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Case Reports
. 2014 Oct;43(7):981-6.
doi: 10.1097/MPA.0000000000000186.

Portal annular pancreas: a systematic review of a clinical challenge

Jonathan M Harnoss  1 , Julian C Harnoss, Markus K Diener, Pietro Contin, Alexis B Ulrich, Markus W Büchler, Friedrich H Schmitz-Winnenthal
Affiliations
Free PMC article
Case Reports

Portal annular pancreas: a systematic review of a clinical challenge

Jonathan M Harnoss et al. Pancreas. 2014 Oct.
Free PMC article

Abstract

Portal annular pancreas (PAP) is an asymptomatic congenital pancreas anomaly, in which portal and/or mesenteric veins are encased by pancreas tissue. The aim of the study was to determine the role of PAP in pancreatic surgery as well as its management and potential complication, specifically, postoperative pancreatic fistula (POPF).On the basis of a case report, the MEDLINE and ISI Web of Science databases were systematically reviewed up to September 2012. All articles describing a case of PAP were considered.In summary, 21 studies with 59 cases were included. The overall prevalence of PAP was 2.4% and the patients' mean (SD) age was 55.9 (16.2) years. The POPF rate in patients with PAP (12 pancreaticoduodenectomies and 3 distal pancreatectomies) was 46.7% (in accordance with the definition of the International Study Group of Pancreatic Surgery).Portal annular pancreas is a quite unattended pancreatic variant with high prevalence and therefore still remains a clinical challenge to avoid postoperative complications. To decrease the risk for POPF, attentive preoperative diagnostics should also focus on PAP. In pancreaticoduodenectomy, a shift of the resection plane to the pancreas tail should be considered; in extensive pancreatectomy, coverage of the pancreatic remnant by the falciform ligament could be a treatment option.

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Figures

FIGURE 1
FIGURE 1
Classification of PAP. According to Joseph et al, PAP is classified (types 1–3) depending on the topography of the MPD; type 1 is the fusion of the ventral bud of the pancreas with the body and RMPD (A); type 2 is type 1 associated with pancreas divisum (B); type 3 is the pancreatic encasement with a normal AMPD (C). Following Karasaki et al, each type can be subdivided (A, B, and C) depending on the relation to the portal confluence: suprasplenic (C), infrasplenic (B), and mixed type (A). The most common type of PAP is 3A (C) and the second most common type is IA (D).
FIGURE 2
FIGURE 2
Portal annular pancreas. Contrast-enhanced CT axial image (A), coronal image (B). Arrow head indicates portal vein; solid arrow, pancreas; dotted arrow, retroportal part of circumportal pancreas; asterisk, suprarenal cancer.
FIGURE 3
FIGURE 3
Flow chart of the systematic literature search. Adapted from PLoS Med. 2009;6:e1000097.
See this image and copyright information in PMC

References

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MeSH terms

Supplementary concepts