A Case of Pseudoaneurysm of a Branch of the Dorsal Pancreatic Artery after Robotic Gastrectomy

Fujita Masahiro, Shibasaki Susumu, Nakamura Kenichi, Tanaka Tsuyoshi, Kato Ryoichi, Urano Makoto, Inaba Kazuki, Uyama Ichiro, Suda Koichi

doi:10.5833/jjgs.2021.0066

<p>We report a case of pseudoaneurysm that developed after robot-assisted gastrectomy. A 43-year-old man diagnosed with advanced gastric cancer underwent robotic distal gastrectomy with D2 dissection. Suprapancreatic nodal dissection was technically demanding due to a high body mass index, but the operation was completed without any intraoperative problems. On postoperative day (POD) 3, abdominal contrast-enhanced CT was performed to rule out intra-abdominal infectious complications, and revealed a suspected 1-cm pseudoaneurysm near the origin of the splenic artery. An angiography showed a pseudoaneurysm of a branch of the dorsal pancreatic artery, and then coil embolization was performed. A retrospective review of the surgical video suggested that pseudoaneurysm formation may have been caused by dividing the small arteriole running from the dorsal side of the pancreas to the ventral side near the root of the splenic artery using bipolar cutting dissection with insufficient coagulation. The subsequent postoperative course was uneventful, and the patient was discharged on POD 16. This case shows that it is important to recognize that bipolar cutting dissection using Maryland bipolar forceps in robotic gastrectomy can unintentionally divide small arterioles with inadequate coagulation.</p>

A Case of Pseudoaneurysm of a Branch of the Dorsal Pancreatic Artery after Robotic Gastrectomy

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