Emergency pancreaticoduodenectomy for traumatic pancreaticoduodenal injury with celiac axis stenosis

Abstract

Emergency pancreaticoduodenectomy (PD) for trauma is technically demanding, and unrecognized celiac axis stenosis (CAS) may compromise hepatic arterial inflow after gastroduodenal artery (GDA) division. A 59-year-old man presented in hemorrhagic shock after blunt abdominal trauma. Computed tomography demonstrated destructive pancreaticoduodenal injury, active bleeding, and proximal CAS with a hooked configuration suggesting median arcuate ligament (MAL) compression. After inferior pancreaticoduodenal arterial embolization, superior mesenteric arteriography showed retrograde filling of the celiac territory. Persistent hemodynamic instability necessitated emergency laparotomy and PD. Temporary GDA clamping markedly weakened common hepatic artery pulsation, confirming collateral-dependent hepatic arterial inflow. MAL release promptly restored pulsation, allowing PD with immediate reconstruction. The patient was discharged on postoperative day 34. In emergency PD for trauma, CAS or retrograde celiac filling should prompt temporary GDA clamping before irreversible division to guide MAL release or another inflow-preserving strategy.

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BibTeX RIS

BibTeX

@article{oishi2026emergency,
  title = {{Emergency pancreaticoduodenectomy for traumatic pancreaticoduodenal injury with celiac axis stenosis}},
  author = {Takahiro Oishi and Takashi Muroya and Fumiko Nakamura and Kouhei Ueda and Keisuke Tamagaki and Yoshihiro Nakamura and Atsunori Onoe and Kazuhito Sakuramoto and Sohei Satoi and Yasushi Nakamori},
  journal = {Journal of Surgical Case Reports},
  year = {2026},
  month = nov,
  doi = {10.1093/jscr/rjag1022},
  url = {https://doi.org/10.1093/jscr/rjag1022},
  note = {CC BY 4.0},
}

RIS

TY  - JOUR
TI  - Emergency pancreaticoduodenectomy for traumatic pancreaticoduodenal injury with celiac axis stenosis
AU  - Takahiro Oishi
AU  - Takashi Muroya
AU  - Fumiko Nakamura
AU  - Kouhei Ueda
AU  - Keisuke Tamagaki
AU  - Yoshihiro Nakamura
AU  - Atsunori Onoe
AU  - Kazuhito Sakuramoto
AU  - Sohei Satoi
AU  - Yasushi Nakamori
PY  - 2026
DA  - 2026/11/04
JO  - Journal of Surgical Case Reports
DO  - 10.1093/jscr/rjag1022
UR  - https://doi.org/10.1093/jscr/rjag1022
AB  - Emergency pancreaticoduodenectomy (PD) for trauma is technically demanding, and unrecognized celiac axis stenosis (CAS) may compromise hepatic arterial inflow after gastroduodenal artery (GDA) division. A 59-year-old man presented in hemorrhagic shock after blunt abdominal trauma. Computed tomography demonstrated destructive pancreaticoduodenal injury, active bleeding, and proximal CAS with a hooked configuration suggesting median arcuate ligament (MAL) compression. After inferior pancreaticoduodenal arterial embolization, superior mesenteric arteriography showed retrograde filling of the celiac territory. Persistent hemodynamic instability necessitated emergency laparotomy and PD. Temporary GDA clamping markedly weakened common hepatic artery pulsation, confirming collateral-dependent hepatic arterial inflow. MAL release promptly restored pulsation, allowing PD with immediate reconstruction. The patient was discharged on postoperative day 34. In emergency PD for trauma, CAS or retrograde celiac filling should prompt temporary GDA clamping before irreversible division to guide MAL release or another inflow-preserving strategy.
SN  - 2042-8812
ER  -

Abstract

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