ArticleInternational journal of surgery case reports2024
Pancreatoduodenectomy in a patient with complete atherosclerotic occlusion of superior mesenteric artery: A case report.
Article in International journal of surgery case reports, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introduction and importanceIn elderly patients with atherosclerotic disease the occlusion of splanchnic arteries is a frequently observed variation, which doesn't normally affect patient's condition. There are sporadic reports on pancreatoduodenectomy in these cases. CASE PRESENTATION: A 72-year-old female was admitted to our department with cancer of the ampulla of Vater. Pre-operative CT-angiography revealed total atherosclerotic occlusion of the main trunk of the superior mesenteric artery (SMA). Collateral circulation was conducted through gastroduodenal and dorsal pancreatic artery. Pancreatoduodenectomy was performed with an intraoperative clamping test, which showed no signs of bowel ischemia. The patient was discharged on post-operative day 14 without any complications, and long-term follow-up revealed adjustment of collateral circulation through the inferior mesenteric artery and Riolan's arcade. CLINICAL DISCUSSION: Most cases of mesenteric artery stenosis occur in patients with underlying cardiac condition. As the occlusion develops chronically, it doesn't cause any symptoms due to collateral circulation, and no preoperative intervention is usually needed. However, there are rare cases reported in the literature, when preoperative endovascular stenting and SMA dilation were performed before pancreatoduodenectomy. In this report we decided to proceed with surgery upfront and perform an intraoperative clamping test.
conclusionIn this report we present a rare case of successful pancreatoduodenectomy in a patient with total atherosclerosis of the superior mesenteric artery. The intraoperative clamping test allowed us to assess both the sufficiency of collateral circulation and the feasibility of the surgery.
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