The Dramatic Consequences of an Accidental Ligation of the Celiac Trunk during Surgery Performed on a Child with Neuroblastoma

Abstract

Neuroblastoma is the most common extra-cranial solid tumor in infants and young children, and accounts for approximately 8–10% of all childhood cancers. The International Neuroblastoma Staging System (INRGSS) is based on the age of patient and preoperative imaging, with attention paid to whether the primary tumor is affected by one or more of specific Image-Defined Risk Factors (IDRFs). Patients are classified into the following groups: locoregional L1 and L2 (absent or present IDRFs respectively), M stage (a disseminated form of neuroblastoma) and Ms (the stage present in children younger than 18 months of age with the disease spread to the bone marrow and/or liver, and/or skin). This publication is aimed to present an unexpected complication associated with an accidental ligation of the celiac trunk during resection of a neuroblastoma tumor in a 2.5-year-old boy after initial chemotherapy, initially with vascular IDRFs, stage L2. The consequences of this complication were pancreatic and spleen ischemia and necrosis, and ischemia and perforation of the common bile duct, gallbladder, stomach, and duodenum. Despite detailed diagnostic imaging (computed tomography, magnetic resonance), the presence of vascular IDRFs may result in an unexpected complication in the surgical treatment of neuroblastoma in children.

Delayed stomach necrosis in a patient with injured celiac artery branches after penetrating abdominal trauma

“…However, a few studies reported delayed necrosis as a complication. A case was reported in which the celiac artery was accidentally ligated during pediatric surgery, and stomach necrosis developed on post-operative day (POD) 59 [ 6 ]. In another case, liver failure was noted 6 days after abdominal trauma with CAI [ 7 ].…”

“…Necrosis probably developed gradually as the blood flow decreased slowly. In a pediatric case, necrosis occurred on POD 59 [ 6 ], which is long after the ligation of the celiac artery, indicating that blood flow was maintained to some extent even after the ligation of the celiac artery. In the current case, the root of the celiac artery was not ligated; however, the branch arteries were ligated; therefore, it is comparable with a case of CAI.…”