Abstract
Background: Portal annular pancreas (PAP) is a rare congenital anomaly consequent of an aberrant fusion of the ventral and dorsal fetal pancreas. When surgery is planned, accurate identification of this anomaly could be crucial to avoid postoperative pancreatic fistula (POPF) related to the possibility of leaving undrained a portion of pancreatic parenchyma. Methods: The present is a case report describing the operative management of PAP during laparoscopic pancreaticoduodenectomy (LPD). Results: A 77 year-old male patient with a recent diagnosis of ampullary adenocarcinoma underwent LPD. Due to PAP presence, two pancreatic transections of the parenchyma respectively located anterior and posterior to portal vein (PV) and superior mesenteric vein (SMV), were required. We decided to perform a further parenchymal transection at the pancreatic body, removing about 2 cm of pancreatic parenchyma in order to obtain a single pancreatic stump. So pancreatic-intestinal continuity was restored performing a minilaparotomy assisted double purse-string pancreatico-gastrostomy at the end of the operation. Conclusion: This report is the first case of LPD in a patient with PAP and the surgical technique we described herein proved to be feasible and safe.
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