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Supraceliac aortic cross-clamping to control bleeding from the celiac axis during pancreatic surgery: a case report.

ABSTRACT: BACKGROUND:Intraoperative bleeding from the celiac axis (CA) can occur during pancreatic surgery, and appropriate management is essential to avoid critical complications. Here, we have reported a case that was managed with supraceliac aortic cross-clamping (SAC) for arterial bleeding from the CA during pancreatic surgery. CASE PRESENTATION:A 70-year-old man was diagnosed with pancreatic cancer located in the pancreatic head and body. Preoperative computed tomography showed a stricture at the root of the CA, which may have been caused by a median arcuate ligament. Pancreaticoduodenectomy with division of the median arcuate ligament was scheduled. Uncontrollable bleeding from the root of the CA was observed during surgery. The bleeding was controlled by performing SAC, and a defect in the CA was confirmed. Arterial wall repair was successfully performed under temporal blood control using SAC. The aortic clamp time was 2 min and 51 s, and the intraoperative blood loss was 480 ml. CONCLUSIONS:Although SAC is primarily a procedure for ruptured abdominal aortic aneurysm, it can be useful for the management of CA injuries during pancreatic surgery.

SUBMITTER: Takano Y

PROVIDER: S-EPMC8674386 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Supraceliac aortic cross-clamping to control bleeding from the celiac axis during pancreatic surgery: a case report.

Takano Yuki Y Fujioka Shuichi S Shozaki Hironori H Toya Naoki N Ikegami Toru T

Surgical case reports 20211215 1

<h4>Background</h4>Intraoperative bleeding from the celiac axis (CA) can occur during pancreatic surgery, and appropriate management is essential to avoid critical complications. Here, we have reported a case that was managed with supraceliac aortic cross-clamping (SAC) for arterial bleeding from the CA during pancreatic surgery.<h4>Case presentation</h4>A 70-year-old man was diagnosed with pancreatic cancer located in the pancreatic head and body. Preoperative computed tomography showed a stric ...[more]

PMID: 34910267

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Project description:Background/Aims:In most instances of abdominal pain associated with pancreatic cancer, pain may become refractory to increasing doses of narcotics. Celiac plexus neurolysis represents an option; however, altered celiac plexus anatomy may render this treatment infeasible or ineffective, where splanchnic nerve neurolysis may represent another option. This study aimed to investigate the outcomes of splanchnic neurolysis in pancreatic cancer patients not responsive to celiac plexus neurolysis. Patients and Methods:Among all 84 patients who underwent celiac plexus neurolysis for pancreatic cancer pain during the study period, 34 patients did not respond and underwent splanchnic nerve neurolysis under fluoroscopic guidance and thus included in this retrospective study. Stage IV, III, and II disease was present in 38.2%, 47.1%, and 14.7% of the patients. During the study, 88.2% were receiving chemotherapy, whereas none were on radiotherapy. Data for daily narcotic dose equivalents and Visual Analogue Scale (VAS) scores during outpatient visits at baseline, 2 weeks, 2 months, and 3 months were extracted. Results:Pain response rates were 76.5%, 84.4%, and 71.0%, at 2 weeks, 2 months, and 3 months, respectively. A significant and dramatic reduction was seen in VAS scores at 2 weeks (2.8±1.2 versus 6.3±1.1, p<0.001), and this significant decline was maintained for 3 months. Similarly, a significant and dramatic reduction was seen in daily narcotic need at 2 weeks (20.8±32.9 versus 93.4±86.2 mg, p<0.001), which was also maintained during the 3-month follow-up. The procedure was generally well tolerated. Conclusion:Findings of this study suggest that splanchnic neurolysis represents a durable and effective option for pain control in pancreatic cancer patients in whom the neurolysis of the celiac plexus is ineffective. However, these conclusions refer to only preliminary single-center results in a selected patient group; thus, further large studies are warranted.

Dataset Information

Supraceliac aortic cross-clamping to control bleeding from the celiac axis during pancreatic surgery: a case report.

Publications

Supraceliac aortic cross-clamping to control bleeding from the celiac axis during pancreatic surgery: a case report.

Similar Datasets

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