Kajioka Hiroki, Muraoka Atsushi
Department of Surgery, Kagawa Rosai Hospital, 3-3-1 Joto-cho, Marugame-shi, Kagawa, 763-8502, Japan.
Ann Med Surg (Lond). 2021 Mar 8;64:102212. doi: 10.1016/j.amsu.2021.102212. eCollection 2021 Apr.
Ischemic stomach perforation and bleeding are major complications after distal pancreatectomy with en bloc celiac axis resection (DP-CAR) for locally advanced pancreatic cancer. Although there are some treatment options for ischemic gastric events, we need to discuss the optimal treatment based on the patient's general condition and history.
A 76-year-old woman with advanced pancreatic cancer underwent DP-CAR with the reconstruction of the common hepatic artery-celiac artery. She presented with a high fever and melena at 13 days and twenty-nine days after the operation, respectively. Contrast-enhanced computed tomography (CECT) demonstrated ischemic stomach perforation, which was localized. Although nonsurgical treatments, including endoscopic clipping and proton-pump inhibitor administration, were attempted, her symptoms were not relieved. Therefore, we performed intragastric suture repair using oral endoscopy (ISE) for gastric perforation. Although she presented with surgical site infection and a catheter-related blood stream infection after ISE, she was discharged 140 days after the first operation.
Ischemic gastric events following DP-CAR can be treated with non-surgical and surgical approaches. In this case, non-surgical management could not improve the patient's gastric complications, and she had to undergo surgery. Given the patient's condition, ISE was an indication for this complication and was, thus, performed among surgical procedures, resulting in the alleviation of the complication. Using ISE may provide safe and less invasive surgery.
This is the first case of ISE for use in refractory ischemic stomach perforation following DP-CAR. ISE can be a useful and minimally invasive surgical procedure.
对于局部晚期胰腺癌行胰体尾联合腹腔干整块切除（DP-CAR）术后，缺血性胃穿孔和出血是主要并发症。虽然针对缺血性胃部事件有一些治疗选择，但我们需要根据患者的一般状况和病史来讨论最佳治疗方案。
一名76岁的晚期胰腺癌女性患者接受了DP-CAR手术，并重建了肝总动脉-腹腔干。她分别在术后第13天和第29天出现高热和黑便。增强计算机断层扫描（CECT）显示为局限性缺血性胃穿孔。尽管尝试了包括内镜夹闭和给予质子泵抑制剂在内的非手术治疗，但她的症状并未缓解。因此，我们采用经口内镜下缝合修补术（ISE）治疗胃穿孔。虽然ISE术后她出现了手术部位感染和导管相关血流感染，但在首次手术后140天出院。
DP-CAR术后的缺血性胃部事件可采用非手术和手术方法治疗。在本病例中，非手术治疗未能改善患者的胃部并发症，她不得不接受手术。鉴于患者的病情，ISE是针对该并发症的一种治疗选择，因此在手术方式中得以实施，从而缓解了并发症。使用ISE可能提供安全且侵入性较小的手术。
这是首例将ISE用于DP-CAR术后难治性缺血性胃穿孔的病例。ISE可以是一种有用且微创的手术方法。
