Abstract
In this paper we discuss a case of pancreatoduodenectomy associated with celiac axis compression syndrome (CACS), complicating multiple liver abscess postoperatively. A male patient in his 40ʼs was admitted with abdominal fullness and vomiting. After the imaging examination of the patient a duodenal obstruction and mass around the head of pancreas was discovered. A diagnosis of cancer of pancreas head was made and pancreatoduodenectomy was performed. We could not discover a pulsing of hepatic artery and found CACS intraoperatively. Connective tissue around celiac artery was divided but pulsing of hepatic artery continued. An elevation in the blood pressure restarted the pulsing. We use prostaglandine E1 (PGE1) and dopamin to preserve the hepatic blood flow and elevation of blood pressure. Multiple liver abscesses occurred but they improved with adequate drainage. Two months after the operation, computed tomography imaging indicated that the hepatic blood flow increased by collateral blood flow. When pancreaticoduodenectomy is performed on patients with CACS and revascularization is difficult, preservation of hepatic blood flow by monitoring and securing the hepatic arterial blood flow using PGE1 and dopamine is useful until collateral blood flow is established.
