Celiac axis stenosis and lethal liver ischemia after pancreaticoduodenectomy

Area of Science:

• Gastroenterology
• Vascular Surgery
• Surgical Oncology

Background:

• Celiac axis stenosis is a potential complication during pancreaticoduodenectomy for periampullary cancer.
• Hepatic ischemia can be a fatal outcome if celiac circulation is compromised.
• Simultaneous revascularization or decompression of the celiac artery may be necessary.

Observation:

• Three cases of celiac axis stenosis in patients with periampullary cancer undergoing pancreaticoduodenectomy are presented.
• Case 1: A patient with pre-existing conditions experienced fatal hepatic ischemia post-Whipple operation despite initial signs of adequate hepatic artery flow.
• Cases 2 and 3: Patients with significant celiac axis stenosis underwent successful decompression of the celiac trunk during pancreaticoduodenectomy, with no postoperative complications.

Findings:

• Celiac axis stenosis can lead to severe, potentially fatal, hepatic ischemia following pancreaticoduodenectomy.
• Surgical division of a fibrotic ring around the celiac axis successfully decompressed the celiac trunk in two cases.
• Preoperative assessment of celiac artery patency is crucial, as demonstrated by the ischemic event in Case 3 during an intraoperative occlusion test.

Implications:

• Early identification and management of celiac axis stenosis are critical for preventing postoperative hepatic ischemia.
• Surgical decompression of the celiac axis during pancreaticoduodenectomy is a viable strategy to ensure adequate hepatic perfusion.
• These cases highlight the importance of considering vascular compromise in patients undergoing major abdominal surgery for malignancy.