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KMID : 0371420160910030149
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Annals of Surgical Treatment and Research
2016 Volume.91 No. 3 p.149 ~ p.153
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Celiac axis stenosis as a rare but critical condition treated with pancreatoduodenectomy: report of 2 cases
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Park Hyeong-Min
Lee Seung-Duk
Lee Eung-Chang
Lee In-Joon
Han Sung-Sik
Kim Hyun-Boem
Kim Seoung-Hoon
Lee Soon-Ae
Park Sang-Jae
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Abstract
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We describe 2 cases of patients with loss of hepatic arterial flow during surgery for pancreatic head cancer due to celiac stenosis caused by median arcuate ligament compression. The first case underwent pylorus-resecting pancreatoduodenectomy for pancreatic head cancer. After resection of the gastroduodenal artery, flow in the common hepatic artery disappeared, and celiac axis stenosis was identified. Interventional stent insertion was attempted, however, it failed due to the acute angle of the celiac orifice (os). This problem was resolved by arterial reconstruction. The second case underwent pylorus-preserving pancreatoduodenectomy for pancreatic head cancer and the same phenomenon occurred during the procedure. Interventional stent insertion was also tried; in this patient, however, it failed due to the acute angle of the celiac os. The problem was resolved by changing a femoral approach to a brachial approach, and the stent was inserted into the celiac os successfully.
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KEYWORD
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Median arcuate ligament, Celiac axis stenosis, Pancreatoduodenectomy
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