Hepatic ischaemia during Whipple resection: case report of a rarely required revascularisation

With the performance of a partial duodenopancreatectomy, the collateral vas cular bed between the coeliac trunk and the superior mesenteric artery is r educed. Normally, this does not lead to ischaemia of the upper abdominal or gans. However, we present the rare case of a patient in whom a Whipple rese ction in combination with a hyploplastic coeliac trunk led to hepatic and s plenal ischaemia and aorto-hepatic bypass grafting. The indication for preo perative arteriography is in discussion, since variations or alteration of the upper abdominal vessels are known to be common but manifest organ ischa emia during resection is a rare complication. Patients with signs of genera l arteriosclerosis or those in whom upper abdominal resection has been perf ormed previously may benefit from angiography. In other cases a test occlus ion before vessel ligation is considered to be suitable in assessing the ne ed for vascular surgical intervention.