[Ischemic risk in the case of celiac trunk occlusion in patients undergoing pancreatodeodenectomy. Multicenter study and review of literature].

OBJECTIVES OF THE STUDY: To assess the risk of ischemia in patients undergoing pancreatoduodenectomy and presenting celiac trunk occlusion.

METHODS

Multicenter survey and review of the literature.

PATIENTS: We collected data from 22 patients (15 males and 7 females), with a median age of 66 years. Indication for pancreatic resection was adenocarcinoma of the head of pancreas (N = 9), other peri-ampullary tumors (N = 7) and chronic pancreatitis (N = 6). Trial clamping of the gastroduodenal artery was performed in 16 patients and was found to be positive in 9, who underwent a revascularization procedure. Among 6 patients who did not undergo trial clamping, 4 developed ischemia during pancreatic resection and unplanned revascularization had to be performed. Five patients developed complications (morbidity = 23%), which were fatal in 2 cases (mortality = 9%). Prevalence of celiac trunk occlusion has been estimated at 2-3% of all pancreatoduodenectomies.

CONCLUSIONS

The risk of supra mesocolic ischemia by obstruction of the coeliac trunk is low, but can be minimized by performing trial clamping of the gastroduodenal artery. Revascularization should be performed if trial clamping induces a reduction of blood flow.