Introduction: The celiac axis (CA) is usually dependent on blood supply from the superior mesenteric artery via the pancreatic arcade, particularly in cases of CA stenosis. During pancreaticoduodenectomy, excision of the gastroduodenal artery poses a significant risk of organ ischemia in the CA territory and may compromise anastomotic integrity. In cases of median arcuate ligament syndrome (MALS), blood flow typically improves after ligament transection. However, if atherosclerosis is present and chronic arterial compression is induced by the median arcuate ligament, stenting or revascularization may be required. Although revascularization is the most definitive technique, it raises concerns about anastomotic disruption due to postoperative pancreatic leakage. Considering these complexities, a thorough preoperative assessment of blood flow and the development of strategies to ensure adequate perfusion after resection are critical. Here, we encountered a patient with pancreatic cancer and MALS complicated by atherosclerosis.

Case presentation: A 76-year-old female patient with a history of acute appendicitis presented with generalized pruritus. Laboratory test results revealed significant elevations in her hepatobiliary enzymes and tumor markers. Imaging confirmed a 29-mm tumor in the pancreatic head and severe CA stenosis. Endoscopic ultrasonography and fine-needle aspiration confirmed pancreatic ductal adenocarcinoma. Due to severe CA stenosis and the inability to preserve the collateral vasculature, a multidisciplinary team decided to perform an abdominal aorta-to-splenic artery bypass using a saphenous vein graft. The surgery was successful, lasting 470 min with a blood loss of 700 mL. The patient was discharged on postoperative day 19 without complications and completed adjuvant chemotherapy. One year postoperatively, she remained recurrence-free with a patent graft and good hepatic artery flow.

Conclusions: This report discusses a case of a successful pancreaticoduodenectomy with an abdominal aorta-to-splenic artery bypass without the complication of a pancreatic leak, thereby demonstrating the viability of the procedure for revascularization and reconstruction.

Keywords: arterial reconstruction; celiac axis stenosis; pancreaticoduodenectomy.

© 2025 The Author(s). Published by Japan Surgical Society.

简介： 胃十二指肠动脉在胰头癌和中弓韧带综合征（MALS）患者中的狭窄通常依赖于来自胰腺弧形支的上肠系膜动脉供血。在胰十二指肠切除术期间，切除胃十二指肠动脉会增加腹腔干区域器官缺血的风险，并可能影响吻合口的完整性。在MALS的情况下，韧带切断后血液流动通常会改善。然而，如果存在动脉粥样硬化并且中弓韧带导致慢性动脉压迫，则可能需要放置支架或重新血管化。尽管重新血管化是最具确定性的技术，但术后胰漏可能导致吻合口破裂的问题值得关注。鉴于这些复杂性，在术前进行全面的血流评估并制定确保切除后充分灌注的战略至关重要。本报告中遇到一名患有胰腺癌和MALS并发动脉粥样硬化的患者。

病例介绍： 一位76岁女性患者有急性阑尾炎病史，因全身瘙痒前来就诊。实验室检查结果显示其肝胆酶和肿瘤标志物显著升高。影像学确认胰头有一29毫米的肿瘤，并伴有严重的腹腔干狭窄。内镜超声和细针穿刺活检确诊为导管腺癌。由于腹腔干严重狭窄且无法保留侧支血管，多学科团队决定采用大隐静脉移植进行腹部主动脉至脾动脉旁路手术。该手术历时470分钟，出血量为700毫升，并成功完成。术后19天患者无并发症出院并完成了辅助化疗。一年后，她未见复发，移植物通畅且肝动脉血流良好。

结论： 本报告讨论了一例成功的胰十二指肠切除术与腹部主动脉至脾动脉旁路手术案例，并未出现胰漏并发症，从而证明了该程序在重新血管化和重建中的可行性和有效性。

关键词： 动脉重建；腹腔干狭窄；胰十二指肠切除术。

© 2025 The Author(s). Published by Japan Surgical Society.