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Case Report
Cancer Research Frontiers. 2016 Sept; 2(3): 427-431. doi: 10.17980/2016.427
Whipple’s Procedure Complicated by Celiac Artery Stenosis: Case Report and Review of Treatment Options
Konstantinos Bramis1, Georgios Kourounis2,3, Patrick (Paul) Tabet3,4*, Dementrios Moris5, Athanasios Petrou6
1 First Department of Propaedeutic Surgery, University of Athens Medical School, Laiko Athens General Hospital, Agiou Thoma Road, Goudi Athens, Greece
2 Dumfries and Galloway Royal Infirmary, Bankend Rd, Dumfries, UK.
3 University of Edinburgh, Old College, South Bridge, Edinburgh, UK
4 King George hospital, Barley Ln, Goodmayes, Ilford, UK
5 Lerner Research Institute, Cleveland Clinic Foundation, 9620 Carnegie Ave, Cleveland, OH, USA
6 New Nicosia General Hospital, 215 Limassol Old Road, Strovolos, Nicosia, Cyprus; St George’s University of London Programme, University of Nicosia, 93 Agiou Nikolaou Street, Engomi, Nicosia, Cyprus
*Corresponding author: Dr Patrick Paul Tabet, King George hospital, Barley Ln, Goodmayes, Ilford, UK; University of Edinburgh, Old College, South Bridge, Edinburgh, UK. Email:
Citation: Konstantinos Bramis, et al. Whipple’s Procedure Complicated by Celiac Artery Stenosis: Case Report and Review of Treatment Options. Cancer Research Frontiers. 2016 Sept; 2(3): 427-431. doi: 10.17980/2016.427
Copyright: @ 2016 Konstantinos Bramis, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Competing Interests: The authors declare no competing financial interests.
Received Oct 21, 2016; Revised Dec 8, 2016; Accepted Jan 7, 2017. Published Jan 13, 2017
Abstract
Although infrequently symptomatic, celiac artery stenosis is a vascular pathology that can commonly be encountered in hepatobiliary surgery. Secondary to celiac artery stenosis, the supramesocolic viscera may rely on blood supply from the gastroduodenal artery which, if ligated, can lead to detrimental ischaemia causing postoperative morbidity and mortality. We report the case of a 53-year-old female scheduled to have a pancreaticoduodenectomy and an asymptomatic extrinsic celiac artery stenosis identified during preoperative imaging workup. The stenosis was significant, with confirmed retrograde flow in the gastroduodenal artery. Pre-operative endovascular management was considered, but surgical management was preferred due to the young age of the patient and the non-atherosclerotic nature of the stenosis. In conclusion, the release of extrinsic compression on the celiac artery lead to a safer and less complicated procedure, eliminating the need for vascular reconstruction or endovascular intervention.
Key words: Celiac artery stenosis; pancreaticoduodenectomy; Whipple procedure; pancreatic neoplasms.
