Disruption of Blood Flow to the Remnant Stomach and Spontaneous Hemodynamic Stabilization after Pancreaticoduodenectomy following Proximal Gastrectomy —A Case Report—

Abstract

Ensuring optimal blood supply to the remnant stomach after pancreaticoduodenectomy following proximal gastrectomy is a serious difficulty observed in clinical practice. We report a case of pancreaticoduodenectomy performed for ampullary cancer in a patient with a history of proximal gastrectomy 13 years earlier. Preoperative computed tomography (CT) revealed that the left gastric, the short gastric, and the left gastroepiploic arteries were ligated during the previous operation, and the right gastric artery was not visualized. Blood flow to the gastric remnant was maintained only through the right gastroepiploic artery. Subtotal stomach-preserving pancreaticoduodenectomy with preservation of the gastroduodenal and the right gastroepiploic arteries was performed to prevent ischemia of the gastric remnant. On postoperative day 2, blood-stained exudate was discharged through the intraperitoneal drain, and CT revealed a pseudoaneurysm of the preserved gastroduodenal artery. Coil embolization of the gastroduodenal artery was performed to avoid fatal bleeding, causing complete disruption of the major arterial flow to the remnant stomach. Postoperative celiac artery angiography showed that arterial blood flow to the distal aspect of the right gastroepiploic artery was re-established via small branches from the splenic artery. Gastric remnant necrosis was not observed.