Double anastomoses to jejunum of dissected pancreas portions in pancreas divisum

Abstract

The effectiveness of operation for pancreas divisum in patients who exhibit unexplained upper abdominal pain or recurrent pancreatitis is often uncertain. Here we report a successful operation in a patient whose two dissected pancreas portions were anastomosed with the looped jejunum. The patient was a 31-year-old woman who had suffered from continuous upper abdominal pain and relapsing pancreatitis for 10 years. She had a history of excessive alcohol intake from the age of 19–25 years. When she was 24 years old, endoscopic retrograde pancreatography had been performed, revealing pancreas divisum. Thereafter, various treatments had been performed, endoscopic accessory papillotomy; the administration of an anti-secretagogue, a cholecystokinin receptor antagonist; and cannulation of a stent tube into the dorsal pancreatic duct. Each of these treatments led to only short-lived relief of the symptoms. When she was 31 years old, the following operation was performed: The pancreas was cut off at the portal vein and the jejunum was pulled up via the retrocolic route; the two dissected pancreas portions were double-anastomosed with the jejunum by an end-to-side procedure. The postoperative course has been smooth. Fifteen months after the operation, the patient has gained 4 kg in weight and is symptom-free.