Portal Annular Pancreas

Abstract

Portal annular pancreas (PAP) is an asymptomatic congenital pancreas anomaly, in which portal and/or mesenteric veins are encased by pancreas tissue. The aim of the study was to determine the role of PAP in pancreatic surgery as well as its management and potential complication, specifically, postoperative pancreatic fistula (POPF).On the basis of a case report, the MEDLINE and ISI Web of Science databases were systematically reviewed up to September 2012. All articles describing a case of PAP were considered.In summary, 21 studies with 59 cases were included. The overall prevalence of PAP was 2.4% and the patients' mean (SD) age was 55.9 (16.2) years. The POPF rate in patients with PAP (12 pancreaticoduodenectomies and 3 distal pancreatectomies) was 46.7% (in accordance with the definition of the International Study Group of Pancreatic Surgery).Portal annular pancreas is a quite unattended pancreatic variant with high prevalence and therefore still remains a clinical challenge to avoid postoperative complications. To decrease the risk for POPF, attentive preoperative diagnostics should also focus on PAP. In pancreaticoduodenectomy, a shift of the resection plane to the pancreas tail should be considered; in extensive pancreatectomy, coverage of the pancreatic remnant by the falciform ligament could be a treatment option.

Portal Annular Pancreas: A Rare and Overlooked Anomaly

“…Other rare types have also been defined, e.g. an encircling of the portal vein by the pancreatic duct that was forming a ring [ 1 , 4 ].…”

“…Portal annular pancreas is a rare congenital anomaly which is characterised by a complete circumferential encasement of the portal vein by pancreatic tissue. Its exact incidence is unknown as only few cases have been reported in the literature and many of them have been diagnosed incidentally at the time of surgery [ 1 , 2 ]. With the advent of multidetector computed tomography (MDCT) allowing thin slices and direct multiplanar imaging as well as with the advances in magnetic resonance imaging (MRI), it is possible to diagnose this condition accurately on imaging [ 3 ].…”

Radical antegrade modular pancreatosplenectomy for adenocarcinomaof the body of the pancreas in a patient with portal annular pancreas, aberrant hepatic artery, and absence of the celiac trunk

“…[ 11 ] Considering of this deviance preoperatively is significant for surgeons to take appropriate vascular and pancreatic anastomosis, which may decrease the risk of pancreatic fistula. [ 2 , 14 ]…”

“…Portal annular pancreas is a pancreatic deviance without symptoms, where the uncinated process rings portal vein (PV), superior mesenteric vein (SMV), and/or splenic vein (SV), and connects to the reverse side of the pancreas body. [ 1 , 2 ] Because of the different position of the pancreatic duct and the high incidence of concomitant vascular anomaly, portal annular pancreas is considered to increase the postoperative pancreatic fistula risk. [ 3 ] In addition, celiac trunk (CT) usually has 3 branches including left gastric artery (LGA), common hepatic artery (CHA), and splenic artery (SA).…”

Management of portal annular pancreas during laparoscopic pancreaticoduodenectomy

“…PAP is asymptomatic; however, its recognition is crucial when a pancreaticoduodenectomy is planned, to minimise the risk of post-operative pancreatic fistula (POPF), reportedly more frequent in patients with PAP undergoing pancreatic surgery, and probably related to the possibility of leaving undrained an unrecognised portion of pancreatic parenchyma. [ 2 ] Previous articles have reported on pancreaticoduodenectomy performed in case of PAP, herein we describe the first case of laparoscopic pancreaticoduodenectomy (LPD) in a patient with PAP.…”