Intraoperative indocyanine green fluorography is useful in evaluating the blood flow of remnant stomach in distal pancreatectomy post distal Gastrectomy

Abstract

It is still unclear whether the remnant stomach can be preserved when we perform distal pancreatectomy (DP) in cases of post distal gastrectomy (DG). Recently, several studies have reported that intraoperative indocyanine green (ICG) fluorography was useful in evaluating organ perfusion. In this case, we performed intraoperative ICG fluorography to assess the blood flow of the remnant stomach during DP. A 59-year-old man consulted a local hospital with a chief complaint of epigastric pain. He received DG because of gastric ulcer 25 years ago. Pancreatic body cancer was diagnosed which raised the possibility of splenic artery and venous invasion. Preoperative contrast enhanced CT revealed that the left gastric, right gastric and right gastroepiploic arteries and veins were cut in a prior operation. We performed intraoperative ICG fluorography after ligation of the left gastroepiploic, short gastric and splenic arteries. ICG fluorography showed that the remnant stomach was perfused from esophageal or small omental blood vessels. We safely preserved the remnant stomach and the postoperative course was uneventful except for minor pancreatic fistula. ICG fluorography has a potential to evaluate the blood flow of the remnant stomach.