Abstract
We resected the head of the pancreas in three patients with occlusive diseases or anomalous arrangement of the abdominal visceral arteries. The first patient who was diagnosed with cancer of the head of the pancreas; pancreatoduodenectomy (PD) was performed. Preoperative celiac angiography showed no significant occlusion of the celiac axis, while superior mesenteric arteriography visualized the common hepatic artery, with delayed retrograde filling. At the completion of the PD, an unsuspected atherosclerotic celiac occlusion was identified. Celiac reconstruction was performed. The second patient was diagnosed with cystadenoma of the head of the pancreas and had congenital ostial occlusion of the superior mesenteric artery (SMA), with dilated pancreaticoduodenal (PD) arcades as a celiacomesenteric collateral pathway. Duodenum-preserving resection of the head of the pancreas was performed, with preservation of the PD arcades. The third patient was diagnosed with cancer of the common bile duct, and exhibited a replaced common hepatic artery that arose from the SMA and formed PD arcades. PD was performed, with revascularization of the common hepatic artery. Following surgery, the three patients have done well for 18, 27, and 9 months, respectively. Careful preoperative investigation to identify abnormalities of the visceral arteries is necessary before resection of the head of the pancreas is performed.
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References
Child CG III (1944) Pancreaticojejunostomia and other problems associated with the surgical management of carcinoma involving the head of the pancreas. Ann Surg 119:844–855
Thompson NW, Eckhauser FE, Talpos G, Cho KJ (1981) Pancreaticoduodenectomy and celiac occlusive desease. Ann Surg 193:399–406
Miyata M, Takao T, Okuda A, Sasako Y, Sunada S (1988) Pancreatoduodenetomy for periampullary cancer associated with celiac occlusion: A case report. Surgery 103:261–263
Manabe T, Baba N, Setoyama H, Ohshio G, Tobe T (1991) Venous bypass grafting for celiac occlusion in radical pancreaticoduodenectomy. Pancreas 6:368–371
Yamagami K, Manabe T, Baba N, Tobe T, Nara M (1992) A resectable case of pancreatic head cancer with total obstruction due to aneurysm in common hepatic artery (in Japanese with English abstract). Nippon Shokakigeka Gakkai Zasshi (Jpn J Gastroenterol Surg) 25:156–160
Itakura M, Tamura K, Yano S, Nakayama K, Hashimoto Y, Funazuka M, Nakagawa M, Yamamoto T, Nakase A (1993) A case of pylorus-preserving pancreatoduodenectomy for leiomyoma of the duodenum with celiac occlusion (in Japanese). Syujutsu (Operation) 47:1837–1842
Tred M (1985) The surgical treatment of pancreatic carcinoma. Surgery 97:28–35
Harjola PT (1963) A rare obstruction of the coeliac artery. Ann Chir Gynaecol Fenn 52:547–550
Szilagyi DE, Rian RL, Elliott JP, Smith RF (1972) The celiac artery compression syndrome: Does it exist? Surgery 72:849–863
Shigematsu H, Miyazawa Y, Horie Y, Ohashi S, Mishima Y (1980) Celiac axis compression syndrome (in Japanese). Nippon Shokakigeka Gakkai Zasshi (Jpn J Gastroenterol Surg) 13:295–302
Fortner JF, Watson RC (1981) Median arcuate ligament obstruction of celiac axis and pancreatic cancer. Ann Surg 194:698–700
Meaney TF, Kistner RL (1967) Evaluation of intra-abdominal disease of obscure cause. Arch Surg 94:811–816
Plonka AJ, Tolloczko T, Lipski M, Malanowska S, Adelman MH, Williams JS (1989) Atherosclerotic narrowings of the mesenteric circulation. Vasc Surg 23:191–200
Colapinto RF, McLoughlin MJ, Weisbrod GL (1972) The routine lateral aortogram and the celiac compression syndrome. Radiology 103:557–563
Biehl TR, Traverso LW, Hauptmann E, Ryan JA (1993) Preoperative visceral angiography alters intraoperative strategy during the Whipple procedure. Am J Surg 165:607–612
Michels NA (1966) Never anatomy of the liver and its variants: Blood supply and collateral circulation. Am J Surg 112:337–46
Suzuki H (1982) Corrolation and anomalies of the vascular structure in Glisson's area around the hepatic hilum, from the standpoint of hepatobiliary surgery (in Japanese with English abstract). Nippon Geka Hohkan (Arch Jpn Chir) 51:713–731
Daseler EH, Anson BJ, Hambley WC, Reimann AF (1947) The cystic artery and constituents of the hepatic pedicle. A study of 500 specimens. Surg Gynecol Obstet 85:47–63
Matsuno M, Kobari M (1991) Pancreaticoduodenectomy (in Japanese). Shokakigeka (Gastroenterol Surg) 14:1263–1273
Ogata Y (1989) Application of vascular surgery techniques to operation for cancer of the liver, bile duct and pancreas (in Japanese). Nippon Shokakigeka Gakkai Zasshi (Jpn J Gastroenterol Surg) 22:156–160
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Maeba, T., Karasawa, Y., Hamamoto, I. et al. Resection of the head of the pancreas in three patients with anomalous arrangement or occlusive diseases of the major abdominal visceral arteries. J Hep Bil Pancr Surg 3, 480–484 (1996). https://doi.org/10.1007/BF02349796
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DOI: https://doi.org/10.1007/BF02349796