Abstract
In a 45-year-old man with acute pancreatitis and recent onset of diabetes mellitus, intraductal papillary mucinous neoplasm (IPMN) associated with pancreas divisum was found. There were no arguments for an invasive component in the IPMN lesions, which seemed to involve nearly all the dorsal pancreas. Re-section of only the dorsal pancreas was performed with division of the pancreas at the internal side of the duodenum and at the anterior edge of the common bile duct. The gastroduodenal artery was preserved resulting in good vascularization of both common bile duct and proximal duodenum. Postoperative course was marked by a transient pancreatic fistula. Definitive pathological examination revealed nonin-vasive IPMN involving several branch ducts and partially the cephalic dorsal duct, with an 8 mm tumor-free segment from the transection level. Twelve months after resection, the patient had normal gastro-intestinal function with neither clinical exocrine insufficiency nor uncontrolled diabetes. Postoperative magnetic resonance imaging revealed no signs of recurrence in the ventral pancreas. In patients with pancreas divisum, dorsal pancreatectomy can be proposed for noninvasive IPMN involving only the dorsal pancreas to avoid drawbacks of total duodenopancreatic resection.
Similar content being viewed by others
References
Sakamoto Y, Nagai M, Tanaka N, et al. Anatomical segmen-tectomy of the head of the pancreas along the embryological fusion plane: A feasible procedure? Surgery 2000;128:822–831.
Ihse I, Anderson H, Andren-Sandberg A. Total pancreatec-tomy for cancer of the pancreas: Is it appropriate? World J Surg 1996;20:288–293.
Thayer SP, Fernandez-del Castillo C, Balcom JH, Warshaw AL. Complete dorsal pancreatectomy with preser-vation of the ventral pancreas: A new surgical technique. Sur-gery 2002;13:577–580.
Yarze JC, Chase MP, Herlihy KJ, Nawras A. Pancreas divi-sum and intraductal papillary mucinous tumor occurring si-multanously in a patient presenting with recurrent acute pancreatitis. Dig Dis Sci 2003;48:915.
Sauvanet A, Partensky C, Sastre B, et al. Medial pancreatec-tomy: A multi-institutional retrospective study of 53 patients by the French Pancreas Club. Surgery 2002;132:836–843.
Kimura W, Nagai H. Study of surgical anatomy for duode-num-preserving resection of the head of the pancreas. Ann Surg 1995;221:359–363.
Kanazumi N, Nakao A, Kaneko T, et al. Surgical treatment of intraductal papillary-mucinous tumors of the pancreas. Hepatogastroenterology 2001;48:967–971.
Nagakawa T, Ohta T, Kayahara M, Ueno K. Total resection of the head of the pancreas preserving the duodenum, bile duct, and papilla with end-to-end anastomosis of the pancre-atic duct. Am J Surg 1997;173:210–212.
Couvelard A, Sauvanet A, Kianmanesh R, et al. Frozen sec-tioning of the pancreatic cut surface during resection of in-traductal papillary and mucinous tumors of the pancreas is useful and reliable: a prospective evaluation. Ann Surg 2005;242:774–788.
Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: An updated experience. Ann Surg 2004;239:788–797.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Scatton, O., Sauvanet, A., Cazals-Hatem, D. et al. Dorsal pancreatectomy: An embryology-based resection. J Gastrointest Surg 10, 434–438 (2006). https://doi.org/10.1016/j.gassur.2005.06.014
Issue Date:
DOI: https://doi.org/10.1016/j.gassur.2005.06.014