Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2022; 14(11): 1310-1319
Published online Nov 27, 2022. doi: 10.4240/wjgs.v14.i11.1310
Preoperative blood circulation modification prior to pancreaticoduodenectomy in patients with celiac trunk occlusion: Two case reports
Marco Colella, Kohei Mishima, Taiga Wakabayashi, Yoshiki Fujiyama, Malek A Al-Omari, Go Wakabayashi
Marco Colella, Kohei Mishima, Taiga Wakabayashi, Yoshiki Fujiyama, Malek A Al-Omari, Go Wakabayashi, Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Ageo 362-8588, Saitama, Japan
Author contributions: Colella M and Mishima K wrote the manuscript; Mishima K treated the patients; Wakabayashi G, Wakabayashi T, Fujiyama Y, and Alomari M critically reviewed the manuscript; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kohei Mishima, MD, Surgeon, Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, 1 Chome-10-10 Kashiwaza, Ageo 362-8588, Saitama, Japan. mishima0930@gmail.com
Received: July 15, 2022
Peer-review started: July 15, 2022
First decision: September 12, 2022
Revised: September 24, 2022
Accepted: October 19, 2022
Article in press: October 19, 2022
Published online: November 27, 2022
Processing time: 133 Days and 7.8 Hours
Abstract
BACKGROUND

Celiac trunk stenosis or occlusion is a common condition observed in patients undergoing pancreaticoduodenectomy (PD). The risk of upper abdominal organ ischemia or failure increases if the blood circulation in the celiac arterial system is not maintained after the surgery.

CASE SUMMARY

We present two cases of elderly patients with distal cholangiocarcinoma and celiac trunk occlusion who underwent PD. We performed blood circulation modification preoperatively with transcatheter coil embolization of the arterial arcades of the pancreatic head via the superior mesenteric artery to develop collateral communication between the superior mesenteric artery and the common hepatic or splenic arteries to ensure arterial blood flow to the upper abdominal organs. The postoperative course was marked by delayed gastric emptying, but no major surgical complications, such as biliary or pancreatic fistula, or clinical, biochemical, or radiological evidence of ischemic disease, was observed.

CONCLUSION

Preoperative blood circulation modification may be a valid alternative procedure for elderly patients with celiac trunk occlusion who are ineligible for interventional or surgical revascularization.

Keywords: Preoperative blood circulation modification; Cholangiocarcinoma; Pancreaticoduodenectomy; Whipple procedure; Celiac trunk occlusion; Atherosclerosis; Transcatheter coil embolization; Case report

Core Tip: Celiac trunk stenosis or occlusion is a common condition observed in patients undergoing pancreaticoduodenectomy (PD). Celiac trunk occlusion may increase the risk of upper abdominal organ ischemia or failure. In this case report, we present two elderly patients who underwent PD for distal cholangiocarcinoma with celiac trunk occlusion. We performed blood circulation modification preoperatively with transcatheter coil embolization of the arterial arcades of the pancreatic head to develop collateral communication between the superior mesenteric and the common hepatic or splenic artery.