Ileum preserving expanded jejunectomy and pancreaticoduodenectomy with combined resection of the superior mesenteric artery for huge retroperitoneal solitary fibrous tumor

Abstract

We encountered a patient with a large retroperitoneal solitary fibrous tumor, in whom we could preserve approximately 150 cm of the ileum even after pancreaticoduodenectomy combined with resection of the superior mesenteric artery, thus preventing short bowel syndrome.

Keywords: Ileum preserving expanded jejunectomy; pancreaticoduodenectomy; solitary fibrous tumor; superior mesenteric artery resection; two‐staged operation.

Figure 1

Contrast‐enhanced CT showing (A, B) a heterogeneously stained huge abdominal mass displacing the (A) stomach and duodenum anteriorly (arrow) and (B) the pancreas and main branch of the portal vein to the left side (arrow), (B, C) as well as showing involvement of the (B) SMA (arrowhead) and (C) SMV (arrowhead).

Figure 2

Angiographic results showing that the tumor was fed (A) mainly by the gastroduodenal artery and (B, C) also fed by the (B) inferior pancreaticoduodenal artery and (C) right subphrenic artery and an anastomosis from the inferior mesenteric artery.

Figure 3

Surgical course in this patient. (A) View showing that the tumor compressed the pancreas, duodenum, and common bile duct and involved the SMA. (B) Procedure of the first operation, which included pancreaticoduodenectomy, expanded jejunectomy, and total ligation and resection of the SMA, along with anastomosis of the pancreatic duct with the stomach, tube gastrostomy, ileostomy, and tube‐stomy of the common bile duct. (C) Procedure of the second operation, which included anastomosis of the common bile duct with the duodenum and anastomosis of the duodenum with the ileum.

Figure 4

Pathological findings. (A) Intraoperative finding, showing that the horizontal portion of the duodenum was dislocated anteriorly by the tumor. (B) View of the resected specimen, showing that it measured 21 × 18 × 15 cm in size and weighed 4400 g. The duodenum (arrow) and common bile duct (arrow head) were extremely distended. (C) Cross‐sectional view of the resected specimen, showing a solid tumor with a grayish‐white cut surface, a cystic component, and a hemorrhagic focus.

Figure 5

Postoperative findings. (A) Histopathological findings, showing oval‐ or spindle‐shaped cells in a random growth pattern with a collagenous matrix. (B) Immunohistochemical findings, showing that the tumor was positive for CD34.