Intraoperative severe gastric venous congestion during total pancreatectomy with replaced common hepatic artery: a case report.

IF 0.7 Q4 SURGERY Surgical Case Reports Pub Date : 2024-08-08 DOI:10.1186/s40792-024-01983-x

Takahiro Yamanaka, Kenichiro Araki, Hideki Suzuki, Hidenobu Osawa, Ken Shirabe

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Abstract

Background: Gastric venous congestion (GVC) is one of the complications of total pancreatectomy (TP). Here, we report a case of intraoperative severe GVC during TP with a replaced common hepatic artery (RCHA).

Case presentation: A 65-year-old female patient was diagnosed with intraductal papillary mucinous carcinoma. Her CHA branched from the superior mesenteric artery as RCHA. She underwent subtotal stomach preserving TP. The tumor was resected with splenic artery (SpA) and total gastric vein transections. Severe GVC and bleeding from the stomach tube occurred intraoperatively. A strong pulsation was observed in the left gastric artery (LGA), and we suspected an increased blood flow from the celiac artery (CeA) to the LGA after SpA resection. Total gastrectomy (TG) was then performed to control the severe GVC-related bleeding. The patient was discharged without complications 19 days postoperatively.

Conclusion: TP with RCHA may increase the risk of severe GVC due to increased blood flow from CeA to LGA.

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用肝总动脉替代全胰腺切除术时术中严重胃静脉充血：病例报告。

背景：胃静脉充血（GVC）是全胰腺切除术（TP）的并发症之一。在此，我们报告了一例在肝总动脉（RCHA）置换术中发生严重胃静脉充血的病例：病例介绍：一名 65 岁的女性患者被诊断为导管内乳头状粘液癌。她的肝总动脉从肠系膜上动脉分支出来，成为 RCHA。她接受了保留胃的次全胃切除术。切除肿瘤时进行了脾动脉（SpA）和全胃静脉横切。术中发生了严重的GVC和胃管出血。我们观察到胃左动脉（LGA）有强烈的搏动，因此怀疑SpA切除术后腹腔动脉（CeA）流向LGA的血流量增加。于是我们进行了全胃切除术（TG），以控制 GVC 相关的严重出血。术后19天，患者无并发症出院：结论：患有 RCHA 的 TP 可能会增加严重 GVC 的风险，因为 CeA 至 LGA 的血流增加了。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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