Abstract
A 62-year-old man underwent pancreaticoduodenectomy for pancreatic head carcinoma 2cm in diameter. Computed tomography showed celiac axis stenosis and median arcuate ligament syndrome was suspected. The median arcuate ligament was intraoperatively divided, but the arterial flow of the celiac axis could not be restored. Therefore, we performed arterial bypass between the right common iliac artery and the gastroduodenal artery stump by a saphenous vein graft to preserve the arterial blood flow into the liver. Postoperative hemorrhage occurred twice at the anastomosis of the saphenous vein graft and the hepatic artery. Hemostasis was successfully obtained by the treatment with interventional radiology (IVR) using covered metallic stents, which preserved the hepatic arterial flow. Appropriate IVR treatment is critical to the treatment for a sudden onset of postoperative hemorrhage after pancreatic surgery, and the covered metallic stent treatment is an alternative option playing roles in both hemostasis and maintenance of the intrahepatic arterial blood flow.
