A case of preoperative embolization for a giant hypervascular pancreatic serous cystic neoplasm in pancreaticoduodenectomy.

IF 0.7 Q4 SURGERY Surgical Case Reports Pub Date : 2024-09-06 DOI:10.1186/s40792-024-02009-2
Takahito Matsuyoshi, Naoki Ikenaga, Kohei Nakata, Daisuke Okamoto, Takashi Matsumoto, Toshiya Abe, Yusuke Watanabe, Noboru Ideno, Keizo Kaku, Nao Fujimori, Kenoki Ohuchida, Yasuhiro Okabe, Yoshinao Oda, Kousei Ishigami, Masafumi Nakamura
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Abstract

Background: Preoperative vascular embolization is an effective strategy for managing meningiomas, neck paragangliomas, renal cell carcinomas, and bone metastasis by reducing the intraoperative bleeding volume and operation time. Although hypervascular tumors also occur in the pancreas, preoperative embolization for these tumors is not commonly practiced. We herein present a case of a giant serous cystic neoplasm (SCN) of the pancreas with significant arterial vascularity that was managed with preoperative interventional radiology and subsequently resected via pancreaticoduodenectomy.

Case presentation: A 60-year-old man presented with an 8-cm hypervascular tumor located at the head of the pancreas, identified as an SCN on pathologic examination. The tumor had increased by 13 mm over 5 years, necessitating surgical intervention. Computed tomography revealed a substantial blood supply to the tumor from the dorsal pancreatic artery and gastroduodenal artery, both branches of the superior mesenteric artery. To mitigate the risk of severe intraoperative bleeding from this giant hypervascular tumor, branches of the dorsal pancreatic artery and gastroduodenal artery were embolized using metallic coils and further secured using a gelatin sponge 1 day prior to pancreatectomy. During the laparotomy, the tumor appeared to have decreased in size, likely because of reduced distension and congestion. Despite significant adhesions to surrounding tissues secondary to prolonged compression and inflammation, the pancreaticoduodenectomy was completed successfully in 5 h and 15 min with blood loss of 763 mL. The patient was discharged on postoperative day 15 without complications.

Conclusions: Preoperative arterial embolization for hypervascular pancreatic tumors might control the risk of massive intraoperative bleeding, contributing to a favorable postoperative outcome. Utilizing interventional radiology for preoperative inflow control is one of the beneficial strategies for pancreatectomy in patients with a giant SCN.

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一例在胰十二指肠切除术中对巨大的高血管性胰腺浆液性囊性瘤进行术前栓塞的病例。
背景:术前血管栓塞是治疗脑膜瘤、颈部副神经节瘤、肾细胞癌和骨转移瘤的有效策略,可减少术中出血量和手术时间。虽然高血管肿瘤也发生在胰腺,但对这些肿瘤进行术前栓塞治疗并不常见。我们在此介绍一例具有明显动脉血管的胰腺巨大浆液性囊性肿瘤(SCN)的病例,该病例通过术前介入放射学处理,随后通过胰十二指肠切除术进行了切除:一名 60 岁的男性因胰腺头部 8 厘米的高血管肿瘤就诊,病理检查确定为 SCN。5 年来,肿瘤增大了 13 毫米,因此必须进行手术治疗。计算机断层扫描显示,肿瘤的大量血液供应来自胰背动脉和胃十二指肠动脉,这两条动脉都是肠系膜上动脉的分支。为了降低这个巨大高血管肿瘤造成术中大出血的风险,在胰腺切除术前一天,使用金属线圈栓塞了胰背动脉和胃十二指肠动脉的分支,并用明胶海绵进一步固定。在开腹手术中,肿瘤似乎缩小了,这可能是由于胀大和充血程度降低。尽管长时间的压迫和炎症导致周围组织严重粘连,但胰十二指肠切除术仍在 5 小时 15 分钟内顺利完成,失血量为 763 毫升。患者于术后第 15 天出院,未出现并发症:结论:术前动脉栓塞治疗高血管性胰腺肿瘤可控制术中大量出血的风险,有助于获得良好的术后效果。利用介入放射学进行术前血流控制是巨型胰腺肿瘤患者胰腺切除术的有利策略之一。
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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