Pancreatoduodenectomy for circumportal pancreas accompanying the retroportal pancreatic duct: a case report and review of the literature

Shonaka, Tatsuya; Inagaki, Masaru; Akabane, Hiromitsu; Yanagida, Naoyuki; Shomura, Hiroki; Kudo, Toshifumi; Orimo, Tatsuya; Futoshi, Oikawa; Aiyama, Takeshi; Yanagawa, Nobuyuki; Oikawa, Kensuke; Nakano, Satoshi

doi:10.1007/s12328-012-0326-1

Cited by 5 publications

(1 citation statement)

References 15 publications

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“…The second procedure uses the communication between MPD and the accessory pancreatic duct (APD), which courses in the parenchyma opposite to the one containing MPD. Pardiwala and Maker 18 and Shonaka et al 14 and reported successful ligations of the retroportal pancreatic parenchyma and the pancreaticoenteric anastomosis above the PV in cases that showed communication between MPD and APD at the left side to PV. Thus, it is important to note that a surgeon should determine whether APD exists, the location of the APD, and its relation to the MPD when planning pancreatic surgery in a patient with PAP.…”

Section: Discussionmentioning

confidence: 99%

Portal Annular Pancreas With Common Hepatic Artery Trajectory Abnormality

Tahara

Harada²,

Wakui³

et al. 2021

Pancreas

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Portal annular pancreas (PAP) is a rare congenital pancreatic anomaly, in which the uncinate process of the pancreas fuses to the body of pancreas behind the portal vein. Here, we report a case of PAP with common hepatic arterial anomaly, which was identified during surgery. A 57-year-old man who had branch type intraductal papillary mucinous neoplasm in the head of the pancreas developed a nodule in the cystic lesion. We planned pylorus preserving pancreaticoduodenectomy. The common hepatic artery from the celiac artery passing behind the portal vein was revealed in preoperative examinations. During surgery, we discovered that the uncinate process of the pancreas was fused with the body of the pancreas behind the portal vein. We divided the pancreas at the anterior and posterior of the portal vein. The main pancreatic duct was present in the anterior pancreatic stump. We performed pancreaticojejunostomy in the anterior stump and closed the posterior stump by interrupted suture. Forty-four surgical cases of PAP have been reported in the English medical literature. There are few previous reports of PAP which involved an arterial anomaly. Clinicians should consider PAP preoperatively to ensure that the surgeon can appropriately plan pancreatic resection to avoid postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Portal Annular Pancreas With Common Hepatic Artery Trajectory Abnormality

Tahara

Harada²,

Wakui³

et al. 2021

Pancreas

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Portal Annular Pancreas (PAP): an Underestimated Devil in Pancreatic Surgery—Systematic Review of Literature and Case Report

Pandrowala

Parray

Chaudhari

et al. 2021

Journal of Gastrointestinal Surgery

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Introduction Portal annular pancreas (PAP) is an anatomic variation due to aberrant fusion of the ventral and dorsal pancreatic buds around the portal vein. In this article, we present a case report with a systematic review of literature of patient s undergoing major pancreatic surgery with associated PAP. We also intend to discuss and suggest possible surgical strategies to minimise major postoperative complications. Methods A systematic literature search was conducted using the terms “circumportal,” “periportal,” “pancreas,” “annular pancreas,” “portal annular pancreas” and “pancreas anomaly.” All articles describing portal annular pancreas with surgical resection were included. Results We identified a total of 53 patients of PAP from 29 articles, who underwent pancreatic resection with a median age of 65 years. POPF (postoperative pancreatic fistula) was demonstrated in 42.55% of patients and 34% had CR (clinically relevant)-POPF. Following pancreaticoduodenectomy, pancreatic stump was reconstructed in all patients with either pancreaticojejunostomy or pancreaticogastrostomy. Standard line of pancreatic transection, i.e., division of anteportal portion at the pancreatic neck and stapling of the retroportal process, resulted in 71% incidence of CR-POPF, whereas it was only 16% when extended resection was performed to achieve single pancreatic stump and 12.5% when retroportal portion was sutured or ligated. Amongst distal pancreatic resections, 66% had POPF and 33% developed CR-POPF. Conclusion It is of utmost importance for pancreatic surgeons to diligently look for and identify PAP in the preoperative imaging. Additional imaging in the form of MRCP helps to define abnormal pancreatic ductal anatomy. Surgeons need to be cognisant of pancreatic stump management in patients with PAP to reduce associated higher rates of POPF.

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Minimally invasive pancreaticoduodenectomy for circumportal pancreas: literature review and report of two type IIIA cases

Imamura,

Adachi,

Yamashita

et al. 2024

surg case rep

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Background Circumportal pancreas is a rare morphological variant with clinical significance due to the high risk of postoperative pancreatic fistula in patients undergoing pancreaticoduodenectomy. Type IIIA (suprasplenic anteportal) is the most common type of circumportal pancreas. We present two cases of type IIIA treated with minimally invasive pancreaticoduodenectomy, and review the literature on patients with circumportal pancreas who underwent pancreatic surgery. Case presentation Case 1: Laparoscopic Pancreaticoduodenectomy for Non-functioning Pancreatic Neuroendocrine Neoplasm with Circumportal Pancreas. A 69-year-old female with no prior medical history presented with a pancreatic head mass detected during routine ultrasound. CT revealed a 20 mm hypervascular tumor in pancreas head and a suprasplenic circumportal pancreas with an anteportal duct. The main pancreatic duct (MPD) was not in the parenchyma on the dorsal side of the portal vein (PV). Laparoscopic pancreaticoduodenectomy was performed. The anteportal side was resected with an ultrasonic device, and the retroportal side with a mesh-reinforced stapler. Pancreaticojejunostomy was performed without complications. Case 2: Robot-assisted Pancreaticoduodenectomy for Pancreatic Head Cancer and Non-functioning Pancreatic Neuroendocrine Neoplasm in the pancreatic tail with Circumportal Pancreas. A 72-year-old male with no prior medical history presented with a dilated main pancreatic duct on ultrasound. Diagnosed with pancreatic head cancer (Stage IIA), he underwent neoadjuvant chemotherapy. Contrast-enhanced CT revealed pancreatic cancer in the head and a tumor in the tail with unknown pathology. Robot-assisted pancreaticoduodenectomy was performed, and pancreatectomy on the left side of the tail tumor was planned. Intraoperative findings revealed a circumportal pancreas with the MPD not running through the dorsal parenchyma. After resected the parenchyma on the left side of the tail tumor, parenchyma on the dorsal side of the PV was dissected using SynchroSeal®. Pancreaticojejunostomy was performed without complications. The postoperative course was uneventful. Conclusions The optimal location and method of pancreatic resection should be selected according to the type of circumportal pancreas and the location of the lesion to be resected to minimize the risk of pancreatic fistula. Minimally invasive surgery for circumportal pancreas remains challenging even for surgical teams with sufficient experience and skills, and careful consideration are necessary for its application.

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Pancreatoduodenectomy for circumportal pancreas accompanying the retroportal pancreatic duct: a case report and review of the literature

Cited by 5 publications

References 15 publications

Portal Annular Pancreas With Common Hepatic Artery Trajectory Abnormality

Portal Annular Pancreas With Common Hepatic Artery Trajectory Abnormality

Portal Annular Pancreas (PAP): an Underestimated Devil in Pancreatic Surgery—Systematic Review of Literature and Case Report

Minimally invasive pancreaticoduodenectomy for circumportal pancreas: literature review and report of two type IIIA cases

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