Surgery Today

, Volume 43, Issue 8, pp 926–929

Pancreaticoduodenectomy in portal annular pancreas: report of a case

  • Shin Kobayashi
  • Goro Honda
  • Masanao Kurata
  • Yukihiro Okuda
  • Koji Tsuruta
Case Report

Abstract

Portal annular pancreas (PAP) is a rare anatomical anomaly in which the pancreatic parenchyma surrounds the superior mesenteric vein and portal vein (PV) annularly. This anomaly requires careful consideration in pancreatic resection. A case is presented and the technical issues are discussed. A 61-year-old female was referred to the hospital for suspected papilla Vater adenocarcinoma. Preoperative computed tomography showed that the PV was annularly surrounded by pancreatic parenchyma. Surgery revealed the uncinate process extended extensively behind the PV and fused with the pancreatic body. The pancreas was first divided above the PV, and it was divided again in the body after liberating the PV from pancreatic annulation. The postoperative course was uneventful without pancreatic fistula. It is safer to divide the pancreatic body on the left of the fusion between the uncinate process and the pancreatic body to reduce the risk of pancreatic fistula in pancreaticoduodenectomy for PAP.

Keywords

Pancreas Portal annular pancreas Pancreaticoduodenectomy Portal vein 

References

  1. 1.
    Karasaki H, Mizukami Y, Ishizaki A, Goto J, Yoshikawa D, Kino S, et al. Portal annular pancreas, a notable pancreatic malformation: frequency, morphology, and implications for pancreatic surgery. Surgery. 2009;46:515–8.CrossRefGoogle Scholar
  2. 2.
    Child CG III. Carcinoma of duodenum: one-stage radical pancreaticoduodenectomy preserving the external pancreatic secretion, case report. Ann Surg. 1941;118:838–42.Google Scholar
  3. 3.
    Kakita A, Yoshida M, Takahashi T. History of pancreaticojejunostomy in pancreaticoduodenectomy: development of a more reliable anastomosis technique. J Hepatobiliary Pancreat Surg. 2001;8:230–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Joseph P, Raju RS, Vyas FL, Eapen A, Sitaram V. Portal annular pancreas. A rare variant and a new classification. J Pancreas. 2010;11:453–5.Google Scholar
  5. 5.
    Pokorny WJ, Rothenberg SS, Brandt ML. Growth and development. In: O`Leary JP, editor. The physiologic basis of surgery. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2002. p. 64–65.Google Scholar
  6. 6.
    Leyendecker JR, Baginski SG. Complete pancreatic encasement of the portal vein (Circumportal Pancreas): imaging findings and implications of a rare pancreatic anomaly. J Comput Assist Tomogr. 2008;32:61–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Hashimoto Y, Ross AS, Traverso LW. Circumportal pancreas with retroportal main pancreatic duct. Pancreas. 2009;38:713–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Marjanobic G, Obermaier R, Benz S, Bley T, Juettner E, Hopt UT, et al. Complete pancreatic encasement of the portal vein: surgical implications of an extremely rare anomaly. Langenbecks Arch Surg. 2007;392:489–91.CrossRefGoogle Scholar
  9. 9.
    Mizuma M, Suzuki M, Unno M, Katayose Y, Takeuchi H, Matsuno S. A case of “portal annular pancreas” in that the ventral pancreas joints with the pancreatic body encircling the portal vein. Tan to Sui (in Japanese). 2001;22:963–6.Google Scholar
  10. 10.
    Malleo G, Marchegiani G, Salvia R, Butturini G, Pederzoli P, Bassi C. Pancreaticoduodenectomy for pancreatic cancer: the Verona experience. Surg Today. 2011;41(4):463–70.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2012

Authors and Affiliations

  • Shin Kobayashi
    • 1
  • Goro Honda
    • 1
  • Masanao Kurata
    • 1
  • Yukihiro Okuda
    • 1
  • Koji Tsuruta
    • 1
  1. 1.Department of Hepato-Biliary-Pancreatic SurgeryTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan

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