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Celiac axis and superior mesenteric artery: danger zone for left nephrectomy
Pierre Nevoux1, Laurent Zini, Arnauld Villers
1Digestive Surgery and Transplantation Department, Lille Regional University Teaching Hospital (CHRU), Lille F-59037, France.
Journal of Endourology
|November 1, 2008
Summary
Iatrogenic injury to the superior mesenteric artery (SMA) and celiac axis (CA) can occur during left nephrectomy, especially with complex cases. Careful preoperative imaging is crucial to prevent these rare but serious vascular complications.
Area of Science:
- Vascular Surgery
- Abdominal Surgery
- Nephrology
Background:
- Left nephrectomy, whether open or laparoscopic, carries risks.
- Complex surgical cases involving bulky adenopathy or adhered kidneys increase operative difficulty.
Observation:
- Two patients undergoing left nephrectomy experienced iatrogenic occlusion of the superior mesenteric artery (SMA) and/or celiac axis (CA).
- One patient had urothelial carcinoma (open surgery), the other coralliform calculi (laparoscopy).
- Vascular injury was attributed to perihilar adenopathy and kidney adherence.
Findings:
- Prompt surgical repair led to survival in the cancer patient.
- Delayed repair in the second patient resulted in mortality.
- Preoperative CT scans are vital for identifying aberrant arterial anatomy, including duplicate renal arteries.
Implications:
- Meticulous preoperative assessment of vascular anatomy is essential.
- Surgeons must carefully differentiate SMA and CA from renal arteries to prevent iatrogenic injury.
- Timely recognition and repair of SMA/CA occlusion can be life-saving.
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