Abstract
BackgroundPortal annular pancreas (PAP) is a rare pancreatic anomaly in which the uncinate process wraps annularly around the portal vein and fuses to the body of the pancreas. PAP is highly relevant to the development of postoperative pancreatic fistula (POPF) in pancreatic surgery. Here, we describe our experience and surgical technique of laparoscopic spleen-preserving distal pancreatectomy using Warshaw’s procedure for patients with the PAP.Case presentationA 49-year-old woman with PAP was referred to our hospital for a suspicious mucinous cystic neoplasms 1.5 cm in diameter in the pancreatic tail. Laparoscopic spleen-preserving distal pancreatectomy using Warshaw’s procedure was performed. Mobilization of the pancreatic tail was first performed, and then, the splenic artery was cut. After dividing the pancreatic tail from the splenic hilum, the ventral pancreatic parenchyma was divided using a stapler. After cutting the splenic vein, complete mobilization of the pancreatic body and tail enabled easy division of the PAP. Finally, the PAP was also divided using the stapler. Although grade B POPF occurred, she was discharged on the 9th postoperative day.ConclusionsSurgeons should understand the anatomical characteristics of PAP and be aware of the possibility of POPF.
Highlights
Portal annular pancreas (PAP) is a rare pancreatic anomaly in which the uncinate process wraps annularly around the portal vein and fuses to the body of the pancreas
Surgeons should understand the anatomical characteristics of PAP and be aware of the possibility of postoperative pancreatic fistula (POPF)
We describe a case of a patient with a serous cystic neoplasm with the PAP who underwent laparoscopic spleen-preserving distal pancreatectomy (DP) using Warshaw’s procedure
Summary
Portal annular pancreas (PAP) or the so-called circumportal pancreas is a rare pancreatic anomaly without symptoms, in which the uncinate process of the pancreas encircles the portal vein (PV) and/or its influx, the superior mesenteric vein (SMV), and the splenic vein (SV), and extends to the dorsal surface of the pancreas body [1]. Case presentation A 47-year-old female (body mass index, 20.5) had an oval cystic lesion in the pancreatic tail identified by an annual health check and visited the nearby hospital for further examination. She had a medical history of a left parapelvic cyst at 44 years old. Plain computed tomography (CT) scans taken at the same hospital 4 years ago did not indicate any pancreatic cysts She was referred to our hospital for the surgical treatment of a suspected mucinous cystic neoplasm (MCN) without a mural nodule that was 1.5 cm in diameter in the pancreatic tail (Fig. 1a). She was discharged on the 9th postoperative day and was pathologically diagnosed with serous cystic neoplasm
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