A Case of Two-Stage Reconstruction with a 12-Hour Interval for Severe Intestinal Congestion Due to Portal Clamping during Pancreaticoduodenectomy

• Published in: The Japanese Journal of Gastroenterological Surgery Vol. 55; no. 12; pp. 765 - 772
• Main Authors: Kamihata, Kyohei, Kitagawa, Hirohisa, Muto, Jun, Hashida, Kazuki, Yokota, Mitsuru, Nagahisa, Yoshio, Okabe, Michio, Akaike, Yoko, Notohara, Kenji, Kawamoto, Kazuyuki
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 01.12.2022
• Subjects: pancreaticoduodenectomy; prolonged portal clamping; two-stage reconstruction
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.2021.0142

We report a case of two-stage reconstruction after pancreaticoduodenectomy (PD), which was practical and useful for severe intestinal congestion caused by accidental prolonged portal clamping. A 59-year-old man was diagnosed with pancreatic head cancer (cT3N0M0, cStage IIA) and treated with PD. There were wide adhesions between the pancreas and superior mesenteric vein (SMV)/portal vein (PV) due to severe pancreatitis, even in areas distant from the cancer site. Adventitia of SMV/PV peeled off and teared incidentally during dissection from the pancreas, and multiple lacerations of the SMV/PV complicated the procedure and became uncontrollable. For these reasons, we had to clamp the SMV/PV. These difficulties were accompanied by severe intestinal congestion and edema. The damaged SMV/PV was resected and reconstructed with a left renal vein graft using portal vein bypass. However, intestinal congestion and edema continued after reperfusion, and we decided to perform reconstruction in two stages, given the risk of anastomotic failure. The second operation was conducted 12 hours after the first operation, at which time intestinal congestion and edema were significantly improved. This permitted reconstruction with the modified Child method and the patient had a good course. This case suggests that two-stage reconstruction is a practical and useful strategy for severe intestinal congestion and edema after PD.