A Resected Case with Pancreatic Tail Cancer and a Prior Distal Gastrectomy, whose Gastric Blood Flow was Successfully Evaluated Using the ICG Fluorescence Method Intraoperatively

Abstract

Whether the remnant stomach can be safely preserved when performing distal pancreatectomy (DP) in patients with a prior distal gastrectomy (DG) remains unclear. Recent studies have reported that intraoperative indocyanine green (ICG) fluorography is useful in evaluating organ perfusion. A case of successful DP with intraoperative ICG fluorography to assess the blood flow of the remnant stomach is reported. An 88-year-old man visited a local hospital with a chief complaint of upper abdominal pain. He underwent DG because of a gastric ulcer 25 years earlier. Pancreatic tail cancer was diagnosed by CT and endoscopic ultrasound-fine needle aspiration. Preoperative contrast-enhanced CT showed that the bilateral gastric arteries and bilateral gastroepiploic arteries had been cut in a prior operation. Intraoperative ICG fluorography was performed after ligation of the splenic artery, and it showed that the remnant stomach was perfused from esophageal or small omental blood vessels. The remnant stomach was safely preserved, and the patient's postoperative course was uneventful. ICG fluorography has potential to be used to evaluate the blood flow of the remnant stomach.