ロボット支援下胃切除術後早期に背側膵動脈分枝に生じた仮性動脈瘤の1 例

We report a case of pseudoaneurysm that developed after robot-assisted gastrectomy. A 43-year-old man diagnosed with advanced gastric cancer underwent robotic distal gastrectomy with D2 dissection. Suprapancreatic nodal dissection was technically demanding due to a high body mass index, but the operation was completed without any intraoperative problems. On postoperative day (POD) 3, abdominal contrast-enhanced CT was performed to rule out intra-abdominal infectious complications, and revealed a suspected 1-cm pseudoaneurysm near the origin of the splenic artery. An angiography showed a pseudoaneurysm of a branch of the dorsal pancreatic artery, and then coil embolization was performed. A retrospective review of the surgical video suggested that pseudoaneurysm formation may have been caused by dividing the small arteriole running from the dorsal side of the pancreas to the ventral side near the root of the splenic artery using bipolar cutting dissection with insufficient coagulation. The subsequent postoperative course was uneventful, and the patient was discharged on POD 16.