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A new test to avoid arterial complications during pancreaticoduodenectomy.
- Source :
-
Hepato-gastroenterology [Hepatogastroenterology] 2004 Nov-Dec; Vol. 51 (60), pp. 1671-3. - Publication Year :
- 2004
-
Abstract
- Celiac trunk or superior mesenteric artery stenosis are usually innocuous conditions. In such patients, arterial blood supply to the stomach, spleen, liver and bowel is sustained through extraordinarily well-developed pathways through the pancreas. If division of these collateral vessels is necessary during a surgical procedure such as pancreaticoduodenectomy, life-threatening celiac organ or bowel ischemia may occur. The authors describe a new test, using pancreatic inflow occlusion, to reliably identify celiac trunk or superior mesentery artery stenosis. The authors describe two cases of celiac axis occlusion and one case of superior mesenteric artery stenosis. In all three presented cases the gastroduodenal artery clamping test was negative and ischemia was only noticed after pancreatic section, suggesting that in severe occlusions this test may fail in diagnosing the vascular abnormality. All patients were successfully treated by revascularization with no operative mortality. If the diagnosis is unsuspected and in cases where appropriate angiographic studies have not been obtained before pancreatic resection, a test occlusion of the gastroduodenal artery should always precede its ligation. However, this test may not be effective in all cases and in instances where high suspicion of celiac axis or mesenteric stenosis is present, other maneuvers, such as pancreatic inflow test, could be helpful for the diagnosis of these rare and morbid situations.
- Subjects :
- Aged
Celiac Artery surgery
Chronic Disease
Female
Follow-Up Studies
Humans
Ischemia prevention & control
Male
Mesenteric Arteries surgery
Mesentery blood supply
Middle Aged
Pancreatic Neoplasms diagnosis
Pancreatic Neoplasms surgery
Pancreaticoduodenectomy adverse effects
Pancreatitis diagnosis
Pancreatitis surgery
Preoperative Care methods
Risk Assessment
Treatment Outcome
Arterial Occlusive Diseases diagnosis
Celiac Artery pathology
Mesenteric Arteries pathology
Pancreaticoduodenectomy methods
Postoperative Complications prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 0172-6390
- Volume :
- 51
- Issue :
- 60
- Database :
- MEDLINE
- Journal :
- Hepato-gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 15532801