Mizuno³  Yuki Fukumura⁴  Hidehiko Yoshimatsu⁵ 

[1] Department of Anatomy and Life Structure, Juntendo University, Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, 113-8421, Tokyo, Japan;Department of Esophageal and Gastroenterological Surgery, Juntendo University, Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, 113-8421, Tokyo, Japan;Department of Hepatobiliary-Pancreatic Surgery, Juntendo University, Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, 113-8421, Tokyo, Japan;Department of Human Pathology, Juntendo University, Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, 113-8421, Tokyo, Japan;Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, 135-8550, Tokyo, Japan;

关键词: Pancreaticoduodenectomy;    Gastric conduit-preserving;    Esophagectomy;    Celiac artery stenosis;    Microvascular reconstruction;    Dorsal pancreatic artery;   

DOI  :  10.1186/s40792-020-01019-0

来源: Springer

【 摘 要 】

BackgroundPancreaticoduodenectomy after esophageal resection is technically difficult, because blood flow of the gastric conduit should be preserved. Celiac axis stenosis (CAS) is also a problem for pancreaticoduodenectomy, because arterial blood supply for the liver comes mainly through the collateral route from the superior mesenteric artery (SMA) via the gastroduodenal artery (GDA). Herein, we report the case of a patient with pancreatic head cancer who underwent a pancreaticoduodenectomy after esophagectomy with concomitant CAS.Case presentationA 76-year-old man with pancreatic head cancer was referred to our department. He had a history of esophagectomy with retrosternal gastric conduit reconstruction for esophageal cancer. Computed tomography showed severe CAS and a dilated collateral route between the SMA and the splenic artery (SPA). We prepared several surgical options depending on the intraoperative findings, and performed radical pancreaticoduodenectomy with concomitant resection of the distal gastric conduit. The right gastroepiploic artery (RGEA) of the remnant gastric conduit was fed from the left middle colic artery (MCA) with microvascular anastomosis. Despite CAS, when the GDA was dissected and clamped, good blood flow was confirmed, and the proper hepatic artery did not require reconstruction. The patient was discharged on postoperative day 90.ConclusionsWe successfully performed radical pancreaticoduodenectomy after esophagectomy with concomitant CAS, having prepared multiple surgical options depending upon the intraoperative findings.

【 授权许可】

CC BY