A Case of Aggravated Celiac Artery Stenosis after Pancreaticoduodenectomy Treated by Urgent Median Arcuate Ligament Release

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  • Yamamoto Masahiro
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
  • Ideno Noboru
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
  • Abe Toshiya
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
  • Ikenaga Naoki
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
  • Nakata Kohei
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
  • Nakamura Masafumi
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University

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  • 膵頭十二指腸切除術後の腹腔動脈起始部狭窄の増悪に対し緊急正中弓状靭帯切開術を施行した1例

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<p>We experienced a case of worsening of celiac artery (CA) stenosis after pancreaticoduodenectomy (PD) that was treated by urgent median arcuate ligament release (MALR), despite this procedure being judged unnecessary preoperatively and intraoperatively. A 64-year-old woman was found to have stenosis at the root of the CA, but no development of collateral circulation via the gastroduodenal artery (GDA) on a preoperative CT scan. An intraoperative GDA clamp test revealed no sign of decreased hepatic artery blood flow. Hence, we judged MALR not to be necessary at that time. However, on postoperative day 1, hepatopancreatic enzymes elevated markedly and a contrast CT scan revealed worsening of CA stenosis. This resulted in ischemia in the left lateral segment of the liver, stomach, remnant pancreas and spleen. Urgent MALR was performed, and immediate improvement of hepatic artery blood flow and alleviation of organ ischemia was confirmed. This case suggests that worsening of CA stenosis may occur due to postoperative changes in hemodynamics or respiratory condition, or edematous changes in retroperitoneal tissues, even if MALR is initially judged to be unnecessary in PD cases with CA stenosis.</p>

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