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Case Reports
. 2025 Jun 13;17(6):e85950.
doi: 10.7759/cureus.85950. eCollection 2025 Jun.

Management of Pancreatectomy for Pancreatic Cancer in a Patient With Annular Portal Pancreas: A Case Report

Hiroyuki Hakoda  1 , Koichiro Kawasaki  1 , Kiyohiko Omichi  1 , Keiichi Nasu  1 , Kentaro Inada  1 , Michiro Takahashi  1
Affiliations
Case Reports

Management of Pancreatectomy for Pancreatic Cancer in a Patient With Annular Portal Pancreas: A Case Report

Hiroyuki Hakoda et al. Cureus. .

Abstract

Portal annular pancreas (PAP) is one of the rare pancreatic anomalies in which the pancreatic parenchyma surrounds the portal vein (PV) or superior mesenteric vein (SMV), accounting for only around a few proportions of all patients. PAP is thought to be associated with the high risk of postoperative pancreatic fistula (POPF) after pancreatectomy. We describe our experience of a case with PAP and review the literature on pancreatectomy in patients with PAP. A 72-year-old male presented to our department with a pancreatic body mass with a history of previous abdominal surgeries, who underwent distal pancreatectomy (DP) with lymphadenectomy following neoadjuvant chemotherapy with gemcitabine plus nab-paclitaxel. PAP was identified during surgery, which was not found in computed tomography scans and other modalities in the previous examinations. The annular pancreas was resected using tri-staplers with polyglycolic acid (PGA) sheets. His postoperative course was uneventful without POPF, and he was discharged on postoperative day 11. In conclusion, when PAP is suspected in patients with pancreatic cancer, understanding the accurate anatomy of the pancreas is essential to determine the surgical technique and a suitable choice of device for the transection of pancreatic parenchyma for reducing POPF.

Keywords: pancreatic abnormality; pancreatic fistula; pancreatic malformation; rare variation; surgical complication.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. The contrast-enhanced computed tomography image before neoadjuvant chemotherapy
Arrowheads indicate the dorsal pancreatic parenchyma; the asterisk indicates the portal vein; dotted lines outline the pancreatic tumor.
Figure 2
Figure 2. The contrast-enhanced computed tomography image after neoadjuvant chemotherapy
Arrowheads indicate the dorsal pancreatic parenchyma; the asterisk indicates the portal vein; dotted lines outline the pancreatic tumor.
Figure 3
Figure 3. Intraoperative findings of portal annular pancreas
(a) Arrowheads indicate the dorsal pancreatic parenchyma running posterior to the portal vein. The yellow clip is clamping the splenic artery. (b) Transection of the dorsal pancreatic parenchyma is shown. The findings of the transection of the ventral pancreatic parenchyma with a tri-stapler. (c) The findings after transection of both ventral and dorsal pancreatic parenchyma with tri-staplers. (d) Schematic illustration of the intraoperative findings after transection of both ventral and dorsal pancreatic parenchyma. Transection was performed using tri-staplers with polyglycolic acid sheets.
See this image and copyright information in PMC

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