Pancreatoduodenectomy co-morbid with celiac axis compression syndrome: a report of three cases

Abstract

Background: Celiac axis compression syndrome (CACS) is a relatively rare disease. Because of the nature of the blood flow in the celiac region when a pancreatoduodenectomy (PD) is performed for CACS, the celiac region can become ischemic. The aim of this study is to report on the importance of pre-operative diagnosis of CACS in terms of the outcomes for patients post-operatively. In this study, three 3 cases of PD co-morbid with CACS are reported: one intra-operative diagnosis case and two pre-operative diagnosis cases. Case presentation: The one case, not diagnosed with CACS prior to the operation, had a hard post-operative course because of complication caused by ischemia of the celiac region compared with the two cases diagnosed prior to the operation, who had a good post-operative course because of pre-operative or intra-operative intervention. Conclusions: Post-operative complications due to CACS are preventable by pre-operative diagnosis and appropriate interventions.

Precision anatomy for safe approach to pancreatoduodenectomy for both open and minimally invasive procedure: A systematic review

“…When CAS is diagnosed as being secondary to atherosclerosis, division of MAL will not provide benefit 76 and revascularization or preservation of collateral arteries should be considered. In addition, preoperative endovascular stenting or balloon angioplasty can be considered 78,79 …”

Pancreatoduodenectomy in a patient with celiac axis stenosis and a replaced common hepatic artery: A case report

“…The CT angiography finding of characteristic focal narrowing of the proximal celiac axis noted as a “hooked appearance” can help distinguish celiac axis stenosis by the MAL from other causes of celiac axis stenosis, such as atherosclerotic disease [13] , [14] . Interventions for celiac axis stenosis have been reported, including division of the MAL, vessel reconstruction, and preservation of collateral circulation [4] , [11] , [15] . If celiac axis stenosis is due to MAL compression, division of the MAL is considered the primary procedure for surgical treatment.…”

Hyperspectral Imaging (HSI)—A New Tool to Estimate the Perfusion of Upper Abdominal Organs during Pancreatoduodenectomy

“…External causes for CAS are mainly compression by MAL, which is a fibrous ligament that passes over the aorta at the level of or superior to the origin of the CA [ 24 , 25 ]. Arteriosclerosis is the main internal cause of CAS in patients undergoing PD.…”