[A clinical report of vascularized segmental pancreatic autotransplantation in chronic pancreatitis]

Abstract

A vascularized segmental autotransplantation of distal 80% of the pancreas to the right iliopelvic space was successfully performed in a 51-year-old male who had alcoholic chronic pancreatitis. Distal 80% of the gland with severe calcified pancreatitic change was resected and prepared for transplantation by injecting the splenic artery with Ringer's lactate solution containing heparin, albumin and gabexate mecilate cooled to 4 degrees C. The spleen was removed from the specimen. An arteriovenous fistula was constructed at the tail. End-to-side anastomosis of spleno-external iliac veins was carried out after small fusiform resection of the iliac venous wall for the purpose of sufficient venous patency. End-to-end anastomosis of spleno-hypogastric arteries was done. The pancreatic stump was anastomosed to the ileum. Post-operatively, the pain completely resolved. Patency of the graft was demonstrated by angiography. Higher response of the C-peptide immunoreactivity on 75 g OGTT was found in the iliac vein on the transplanted side than in another peripheral vein. The exocrine pancreatic function diagnostant test showed 78.8% post-operatively (vs. 63.2% pre-operatively). Vascularized segmental pancreatic autotransplantation offers an excellent method of relieving pain with preservation of endocrine and exocrine functions in selected cases with chronic pancreatitis.