One Exsample Which Performed of Pancreatoduodenectomy as A 2term-operation in The Bile Duct Cancer Case Complicated with Celiac Axis Obstruction

Kiyoshi Kawaguchi, Nobuo Seo, Keiji Ohta, Yuichi Yasaku, Tohru Tsuge, Kumiko Suzuki and Shinichi Nawata

Department of Surgery, Yamagata Saisei Hospital

Patients with celiac axis obstruction are usually asymptomatic. In those undergoing pancreaticoduodenectomy, however, cutting off the collateral pathways may lead to ischemia of the celiac viscera. We report a patient with cancer of the lower portion of the common bile duct complicated with celiac axis obstruction. A 54-year-old man admitted for obstructive jaundice was found in detailed examination to have cancer of the lower common bile duct or head of the pancreas, necessitating pancreaticoduodenectomy. Abdominal angiography showed an obstruction of the celiac axis, and the blood supply to the celiac viscera sustained through the gastroduodenal artery via the dilated pancreatoduodenal arcades from the superior mesenteric artery. Sagittal imaging of the multiplanar reformation of enhancement abdominal CT suggested that compression by the median arcuate ligament of the diaphragm caused celiac axis obstruction. Celiac circulation had to be reconstructed for pancreaticoduodenectomy. Angioplasty of the celiac axis was conducted using a saphenous vein patch. Aortgram on 14POD showed patency of the celiac axis. On 20POD, conducted pancreaticoduodenectomy. Pathological diagnosis of the isolated specimen was bile duct cancer. The postoperative course was uneventful.

Key words
celiac axis obstruction, pancreaticoduodenectomy

Reprint requests
Kiyoshi Kawaguchi Department of Surgery, Yamagata Saisei Hospital 79-1 Okimachi, Yamagata, 990-8545 JAPAN

Accepted
December 18, 2002

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