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Case Reports
. 2012 Jan;6(1):131-4.
doi: 10.1159/000335210. Epub 2012 Mar 14.

Additional resection of the pancreas body prevents postoperative pancreas fistula in patients with portal annular pancreas who undergo pancreaticoduodenectomy

Jun Muto  1 , Yohei Mano, Noboru Harada, Hideaki Uchiyama, Tomoharu Yoshizumi, Akinobu Taketomi, Ken Shirabe, Yoshihiko Maehara
Affiliations
Case Reports

Additional resection of the pancreas body prevents postoperative pancreas fistula in patients with portal annular pancreas who undergo pancreaticoduodenectomy

Jun Muto et al. Case Rep Gastroenterol. 2012 Jan.

Abstract

Portal annular pancreas (PAP) is a rare variant in which the uncinate process of the pancreas extends to the dorsal surface of the pancreas body and surrounds the portal vein or superior mesenteric vein. Upon pancreaticoduodenectomy (PD), when the pancreas is cut at the neck, two cut surfaces are created. Thus, the cut surface of the pancreas becomes larger than usual and the dorsal cut surface is behind the portal vein, therefore pancreatic fistula after PD has been reported frequently. We planned subtotal stomach-preserving PD in a 45-year-old woman with underlying insulinoma of the pancreas head. When the pancreas head was dissected, the uncinate process was extended and fused to the dorsal surface of the pancreas body. Additional resection of the pancreas body 1 cm distal to the pancreas tail to the left side of the original resection line was performed. The new cut surface became one and pancreaticojejunostomy was performed as usual. No postoperative complications such as pancreatic fistula occurred. Additional resection of the pancreas body may be a standardized procedure in patients with PAP in cases of pancreas cut surface reconstruction.

Keywords: Pancreas fistula; Pancreaticoduodenectomy; Portal annular pancreas.

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Figures

Fig. 1
Fig. 1
Preoperative CT showed that the uncinate process of the pancreas extended and fused to the dorsal surface of the pancreas body by surrounding the portal vein (arrow).
Fig. 2
Fig. 2
Schematic representation of the pancreas. Additional resection of the pancreas body 1 cm to the left of the portal vein seems to be reasonable and can make the cutting surface the same as usual anatomically.
See this image and copyright information in PMC

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