Affordable Access

Access to the full text

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

Authors
  • Minagawa, Masaaki1
  • Ichida, Hirofumi1
  • Yoshioka, Ryuji1
  • Gyoda, Yu1
  • Mizuno, Tomoya1
  • Imamura, Hiroshi1
  • Mise, Yoshihiro1
  • Yoshimatsu, Hidehiko2
  • Fukumura, Yuki1
  • Kato, Kota1
  • Kajiyama, Yoshiaki1
  • Saiura, Akio1
  • 1 Juntendo University, Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan , Tokyo (Japan)
  • 2 Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan , Tokyo (Japan)
Type
Published Article
Journal
Surgical Case Reports
Publisher
Springer Berlin Heidelberg
Publication Date
Oct 08, 2020
Volume
6
Issue
1
Identifiers
DOI: 10.1186/s40792-020-01019-0
Source
Springer Nature
Keywords
License
Green

Abstract

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.

Report this publication

Statistics

Seen <100 times