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- “The tumour was badly entangled between the left gastric artery, splenic artery and hepatic artery, displacing the celiac axis and was pressing against the pancreas and stomach posing a risk to life”
New Delhi, June 20, 2018:
Recently, doctors at Fortis Escorts Heart institute conducted a high-risk surgery on a 32-year-old Ethiopian patient. Mr. Mohammed was presented with a painless progressive upper abdominal swelling, which was later diagnosed as a tumor weighing 1.25 kgs, entangled between his left gastric artery, splenic artery and hepatic artery, pushing his pancreas downwards leading to extreme displacement of the internal structures in his stomach. Dr. Sanjay Verma (Senior Consultant, Minimal Access, Bariatric & GI Surgery, Fortis Liver and Digestives Institute) and Dr. Vivek Vij (Director – Liver Transplant & GI Surgery at Fortis Healthcare) along with their team took stock of the situation and performed the challenging procedure.
Post being presented with complaints of abdominal swelling, Mr. Mohammad underwent an upper gastro intestinal endoscopy, which confirmed the diagnosis. Following this, the patient underwent an Exploratory Laparotomy (a surgical operation where the abdomen is opened and the abdominal organs examined for injury or disease) which led to the excision of the tumor. The complexity and criticality of the surgery lay in the fact that the celiac axis (The celiac artery is the first major branch of the abdominal aorta) and its branches were displaced, because of which all the arteries were entwined around each other and the tumor. As a result, during dissection, the splenic artery had to be sacrificed, while the hepatic artery had to be re-implanted at the celiac axis.
Dr. Sanjay Verma, Senior Consultant, Minimal Access, Bariatric & GI Surgery, Fortis Liver and Digestives Institute said, “In the post-operative period, a USG Color Doppler test was used to confirm the vascularity of the spleen and the normal flow of blood in the celiac axis and the hepatic artery. A noninvasive procedure, the device allows one to estimate the blood flow through the blood vessels by bouncing high-frequency sound waves (ultrasound) off circulating red blood cells. The patient tolerated the treatment satisfactorily and recovered well. He was discharged on the fifth day of the post-operative period and is presently doing fine in the follow-ups.”
Dr. Vivek Vij, Director – Liver Transplant & GI Surgery at Fortis Healthcare said “The rarity of this case, lies in the fact that the retroperitoneal tumor was densely stuck to celiac plexus and enchasing the spleenic artery and hepatic artery. In such cases complete excision is not possible normally, if tried it will injure spleenic and hepatic artery which would be fatal to the patient. If spleenic artery is injured in removing the tumour, splenectomy needs to be done. Moreover, if hepatic artery is injured, the blood supply of liver will go and it will lead to a vascularity of major portion of liver. The procedure adopted was replanting the splenic and hepatic artery to celiac trunk by vascular anastomoses. This is a rare procedure, undertaken by a few hospitals.”
Despite the relatively high prevalence of celiac artery compression, clinically relevant celiac artery compression syndrome is rare. Symptoms of celiac artery compression syndrome are typically chronic and nonspecific, including vague upper abdominal pain, nausea, and emesis. In patients with long-standing symptoms, weight loss may occur.
Dr. Kousar Ali Shah, Zonal Director, Fortis Escorts Heart Institute said- “I am glad we have a team of excellent doctors who are renowned for handling delicate cases. Under the supervision and expertise of Dr. Sanjay Verma and Dr. Vivek Vij, the surgery was successfully conducted and the procedure was well-tolerated by the patient. Their team adopted a very comprehensive and rare procedure to tackle the case and their remarkable efforts paid off when the patient got a second chance at life.”
